VVA Testimony VVA Testimony
VVA Testimony

STATEMENT

OF

VIETNAM VETERANS OF AMERICA

 

SUBMITTED BY

ALAN GIBSON, PRESIDENT
VIETNAM VETERANS OF AMERICA
MISSOURI STATE COUNCIL

 
BEFORE THE


HOUSE VETERANS' AFFAIRS SUBCOMMITTEE
KANSAS CITY VETERANS ADMINISTRATION HOSPITAL


REGARDING

PROBLEMS WITHIN THE MEDICAL CENTER

JUNE 17, 2002

  

Chairman Moran, Ranking Member Filner and other distinguished members of the House of Representatives, Missouri State Council, Vietnam Veterans of America (MSCVVA) is honored to appear here today to express our views in response to Medical Problems at the Kansas City Veterans Administration Medical Center (KCVAMC).  It is indeed a shame that it takes a press article to get one of the problems under control. 

Before we go further into this Hospitals situation, we feel that these problems permeate the VA System but was the one that come to light.  There was an account of maggots in a foot of a Veteran in the Columbia, VA Hospital just a few weeks ago.   

We can trace the foundation of these problems to two sources.   

1.      The “flat line” funding for the VA even though the costs of services and supplies continued to rise. 

2.      The measurements of Directors of the Medical Centers and of the VISN (Networks) for receiving bonuses depended on how much money they saved. 

Both of these issues, simply put, mean a cut in services and programs for veterans at the Veterans Health Administration (VHA).  Prescription drugs raised an average of 10% and COLA raised an average of 3.5% each year during the last 5 years with a “flat line” funding.  Not hard to figure where those expenses come from. In fact, medical inflation in the civilian sector from FY ’96 to date has varied between 10.1% and 11.3%.  Even assuming that salaries do not rise as quickly as the private sector, VVA believes that the true inflation rate at VHA is about 8% per year. 

Likewise the savings made by the Directors resulted in the VISN Director receiving at or near the maximum bonus in each of the last 5 years.  Let us not kid ourselves, these savings come from vitally needed programs for ill veterans and further reductions in health availability primarily, and not from administrative areas.  It is believed that VISN 15 (and probably all the VISN’s) made the decision to: 

1.      Completely restructure the organizational chart. Although the claim was that moving to the VISN system would reduce administrative overhead and reduce the number of clinicians who did not see veterans but were primarily paper-shufflers, in fact the administrative number of positions in VHA has increased since 1996. 

2.      Develop a plan that would prevent or make it very difficult for veterans to travel from their local areas to a VA of their choosing for better care. 

3.      Contract with local private hospitals for care. 

4.      To remove physicians from direct control of their programs 

5.      To reduce the number of physicians (in whole and/or in eighth’s) 

6.      To drastically reduce program funding so the purchase of types and quantities of supplies required for an expanding workload could not be accomplished. 

7.      To drastically reduce the number of inpatient beds that could accommodate patients referred from other centers. This in turn prevents patients from being referred to specific hospitals with particular expertise from being sent.  This also reduces the number of beds being used and those could be cut because of “lack of use”.  To us this sounds like a vicious cycle.  The Congress needs to probe the so-called reasons heard about the need to reduce beds. 

8.      Gradual conversion of our hospitals to outpatient centers (so numbers can be greater). 

9.      Create dissent, discontent, and discord within the ranks of VHA with rumors that other programs will soon be closing in order that employees scramble to find jobs at other facilities (not VA) in fear that they may be out of a job when the program(s) close.  

10.  Once employees leave, VHA does not replace them, so therefore the number of beds and programs have to be reduced due to lack of staff & patients. 

11.  Create performance measures for the Hospital Directors that are nearly impossible to meet unless drastic action to reduce costs of staff, inpatient beds and yes, in the case that brings you all here today, housekeeping. 

12.  Have all VISN 15 hospitals contract with the private sector for as many services as possible. 

“Congratulations” are in order for the managers in VISN 15 for responding quickly to the real priorities of the VHA senior bureaucracy, since most of these were accomplished within two (2) years.  No wonder the bonuses mentioned above were given and accepted while Veterans must wait for services (up to 18 months for eye appointment, 1year after registering with the VA to have an intake and receive a primary care Dr. even when been diagnosed at a Cancer Treatment Center with Cancer and a prognosis of 6 months to live, 2-9 months to have cardiac problems scheduled for surgery, live on the streets while attending alcohol & drug abuse treatment during the day.  This list could go on and on but believe time precludes you from sitting here and listening to me for at least two days.  I have a hard time doing that myself.  I believe you all see our point about some of the causes for these problems. 

If you please, three more items to speak about on diminishing health care for Veterans. 

1.      In July (I believe it was) of 1998 one VA Hospital received a “Scissors Award” and “A Center of Excellence” designation for its cardiovascular program.  By July 1, 2000 this program was cut to one (1) Cardiologist. 

2.      This is a veterans’ health care system, and as such a complete military history needs to be taken for each veteran and used in the diagnosis and treatment plan.  That is not done here, nor apparently anywhere else in the country.  This must be fixed soon. 

3.      The over $300 Million set aside for Hepatitis C testing of veterans cannot be accounted for once it reached the VISN levels.  This lack of accountability is not acceptable to this organization.  If it happens for this program, how many others have been cut and where did the money go.  It certainly was not for health care or for cleanliness of facilities such as the KCVAMC. 

MSCVVA cannot stress too strongly that the VHA needs an increase to at least $25.5 Billion for general operating funds for FY 2003, as a bare minimum. The numbers  recently secured by the VVA national office indicate that the current rate of increase of category 7 veterans seeking VHA services is 18% and the rate of “new” categories 1 thru 6 veterans seeking services from VHA are now increasing at the rate of 9% per year.  Should this prove out to be the case after further analysis, the amount needed just to stay where we are, long wait times and shoddy care, would be over $28 billion.  So, more money is needed. 

MSCVVA believes that it is time to make spending for veterans’ health care mandatory.  It is NOT “discretionary” as whether to properly treat America’s disabled veterans. The level must start at the capitation of funding available in FY 96, and index it for 8% per year, with the gross number of funding available to rise as the numbers served rises. 

MSCVVA believes that it is high time to start holding the VHA structure much more accountable here in VISN 15, as well as nationally. First, the bonus and presidential awards processes should be transparent and the criteria clear.  Second, each hospital must have a real veterans committee that meets with the Director and the Chief of Staff at each hospital every three months at minimum, with the agenda set by the veterans’ service organizations and other stakeholders as well as the VA.  These meetings must be separate and apart from the VA Voluntary Services meetings, and should be open to the public, including congressional staff. 

MSCVVA urges the Congress to demand that the VHA develop an effective financial tracking system by FY 2005 whereby you cannot “lose” $326 million as VHA did in the case of the missing hepatitis C funds.  Now I don’t know about Kansas or California, but we in Missouri believe that $300 million is a good chunk of money, even in a system as big as the VA, and should not just disappear.  We can and must do better. 

Similarly, we in Missouri believe that VHA (and all of VA) cannot go on without a “real time” management information system.  The Secretary and the Undersecretary for Health cannot tell you today how many people they have with what kind of training and what kind of equipment at the Ft. Riley VAMC, at KCVAMC, at San Diego, or any place else.  Can you imagine the Chief of Staff of the Army or the Commandant of the Marine Corps lasting even 24 hours if they could not answer those questions? We urge the Congress to require such a system by at least FY 2005, if not FY2004. 

If the VA computer and information technology people are not up to the job (and they may not be, given the lousy track record of that area and the consistently poor job of furnishing them with clear requirements/specifications by top VA officials from all areas, benefits as well as health), then it is time to find someone who can get the job done.  UPS can find their packages in the outback of Australia or the Ozarks of Missouri.  Maybe we should seek advice from them. 

The point I am making Mr. Chairman, is that the Missouri State Council of Vietnam Veterans of America strongly believes that we need significantly more money put into this system, at the same time that Congress demands much, much more accountability out of the VA. The money is necessary, but without strict accountability money alone won’t solve the problems. 

Mr. Chairman, this concludes the testimony of the Missouri State Council, Vietnam Veterans of America.  I will be more than happy to answer any question that the committee may have.


For more information contact Alan Gibson:

MISSOURI STATE COUNCIL
VIETNAM VETERANS OF AMERICA
OFFICE OF THE PRESIDENT
5599 PINEHURST LANE
COLUMBIA, MO 65202
Phone: 573-474-2486
Fax: 573-814-0348
E-mail: Vvamo1@aol.com

 


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