As a US Army Infantry veteran with a service connected injury, the recent allegations of deaths due to health care failures within the VA medical system that directs my healthcare, has, needless to say, been a concern the past few weeks. My greatest unease though is with the rush to judgment along with an Inquisition-like process that will end up serving as gauze and tape to a situation that requires a tourniquet, exploratory surgery and a thorough history and physical to triage the true systemic issues and strategize lasting corrective measures.
Unfortunately, with the healthcare system we have in place, it takes loss of life to attract the necessary attention to the open and honest dialogue required to define a problem through the smoke screen of oppositional defiant parties protecting their self interest. Case in point, if it were not for the resilience of women, to stand up to breast cancer, over a quarter century ago, where would we be today? The resolve of these health reform pioneers proved the power of voice in healthcare. Armed with detailed and accurate information on the veracity of breast cancer, they disarmed the deceptive patterns of arguing and disruptive behaviors of entities clouding the realities to defend their wellbeing. More recently, it has taken the deaths by suicide of NFL players like Dave Duerson and Junior Seau, along with the bomb blast experiences of thousands of war veterans to step up the much needed dialogue on Traumatic Brain Injury (TBI) and Chronic Traumatic Encephalopathy (CTE). According to the latest data published by the CDC, 2.5 million TBI’s lead to emergency room visits, hospitalizations or death (50,000) in 2010 with a reported cost of $76.5 billion.
The other US Healthcare “Elephant in the Room” overwhelming the VA healthcare system has been the vast need for Behavioral Health services. Over the past 40 years the importance and integration of Behavioral Health services has dwindled in the US health system. The systematic closings of state mental health hospitals gradually forced mental health and behavioral health into separate silos on the healthcare continuum. Yet, the two most talked about issues in VA health today are TBI and Post Traumatic Stress Disorder (PTSD). The reality is that our medical and behavioral health teaching institutions and hospital administration programs have become focused on curriculums dedicated towards either medicine or mental health which lines up with the societal direction of our health system. At the same time, we point fingers at a VA system we are asking to be managed differently than the traditional medical institutions in our society. Then we scratch our heads or become enraged when we hear how over- medicated our soldiers have become.
Since 2009, the VA health system has made some significant improvements that should be recognized. It has made strides in creating partnerships within communities in the areas of homelessness and veteran’s treatment courts. The VA has come to respect the unique needs of female veterans with dedicated VA Women’s clinics (She Served Too…). It has introduced Peer Support Specialists which utilizes veterans who know how to direct other veterans to VA services. The most significant challenges that I have noticed in the 3 VISN’s (Veterans Integrated Services Networks) have occurred during the past 6 years. It has been the much needed cultural changes in attitude and approach from most of my VA health providers.
The greatest immediate challenge is a timely identification of the resource issues at the center of the “VA Secret Waitlist” scandal, accurate identification of veterans in need of those services, and timely direction toward providers capable of providing the identified care needs (whether this is inside or outside of the VA system). The long-term challenge is the integration of a continuum of care that meets the unique physical medicine and behavioral health challenges of our veterans. At the same time, the cultural change to person centered care must be maintained. Beware of those with oppositional defiant tendencies, they have an agenda.