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.
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:
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.
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)
drastically reduce program funding so the purchase of types and quantities of
supplies required for an expanding workload could not be accomplished.
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.
conversion of our hospitals to outpatient centers (so numbers can be greater).
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
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.
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
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
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:
VIETNAM VETERANS OF AMERICA
OFFICE OF THE PRESIDENT
5599 PINEHURST LANE
COLUMBIA, MO 65202
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