Centralization Key to Revival of Blind Rehabilitation

Dear Sgt. Shaft:

As I have previously written to you, within the past decade VA decentralization has resulted in the deterioration of the VA's renowned blind rehabilitation centers and their programs. In order to reverse this deterioration of the esteemed Blind Rehabilitation Service, we must regain the ability to retain uniformity in quality training nationwide plus the oversight capability by restoring centralization of this vital program.

Amateurs -- newcomers not attuned in the field of rehabilitation and those who think they can save public money with their so-called new ideas -- are actually going back to the practices of the past that have consistently failed for decades. Too many people tried to fix something that was not even broken. Years of decentralization have devastated the VA Blind Rehabilitation Service by reckless local micromanagement.

Blind Rehabilitation Service has been severely diluted, as rehabilitation teaching positions have been abolished, frozen or deferred.

Another issue is the need for a balanced system of oversight and establishment of lines of supervision within all components of Blind Rehabilitation Service from local to the VA central office level ensuring accountability and maintenance of national standards. Within the new decentralized structure -- there is a deep sense that centralized guidance is not needed, wanted or required. Each Veterans Integrated Service Network (VISN), in fact each hospital, attempts to function independently with different governing philosophies, goals and priorities while operating under mounting pressures created by shrinking resources.

Within such an environment, it is highly improbable that all 22 VISNs will adequately provide or properly manage Blind Rehabilitation Services without a check-and-balance system under guidance from VA Headquarters. The uniformity and equity of programs for blinded veterans is at great risk under the current system. There is no oversight or unifying force for this small but highly visible program.

Local management teams within VISNs and medical centers do not possess the professional expertise to strategically plan blind rehabilitation services, nor can they provide strong oversight and peer review to the blind rehabilitation specialists scattered in the field.

What I am describing is a system of blind services influenced and controlled by local officials who are not attuned to blind rehabilitation, with no good system of quality control, no system of stakeholder oversight and no significant subject matter (BRS VACO) oversight, all in an environment of fiscal shortages. There can be little hope for any continued and sustainable success if this scenario does not change.

We need immediate and viable corrective measures to restore centralization of BRS because we strongly believe the centralization of the Blind Rehabilitation Service is the best insurance we can give our blinded veterans. Centralization was the reason for the success of the program for blinded veterans in the past.

Respectfully submitted,

Steve Miyagawa
Chicago

Dear Steve:

As I have stated in past columns, history has shown us what works: a standardized, centralized and comprehensive approach to rehabilitation for our American blinded veterans; a program dedicated to the individual blinded vet, his or her psychological adjustment to blindness, inclusion of family and, of course, vocational testing, training and job placement.

I urge the secretary of Veterans Affairs and his undersecretary of health to restore centralization of the VA's Blind Rehabilitation Service. I also urge the Senate and House veterans affairs committees to review this essential VA program. 
    
Shaft Notes:

VA's Polytrauma System of Care has a new Web site: www.polytrauma.va.gov. This site contains general information about Polytrauma and is home to a page for each of the 21 facilities.

Additionally, there are Polytrauma Support Clinic Teams. Plans put the final number of these near 75. The expectation is that the facility pages will be able to provide contact information for these clinic teams as well as their own.

There are fact sheets available for both traumatic brain injury and polytrauma. The files are titled "Polytrauma Fact Sheet," "TBI Talking Points" and "TBI News Release."

VA will be providing additional information about the Seamless Transition conference in Las Vegas, where these issues were discussed. 
    
Send letters to Sgt. Shaft, c/o John Fales, P.O. Box 65900, Washington, DC 20035-5900; fax 301/622-3330; call 202/257-5446; or e-mail sgtshaft@bavf.org.