Larry Scott (former E-5) served four-plus years in the U.S. Army with overseas tours as a Broadcast Journalist at AFKN HQ, Seoul, Korea and AFN Lajes Field, The Azores, Portugal and a stateside tour as a Broadcast Journalism Instructor at the Defense Information School (DINFOS). Larry was decorated four times including the Joint Service Commendation Medal with Oak Leaf Cluster. He was awarded DOD's First Place Thomas Jefferson Award for Excellence in Journalism. After the Army, Larry went back to radio news, working in Indianapolis as a News Anchor on WIFE Radio and then in New York City as a News Anchor on WNBC Radio. He receives VA compensation for a service-connected disability and uses the Portland, Oregon/Vancouver, Washington VA facilities for healthcare. Today, Larry resides in Southwest Washington and operates the veteran's help website YourVABenefits.org. To contact Larry Scott email larry@yourvabenefits.org.
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Opinion By Larry Scott
"Hurry up and wait," was the rule of the day when I was in the Army. We waited for everything from chow to ammunition. Now that old phrase has a new and potentially deadly meaning for many veterans.
Veterans have always had to wait for their health care services. Most of the "waits" have been, at the most, inconvenient -- the doctor is running an hour late, there's a long line at the pharmacy, etcetera. As veterans, we have come to accept this as the way the VA system works.
But there are two large groups of veterans who have a different view of waiting. One is the veterans who have just enrolled in the VA system and are waiting to be assigned a Primary Care Provider. The other is the newly enrolled veterans who now must wait inside the system for needed health care beyond the Primary Care level. So they wait and wait and wait.
The waiting list problem became a severe issue about six years ago when the VA introduced the VISN (Veterans Integrated Service Network) system. There are 21 VISNs in the VA that are, basically, regional co-ordination centers. Many veterans see the VISNs as just another layer of unnecessary bureaucracy that drains badly needed health care dollars from individual hospitals. For those in the VA, VISNs are useful because the home office only has to deal with 21 regional directors and not the directors of every hospital. Whichever analysis you choose to believe, it is obvious this system has cost the VA millions, perhaps billions, of dollars.
The VA home office allocates money to the VISNs, and each VA hospital must request their budget dollars from their VISN. The funding for VA hospitals was based on how many veterans were enrolled for care, not the number of veterans actually receiving care. So, the VA hospitals went on enrollment drives that can only be described as manic in nature. They wanted to sign up every veteran they could so they could justify their increased budget requests.
On the surface this was a great idea, but the VISNs didn't come through with the funds needed to handle the onslaught of veterans seeking health care. Also, the VA home office never put needed funding requests in their budget submissions to Congress. Result: Hundreds of thousands of veterans enrolled for care and then couldn't get that needed care. The VISNs didn't have enough funding to handle the requests from the hospitals. And, at the hospital end of this chain, the lines kept getting longer and longer.
When I moved from the East Coast to the Portland, Oregon area about five years ago, I had all my VA records forwarded and lived under the assumption that care for my service-connected disability would pick up right where it left off. What a surprise I had coming! I had to wait 18 months to be assigned a Primary Care Provider. Other veterans in lower priority categories and veterans enrolling for the first time waited as long as 30 months. This story is not atypical, as it was happening at VA hospitals all over the country.
In a flurry of "creative thinking" the VA came up with a way to help solve this problem. Request more funding to hire more doctors and nurses? No! On January 17, 2003 they ceased to enroll Priority Group 8 veterans. This would cut potential enrollees by at least 500,000, and free up the system to handle veterans in the other seven categories. At the same time, VA Secretary Anthony J. Principi said he would be overhauling the VISN funding system to "strengthen the ability of VA clinics and hospitals to meet the needs of their patients." Unfortunately, this has not happened.
However, the VA did hire more office staff to speed the enrollment of those on the waiting lists. This turned out to be a band-aid that the VA has tried to turn into good news, with the help of the Public Affairs Office. Secretary Principi has said that "these days, the only cuts at VA are to the waiting lists for medical care," but it has not been mentioned that Priority Group 8 veterans cannot even enroll in the system, much less get any benefits. It was not mentioned that the needed medical staff to serve those now in the VA system has not been hired, and will not be hired because of hiring freezes caused by severe under-funding.
Also not mentioned were the veterans who died while waiting for their first appointment with a Primary Care Provider. The VA will not release any information on this issue. Recently, I spoke with a VA employee whose job it has been to "work the waiting list" for the past few years. This employee is one of the pleasant people who phones veterans and tells them their time on the waiting list is over and they actually have an appointment with a Primary Care Provider. I commented that the job must be very rewarding. The answer: "In theory. Some of these guys waited over two years and they're really excited about seeing a doctor. But, this job has a terrible downside. Do you know how many times I get the spouse on the phone and they tell me, 'Oh. He passed away a short time ago.' It breaks my heart."
Could these deaths have been prevented? We will never know. We must, however, make some basic assumptions. Veterans enrolling in the VA system who immediately request health care do so for a reason. But, they have to wait. No other health care organization in this country makes you wait months, or even years, to see a doctor for the first time. Can we blame the VA for these deaths? No! We can, however, make a common sense extrapolation of the facts. Many of the veterans MIGHT NOT have died if they had received timely health care.
Where do we stand on the "waiting list" issue today? The waiting lists to be assigned a Primary Care Provider are shorter because so many veterans have been cut from the rolls and many more have been enrolled. But, how short is short and how many veterans are waiting? In September of 2004 the VA released statistics on this subject, claiming the wait for Primary Care is down to 24 days with fewer than 5,000 veterans on the lists nationwide. But this apparent good news hides a terrible truth.
Now the wait is INSIDE the system. The newly enrolled veterans find themselves inside a system so under-funded and under-staffed that they will wait months for the most basic surgeries, diagnostic tests and medical procedures. Nowhere was this more apparent than at the Portland, Oregon VA hospital that had to cancel surgeries because it didn't have the funds to keep their operating rooms open.
The spending bill passed over the weekend also paints a bleak picture for the future. From the Associated Press, Sunday, November 20, 2004: "Veterans' health care got a lot of attention in the just-concluded election campaign, but the Republican-led Congress is not devoting as much money to it as veterans groups and even some GOP lawmakers wanted. The expenditure for veterans' health care will grow in 2005 to a record $30.3 billion, $1.9 billion more than this year. Yet the total is $1.2 billion less than what the House Veterans Affairs Committee said in February was needed to maintain current benefits and services. 'The demand on the system has never been higher,' said Richard Fuller, national legislative director of the Paralyzed Veterans of America. 'The cost of health care has never been higher. This is not going to be adequate.'"
I have been spending lots of time on the phone with the wife of a veteran named Bob. Bob is 79, blind, diabetic and has a rare form of cancer. The VA hospital where Bob is treated cancelled a scheduled CATscan because it didn't have enough technicians in the Imaging Department to perform the procedure. This was done without the knowledge of Bob's VA physician, who needs the diagnostic procedure performed to see if the cancer has spread to Bob's brain. After nearly two weeks of what she described as begging, Bob's wife informed me the CATscan has been rescheduled. No, the VA hospital didn't hire more imaging technicians. They can't because they are working under a hiring freeze. They had to cancel another veteran's CATscan so Bob could get his.
In my last opinion piece I predicted a dire picture for VA health care in 2005.
