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VA Scandals, IHS Funding, and Shinseki’s Job

Steve Russell
5/23/14

I’m not here to call for Eric Shinseki’s scalp on a lance. There have been substantial improvements on his watch and his heart is with veterans. Nothing would be improved by imposing a new blood learning curve on the VA right now.

Still, most veterans have more than one story about treatment delay. I’ll share my latest while explaining that I have Medicare and Medigap and I can see a civilian without paying as much as a vet with no other insurance.

On August 14 of last year, I reported to the VA Hospital for my required yearly physical. I came up with blood in my urine. The blood was not visible and I had no other symptoms. I have a history of kidney stones going back to the 1980s and I’m familiar with the excruciating pain, so I expressed the opinion I did not have one.

The VA doc told me to come back in two weeks and see if the blood was still there.

On August 27, the blood was still there and the doc ordered a CT scan and a urology referral. She told me to wait for an appointment in the mail.

On September 6, the blood was visible. That had never happened before. I also began to have difficulty emptying my bladder. I took various dumb self-help measures until September 9, when I got scared enough to do something.

In the past, I had visited the VA urgent care clinic in serious pain and had to sit the entire day before being seen. I can’t complain because the vets in front of me had more than just pain, but that experience led me to call the civilian doc.

My regular doc was not available, but when I described my symptoms, they wanted to see me immediately. The doc I did see scolded me for waiting so long and ordered a CT scan and a urology referral. Notice this is exactly the same action the VA doctor took.

The difference was that I got the CT scan the next day.

I was by that time thinking cancer, because there was no kidney stone pain. Then the pain showed up.

I wound up playing some telephone tag with the doctor’s office to get the results of the CT scan because they won’t leave medical messages on a machine, but in the meantime I went on line and found a urologist.

The confusion about getting the results lasted until September 13, and by that time I was running on painkillers. On Friday the 13th (no wisecracks, please), I finally got the results: a large kidney stone unlikely to come out by itself. I called the urologist the same day.

The first urology appointment was two weeks off, but when I explained my symptoms, he got me in first thing Monday the 16th.

The same day, I got a notice that I could see a VA urologist on September 30. My pain level meant there was no serious question. I went to the civilian, who wanted to operate the next day, but required some time to get some medications out of my system.

On September 18, I was wheeled into surgery and when I came to in the recovery room, my wife had brought my mail: A VA appointment for a CT scan on September 26th.

Some of the civilian delay, but none of the VA delay, was my fault. The contrast in the two systems was stark. The civilians considered my symptoms a flaming emergency and moved to get a diagnosis right away. Since it turned out to be “only” a kidney stone, the delay only cost me some pain and not my life.

I can anticipate a judgment from some of my fellow vets: “Dude, you know it’s overcrowded, so why use the VA if you don’t have to?” Because I’m a disabled vet and that means I get my medications free from the VA. Since I’m a walking pharmacy and living on retirement income, that’s a big deal. I can’t get my meds unless I keep a VA doc.

So my experience validates what has been in the news and the allegations add up to 167 vets dead because of delays in treatment. According to Stars and Stripes, the VA admits to 23.

Polling data show that veterans are generally satisfied with VA care, but not with the time it takes to get it. I am told there is similar evidence for Indian Health Service, for which I am also eligible but outside of a service area, but I can’t find it. Unlike the VA, it appears that IHS does not collect or publish patient satisfaction numbers routinely.

For the dissatisfied, the IHS complaint process does not appear to be user friendly, since the website only refers you back to your local facility. In contrast, the VA allows you to go over the head of the persons about whom you are complaining.

Indian Health Service covers less services than the VA because of very limited mental health and substance abuse treatment. Still, according to the old numbers I found looking for a straight up comparison, the IHS spent $1,578 per patient per year while the VA spent $4,798. The numbers I found were only available because Congress asked the General Accounting Office to do a straight up comparison in 1967.

The numbers of veterans being treated for serious combat injuries might explain some of the differential. Medicare spends $5,450 but the entire service population is elderly, while the VA and the IHS only serve some elderly.

Under President Obama, VA health care funding has seen historic increases and, as important, he signed a law in 2009 that veterans’ groups had long sought requiring that VA health care be funded a year in advance. This became very important when Republicans took the House in 2010 and rendered Congress unable to pass gas.

On the other hand, the VA hospitals are dealing with the casualties of the longest war in US history as well as the two Iraq wars.

Given the challenges and my personal experience, why am I disinterested in taking Eric Shinseki’s hair? Both the VA and the IHS have too many patients for their resources. This is on Congress rather than Shinseki for the VA or Dr. Yvette Roubideaux for the IHS.

The real scandal for the VA is not the delays, but the allegation that the VA has cooked the books to hide the delays. The Inspector General has found the cover-up happened and Shinseki has ordered an audit that should reveal who was responsible.

On May 21, Gen. Shinseki was summoned to the White House. In the press conference afterwards, President Obama agreed that cooking the books was a bigger deal than delay, because if the books are cooked the delay will never be fixed.

One reporter chuckled that the POTUS gave “the longest answer I ever heard to a yes or no question without answering it.” The question was “Did General Shinseki tender his resignation?”

I’m betting that he did, but Mr. Obama decided correctly this is not the time.

Shinseki needs to fire everybody who created or tolerated a culture of cover-up. If he fails to do that, then I can join the war party.

Steve Russell, Cherokee Nation of Oklahoma, is a Texas trial court judge by assignment and associate professor emeritus of criminal justice at Indiana University-Bloomington. He lives in Georgetown, Texas.

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