Veterans Affairs officials are taking yet more fire over medical services provided at the sprawling agency’s facilities:
The incident at the VA medical center in the nation’s capital (shown above) hit on multiple areas where the agency has been much criticized, including mental health care for veterans, high rates of suicide among military personnel and vets, and the reliance of non-staff, consulting medical personnel.
If you are in crisis or know someone who may be, please call the National Suicide Prevention Lifeline at 800-273-TALK (8255) or text HOME to 741741. Both work 24/7. More resources are available at SpeakingOfSuicide.com/resources.
The VA Office of the Inspector General did not release key details about the treatment it condemned and called for resulting reforms. VA officials said they have taken steps to avoid similar abuses.
The incident started, the Wall Street Journal reported, when an unidentified patient in with “suicidal ideation” visited the med center ER and clinicians disagreed about what to do. The individual’s gender was not disclosed but the patient was 60-something and had a history of “dependence on anxiety medications and opioids, panic attacks, and withdrawal seizures. The patient first visited the VA Medical Center in 2005. A 2014 visit resulted in treatment for benzodiazepine withdrawal. Early last year, the patient visited the VA emergency room, complaining of alprazolam and oxycodone withdrawal and insomnia.”
‘The patient can go shoot themselves’
The patient sought admission for detox and anxiety, and some clinicians agreed. But a psychiatric screening led doctors to recommend the individual be sent, instead, to outpatient care — and the patient became unhappy and resistant.
As the newspaper reported: “A doctor accused the patient of ‘malingering’ and ‘ranting’ and summoned security officers to escort the patient out of the hospital.” The doctor also told a colleague disagreeing about the individual’s treatment that “[the patient] can go shoot [themselves]. I do not care.”
As the newspaper reported:
“Six days later, a family member phoned the medical center to say that the patient had died at home from a self-inflicted gunshot wound. A medical examiner determined suicide as the cause of death. The VA inspector general subsequently initiated an investigation into the episode.”
The IG assailed VA staffers for breaking multiple protocols, including not notifying specially trained agency staff about high-risk patients, as well failing to conduct required and extensive screenings of individuals with multiple issues including drug abuse and suicidal thoughts. The medical personnel also did not schedule the outpatient care, nor did they follow up with the individual, as VA protocols require.
A deadly menace for the military
The U.S. military and the VA, pushed by their own leaders as well as Congress, have battled for years to reduce the terrible and sadly increasing toll of suicide among active duty forces and veterans. As the nonprofit, independent RAND Corporation has described the issue:
“More than 6,000 veterans die by suicide every year. It’s a public health crisis, a broken promise to those who served, and the highest priority within the U.S. Department of Veterans Affairs. Yet the numbers have not improved. More veterans still die by suicide every year than the total number of combat deaths in Iraq and Afghanistan combined. A decade of research at RAND has sought to focus the national conversation about suicide in general, and veteran suicide in particular, around solutions that work. The overwhelming message: We could do more to save the lives of veterans …”
The military, VA, and health policy experts have conducted major awareness campaigns and they have labored to identify gaps and shortfalls in mental health care services to assist troubled active duty personnel and vets. Still, if frontline medical staff in VA facilities can deal so poorly with a despondent vet ….
The DC facility’s director said he has ordered ER personnel to undergo suicide-prevention training and that all staff that center will receive more education about “employee misconduct and patient abuse.” The director also condemned the contract doctor, who was not identified, for improper and abusive care. The doctor no longer works with the VA and officials are investigating further actions against this care giver.
Concerns about contractor care
This incident, regrettably, also resurfaces the challenges confronting both the gigantic VA and the vets it cares for — too often, critics say, with mediocre medical personnel who are not agency staff and work on contracts that can put them at remove from important legal liability if they perform poorly.
The VA has made no secret of its struggles to get the number of quality medical staff it needs for its giant operations, described not long ago by the respected Foreign Policy journal:
“By law, nearly all of the country’s 21 million former service members are eligible for VA health care; of these, nine million have enrolled, and almost seven million used the system in 2016, at a cost of $63 billion. This system provides comprehensive coverage, not only for injuries and illnesses sustained in the line of duty but also for any other medical needs that may arise at any point. To do this, the VA runs 144 hospitals, 800 clinics, and 300 mental health Vet Centers and employs more than 300,000 people. In addition to treating veterans, the VA trains nearly half of U.S. doctors and two-thirds of U.S. nurses at some point in their careers and conducts more than $2 billion in research each year.”
Brian Tally, who served for four years in the U.S. Marines, has fought with bipartisan congressional support to increase VA accountability for its contract medical personnel, asserting that he suffered life changing and debilitating injuries due to botched care by an agency contractor who treated him in Southern California. Congress has not advanced legislation named after him and altering what he says is a major flaw in how vets may pursue meritorious malpractice claims against VA medical contractors. His effort has been described in a recent news report, thusly:
“The Brian Tally VA Employment Transparency Act would allow any veteran or family member who has filed a claim against VA for damage, injury or death to be entitled to receive, within 30 days, a notice from VA about legal counsel, the employment status of anyone involved in the claim (including whether they work for VA or are a contractor) and the statute of limitations for the claim. ‘Brian has been a tireless advocate for veterans who sought care through VA and were harmed through negligence,”’ [House Veterans Affairs Committee] Chairman Rep. Mark Takano, D-Calif. said during [a recent] hearing, adding that those veterans should have the right to know ‘who caused the harm and what legal remedies are available so they can be made whole.’”
The VA, citing the crushing volume and breadth of the services it provides, has fought off efforts to increase the transparency and, some say, the accountability of its contract care givers.
Questions on ‘Covid cocktail’ at state home for vets
The agency’s left hand-right hand coordination challenges also were on display at VA officials took heat from Congress about drug prescribing and medical care given to vets at the Southeastern Veterans’ Center in Spring City, Pa.
There, 30 residents for two weeks were given a “Covid cocktail,” including the controversial antimalarial medication hydroxychloroquine, the Washington Post reported.
As the newspaper noted, the prescribing occurred “often over the objections of nurses and without the full knowledge of residents’ families. At least 11 residents received the drug even though they had not been tested for Covid-19,” and several of the individuals were known to have heart issues — an underlying condition that should have kept them for safety reasons from taking the drug.
Senior VA officials said that doctors in the agency may use their professional discretion, as all physicians may, to order “off label” prescribing if their judgment leads them to believe this will benefit their individual patients. (It also is worth noting, however, that a VA study early on provided credible scientific evidence to debunk the usefulness of hydroxychloroquine alone or in combination with the antiviral drug azithromycin to treat coronavirus cases).
Further, the residents in the facility that has become the object of media controversy is a state-run home for vets. As the Washington Post reported of these institutions:
“Lawmakers … called on VA to step up oversight of the more than 150 homes, run by state governments with about $1 billion a year federal funding. One is the Holyoke Soldiers’ Home in Massachusetts, where 76 people died of Covid-19 amid one of the most lethal outbreaks in the country. The Government Accountability Office reported last month that the home failed to enforce social distancing between residents and lacked staff and protective equipment.
“[A congresswoman at the hearing] said VA’s inspections [of the homes] provide only ‘loose oversight,’ relying on an outside contractor to assess homes and issuing recommendations rather than mandates for improvement. [A VA official] said that states generally ensure quality care and proper staffing [at the facilities].”
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the ordeals that service personnel and their families must endure if they or their loved ones are seriously hurt by negligent medical care at a hospital or clinic run by one of the armed services or the VA. Congress and the president recently gave this important group of Americans half a loaf when it comes to a fundamental constitutional right — the chance for active duty personnel to seek justice in the civil courts if they suffer harms while receiving medical services in noncombat situations.
They now have a little more leeway to pursue malpractice claims, still in a military system and not in the civil justice system that protects civilians. But what will shield them and veterans from other serious, systemic, and persistent problems in the VA, including political machinations at the agency’s top and high-level, outside meddling from President Trump’s pals?
Shouldn’t Congress, as it has with active duty personnel and their medical malpractice claims, look deeper into challenges posed by abusive, negligent, or bad care given by VA medical contractors? Would it not be right for Congress, not the agency, to determine what vets deserve to know about the employment status of their medical care givers and what appropriate courses may be available if patients think they have been harmed by them?
Vets and service personnel and their loved ones — like all of us — deserve safe, excellent, accessible, and affordable medical services. Health care is a right, not a privilege. To be fair, the VA wins many praises for the overall quality and safety of hits medical care. But, as with all medical providers, the agency needs to step up and sustain the vigilance needed to protect the vulnerable from negligent, abusive, and criminal wrongdoing (such as the case involving an aide killing at least seven hospitalized vets). We’ve all got a lot of work to do here.