VVA Testimony VVA Testimony
VVA Testimony

Statement of

 

VIETNAM VETERANS OF AMERICA

Submitted by
 

Richard Weidman,
Director, Government Relations
Vietnam Veterans of America

Before the
Presidential Task Force to Improve Health Care Delivery
for Our Nation's Veterans

Regarding
Concrete opportunities to improve coordination between
The Department of Defense (DoD)
And
The Department of Veterans Affairs (VA)

January 15, 2002 

 

Madame Chairwoman, distinguished members of the Presidential Task Force, on behalf of Vietnam Veterans of America (VVA), I thank you for allowing us to present our views to you here today.

VVA has followed with keen interest your deliberations to determine how our nation can better serve veterans; as well your deliberations as to how we can better serve our active duty military personnel and their families.  Sometimes those two functions can overlap in some medical services.  However, the purposes of the two medical systems (and therefore their missions, corporate culture, and mind-set) are very different, and that therefore the needs of each system must be tailored to the needs of the specific population it serves.

Any attempts at DoD-VA sharing must be focused primarily on

1)      Changing the DoD and VA healthcare system’s corporate culture from one of “generic health care for veterans and service members” to one of a “military and veterans unique health care”

2)      Establishing a medical education system that emphasizes the unique nature and hazards associated with military service, and the communication of those hazards to all medical providers within both medical systems;

3)      Creating a common, life-long military medical history for each service member that can be seamlessly transferred to and updated by the Veterans Health Administration when the service member becomes a veteran;

4)      Reversing years of declining appropriations, and therefore ever-diminished organizational capacity, by providing adequate resources for both systems to deal with the existing and future population of veterans.

 

VVA contends that many changes need to be made before either the Pentagon or the VA addresses the special needs of veterans or the special needs of those still on active duty who may have been exposed to certain conditions unique to military service. Let me share with you our philosophical approach to veterans and military health care.

VHA Must Deliver Quality Veterans Health Care

First let me stress that VVA strongly believes that the Veterans Health Administration (VHA) of the Department of Veterans Affairs cannot just be a hospital system delivering general health care that happens to be for veterans.  The very purpose of the system is “To care for him (her) who hath borne the battle, his (her) widow and orphan.” VVA believes general health care will overlook many maladies and conditions that are particular to the veteran population, and therefore veterans health care is different than general health care.  The average civilian will never be exposed to the kinds of toxic hazards and battle-related stressors that veterans have endured. Accordingly, any medical system designed to deal with the unique medical and psycho-social problems affecting veterans must put those wartime or service-related experiences and exposures at the heart of all medical education, diagnostic, and treatment programs for veterans.

Need for Taking a Complete Military Service History

To properly diagnose a veteran, the VHA must properly assess and deal with the events, conditions, and experiences that may have occurred to the individual while in military service.  VVA strongly believes that this must be the first priority of both the Pentagon medical system and the VHA in order to provide quality veterans health care. One must first start with a complete and intelligently gathered military history, that would include the questions “what branch did you serve in, when did you serve, where did you serve, what was your MOS (i.e., your military job), and what actually happened to you in military service.”  The average American taxpayer would be amazed and possibly outraged (and often are when we tell them) that the VHA does not ask, “What did you do in the war, Dad? What did you do in the service, Mom?” That is not how they believe their tax dollars are being used.  But that is generally the case today, as the Institute of Medicine observed in its 2000 report Protecting Those Who Serve: Strategies to Protect the Health of Deployed U.S. Forces.

Indeed, if one examines the post-deployment health instruments currently being used by DoD’s Deployment Health Clinic Center at Walter Reed Army Medical Center you will find that said instruments do not capture the kinds of data that VVA and IOM believe are essential to properly track environmental or other hazards deployed personnel may encounter. Presently the DHCC post-deployment health questionnaire contains no questions about a service member’s  potential exposures to pesticides, chemical or biological agents, or other similar exposures—a completely inexcusable omission in light of the Vietnam and Gulf War experiences. By not getting it right up front, DoD is ensuring that the decades-long problem of incomplete medical and environmental exposure documentation will continue to compromise the ability of veterans to receive accurate diagnoses and treatment.

Once one has the answers to the above questions about when and where, etc. about a veteran’s service, then additional knowledge of various military campaigns and cruises must be available online (preferably automatically) to the physician, so that the proper tests can be administered to properly diagnose diseases and conditions that the veteran may have as a result of military service. VVA believes strongly that VHA must start to truly offer quality veterans health care, or the Congress will decide there is no reason for the separate system to exist.  As an example, a veteran who served on the ground in Vietnam should automatically be tested for tuberculosis, hepatitis C, dioxin levels and possible herbicide related illnesses, possible post traumatic stress syndrome or other neuropsychiatric wounds of war, and the tropical diseases and parasites that can remain in the body for decades before manifesting, such as strongyloides, melioidosis (Whitmore disease), malaria, and the like. There may well be additional possible exposures and conditions for which one should test veterans who were deployed to Vietnam, other than the few illustrations noted above.

Currently no VHA facility we know of regularly does testing for all of the above. (We would note that all facilities are currently required to offer testing for hepatitis C to all Vietnam era veterans, although it often does not happen.) Most VHA physicians have never even heard of melioidosis or strongyloides, although both are endemic in Southeast Asia, particularly Vietnam. So is tuberculosis and hepatitis C.  Vietnam has one of the highest hepatitis (of all types) rates in the world.  Obviously veterans who were deployed in Korea or other cold climates would have a different set of exposures, as would those deployed in Southwest Asia, Bosnia, or those currently serving in Central Asia. These veterans today may well be carrying these diseases today, but do not know it because no one has ever known to test for these conditions and the individual veteran had no knowledge either. But the VHA (and the military hospitals) could and should have known and taken positive and useful steps, but both have failed to act to date.

We have provided you with the Military Service History cards (See attachment I) that each clinician at VHA is supposed to have and use.  These cards were especially designed by Dr. David Stevens and his colleagues in VHA Academic Affairs for use with young residents and interns who are constantly rotating through our hospitals and clinics and know very little if anything about veterans, much less the specific conditions or maladies that veterans may have as a result of military service many years ago. The theory was that permanent staff knew these things, understood veterans, and asked the right questions as a matter of course. In fact, most did not, usually out of ignorance themselves.  

One can go to www.va.gov/oaa to secure more information about what each of the questions on the card mean, although there is a great deal to add to the Office of Academic Affairs (OAA) site’s database (or have it linked with other sites) in order to make it useful.  A much larger problem is that the overwhelming majority of clinicians at VHA have never even seen this card, much less use it daily as an aid in diagnosis on a daily basis. The use of electronic clinical reminders has helped some in this regard, where they are regularly employed.

It is axiomatic that if one does not ask the right questions, then one will not get the right answers. If you do not get the right answers, then the clinician will render an incomplete or a wrong diagnosis. If you have an incomplete diagnosis then you will by definition mistreat the patient, and he or she will not really get well. The VHA will send that person along with the wrong course of treatment, and we will then continue to churn veterans back and forth through the system. That is in large measure the case today. If it is worth providing health care to our Nation’s veterans (and I hope we can all emphatically agree that it is), then it is worth doing it right the first time. 

The VHA now has a project known as the Veterans Health Initiative (VHI), which would initiate proficiency tests in veterans health for clinicians.  Those that pass every three years will be rewarded with additional merit pay. In addition, the VHI is working on a format for a complete military history that would be replete not only with clinical reminders on the computer for the physician, but mandatory indicators for certain medical tests will appear on the screen based on the military history.  

A Vital Need for Funds

 

What does all of this have to do with the future of the veterans health care system in America?  You have already heard testimony from previous DoD and Congressional representatives about the radical downsizing of the DoD medical system since the end of the Cold War. The VHA, as all of us in this room know, is being starved to death for funds to operate even at its reduced capacity. It is doing a better job in many ways than it was ten or twenty years ago, and in many ways it has dramatically declined in that period due to the distortions resulting from not enough resources. The VA medical system, however, is indisputably far from what it was in the decade following World War II.  At that time the very best and most advanced medical care in the world was available to our veterans. 

Like the human body does when starved for food, institutions starved for resources are distorted in strange ways, and the weakest parts of the system suffer the most. So it is with the Veterans Health Administration’s health care system after five years of severe and acute under funding, on top of chronic under funding in the past thirty five years.  The VHA distortions have manifested themselves in the slashing of the specialized services, such as spinal cord injury, blind and visual services, serious and chronic mental illness (those least able to fight back), and prosthetics.  All are operating below the legally mandated level of capacity for specialized medical services, which is set by law at the FY96 level. Yet these services are really at the heart of the VA’s mission. 

Even beyond these distortions due to lack of resources, however, it has become apparent that the VA overall, and VHA in particular, needs to do a much better job of meeting the real mission.  To do so, we do need significant additional resources, but at least as much we need a sharper focus, additional tools to hold managers and clinical chiefs truly accountable, and a dramatic change in the corporate culture of the VA overall. VHA must provide “Veterans Health Care” that is truly comparable with the best health care of any sort that is available in America. We need a system that is capable of being even better for veterans than a private hospital because it would understand the special needs of the Americans who have prepaid the price for using it.  

Much has been made of the fact that the appropriation for the Department of Defense (DoD) has significantly declined as a percentage of the Gross Domestic Product (GDP). Whatever the right number is for DoD, it is a good reference point, along with medical inflation rates to understand what has happened to the national treasure that is the VA

health care system, particularly in the past five years and as projected into the future. The rate of increase of the VHA budget has lagged far behind in comparison to DoD and even the minimum of 8% medical inflation (the civilian sector has averaged more than 10% medical inflation for at least the last three years). 

You can find out what a family, an organization, or a Nation really values by where it puts its money.  If we really value our current veterans as much as the President and our elected leadership says we do, then we have to restore lost organizational capacity, keep pace with medical inflation, and seek better accountability from VHA managers. To do anything less is breaking faith with veterans and with the oft-repeated pledge of health care second to none for veterans.

Holistic Model of Veterans Healthcare 

The difficulty with health care at the VHA, as in much of American medicine, is that it focuses only on the immediate presentation, instead of doing a complete workup of what is needed in order to truly make this veterans as well again, as whole again as possible.  Taking a military history, that includes exposures and determination of long term heath effects of all the exposures that occurred in the military, from hostile fire to diseases to exposure to nuclear, chemical, or biological weapons or agents in any form, or herbicides and other toxins.  One must assess the whole veterans as one whole human being.  Treating the veteran as an episode has gotten us in to the “churning” mode of veterans going again and again through the system for acute medical episodes that could have been prevented.

All of the care taken for military history to achieve a complete diagnosis is necessary, including determination of psychiatric health as well as physiological health if one is to meet the goal of assisting the veteran to achieve the highest degree of autonomy and independence possible.  For those of working age, that means helping the veteran get to the point where he/she can obtain and sustain meaningful work at a living wage.  VVA suggests that the goal of all of the programs and services for veterans should be helping each veteran get and keep meaningful work, in actuality and not just theory. Helping veterans realize their potential in the marketplace is (or should be) the primary goal of all of the VA’s programs.  Most of the focus of VHA programs, particularly for veterans of a working age should be to work with the other programs of VA toward this end.  The primary care teams have been a significant step in the right direction, but much more needs to be done.

Corporate Culture and Mindset 

The mindset of all of the managers and key leaders at VHA must be directed at creating an atmosphere where it is the norm to go the extra step to assist a veteran, and keeping all activities truly focused on the needs of the veteran and not the bureaucracy.  We must achieve a corporate culture that rewards public servants for initiatives that better meet the needs of veterans, as opposed to being punished for showing initiative, as is all too often the case today. 

It has always impressed all of us at Vietnam Veterans of America as to just how many fine and dedicated people stay at VHA and just keep struggling to provide the very best veterans health care possible, despite the obstacles and lack of rewards that all too often is the repayment for their labors. 

Accountability 

The issue of greater accountability is one that VVA has focused on for years, especially the past four years.  It now appears that VA is moving toward a financial tracking system where they can actually tell where the money is going and what it is actually being used for at the Network and local levels.  Apparently a comparable Management Information (MIS) system that is “real time” is in the works and should be on line by 2004 as well.  These are welcome and positive steps that VVA applauds. 

VVA also believes that we must go further to make permanent employees in the senior grades (i.e., Grades 14, 15, 16, and SES) more accountable to duly appointed leadership, and to taking the will of Congress as the law, and not just cute ideas suggested to them. This would help senior leadership and all those who wish to the very best job possible for our Nation’s veterans. 

The VHA has the clinicians to get the job done.  The VA has the leadership at the very top to get the job done, if the President will just provide adequate resources.  The question remains whether or not the focus, the accountability tools, and the corporate culture can be changed to the point that VHA is doing its job well enough that real cooperation with the military hospitals becomes possible.  Beyond the contracting for the sharing of some facilities and equipment that is on a somewhat larger scale than what currently exists, it is simply not feasible to combine a VHA in critical flux with an also dramatically downsized military medical system without diminishing both systems.  Adding 2+2 in this case equals three in terms of quality healthcare that is designed and capable of meeting the needs of those who would be projected to use it.

If the goal of this possible combining is to “save money” then it is ill fated from the start. What the question really should be is how can we achieve the most cost effective as well as cost efficient veterans healthcare system, as well as achieving the most cost efficient and cost effective military medical system in the continental United States. That is what our service members and their families deserve.  That is also what our veterans deserve. What is possible and desirable is more joint planning for how to meet the fourth mission, and an honest assessment of how much money it is going to take for these two systems to prepare for what the President has characterized as a long and dirty war until we achieve our objective.

VVA prays to God that we are wrong, but we do believe that it more than possible if not likely we will suffer significant casualties overseas as well as here at home at some point in the next two to three years.  That time may be sooner, or it may be later but we fear we are correct that it will come, and the current organizational capacity of the VHA and of reduced state of military hospitals is such that we are like to be overwhelmed.

 

VIETNAM VETERANS OF AMERICA
Funding Statement
December 13, 2001

Vietnam Veterans of America (VVA) is a national non-profit veterans membership organization registered as a 501(c)(19) with the Internal Revenue Service.  VVA is also appropriately registered with the Secretary of the Senate and the Clerk of the House of Representatives in compliance with the Lobbying Disclosure Act of 1995.

VA is not currently in receipt of any federal grant or contract, other than the routine allocation of office space and associated resources in VA Regional Offices for outreach and direct services through its Veterans Benefits Program (Service Representatives).  This is also true of the previous two fiscal years.

For Further Information, Contact: Director of Government Relations
Vietnam Veterans of America
(301) 585-4000, extension 127

 

Richard Weidman
Director, Government Relations

Richard Weidman serves as Director of Government Relations on the National Staff of Vietnam Veterans of America (VVA).  He served as a medic during the Vietnam War, including service with Company C, 23rd Med, Americal Division, located in I Corps of Vietnam, in 1969.

Mr. Weidman was a volunteer with VVA in 1978 and then part of the staff of VVA from 1979 to 1987, serving variously as Membership Service Director, Agency Liaison, and Director of Government Relations.  He left VVA to serve in the Administration of Governor Mario M. Cuomo (NY) as Director of Veterans Employment & Training for the New York State Department of Labor.

He has served as Consultant on Legislative Affairs to the National Coalition  for Homeless Veterans, and served at various times on the VA Readjustment Advisory Committee, the Secretary of Labor’s Advisory Committee on Veterans Employment & Training, the President’s Committee on Employment of Persons with Disabilities, the Advisory Committee on veterans’ entrepreneurship of the Small Business Administration, and numerous other advocacy posts in veteran affairs.

Mr. Weidman was an instructor and administrator at Johnson State College (Vermont) in the 1970s, where he was also active in community and veteran affairs.  He attended Colgate University, (B.A.-1967), and did graduate study at the University of Vermont.

He is married and has four children.


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