Marijuana and Veterans with TBI

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Thomas Brennan, a former sergeant in the Marine Corps, is the founder of The War Horse, a veterans’ news site, and a co-author of “Shooting Ghosts: A U.S. Marine, a Combat Photographer, and Their Journey Back from War,”  makes an impassioned plea to “make pot legal for Veterans with TBI.”

Cannabis for Veterans with PTSD and TBI

In an “Opinion” piece for the New York Times of September 1, Mr. Brennan states to following:

“Most of the major veterans groups, including the American Legion, Iraq and Afghanistan Veterans of America, Veterans of Foreign Wars and Disabled American Veterans, support regulated research into the medical uses of cannabis . . .

“What I know is that it works for me. If I hadn’t begun self-medicating with it, I would have killed myself. The relief isn’t immediate. It doesn’t make the pain disappear. But it’s the only thing that takes the sharpest edges off my symptoms. Because of cannabis, I’m more hopeful, less woeful. My relationship with my wife is improving. My daughter and I are growing closer. My past is easier to remember and talk about. My mind is less clouded. More than anything, it feels good to feel again. My migraines and depression don’t control my life. Neither do pills.

“But I live in fear that I will be arrested purchasing an illegal drug. I want safe, regulated medical cannabis to be a treatment option. Just like the sedatives and amphetamines the V.A. used to send me by mail. And the opioids they still send to my friends.”

Personally, I am delighted that Mr. Brennan feels better and is recovering his life, but one man’s (or woman’s) experience with “alternative medication” hardly makes a compelling argument to justify universal endorsement.

Superficially, one could argue that pot is far less “addictive” than opium and the opioid variants currently endorsed by the FDA and the AMA, but I suggest that Mr. Brennan compelling argument touches on a far more important issue:

Officially sanctioned / LEGAL therapies to treat Veterans with PTSD and TBI are not working! 

No one should be surprised that Mr. Brennan and many other brave warriors are seeking alternative therapies – either not sanctioned or “illegal” – because the limited treatment options provided by the Department of Veterans Affairs (“the VA”) are tragically failing the needs of our heroes and their families.

Last week, Maj. Ben Richard’s commented on a disturbing series of videos that trace a widow’s tragic quest to seek help from the VA for her husband who committed suicide when denied alternative therapy.

The tragic suicide of Veteran Eric Bivins is just another example of the abuse of power at the VA that literally makes “life and death” decisions based on a long history of failed treatment programs:  Cognitive Process Therapy (“CPT”) and Prolonged Exposure Therapy (“PE”).

If the only choice for Veterans with PTSD and TBI is institutional abuse and lethal prescription drugs, why not run the risk (illegal or unsanctioned) and seek help that works?  In the case of Mr. Brennan, cannabis might be the answer, but SFTT seeks out programs that may offer life-changing therapies rather than medication that simply deals with the symptoms.

Personally, I don’t think that potentially addictive drugs are the long term answer for PTSD and TBI, but I can certainly understand why many Veterans seek relief outside the limited number of options and callous disregard currently shown by the VA.

Perhaps Secretary David Shulkin can bring about much needed reform at the VA, but the odds are firmly stacked against him.

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How the VA Callously Treats Veterans: A National Disgrace

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As we reported earlier, Veteran Eric Bivins committed suicide after being unable to find the support and care he needed from the Department of Veterans Affairs (“the VA”).

Found below are a moving – AND MOST SAD – series of videos by Kimi Bivins, Eric’s spouse which describes her experiences with the VA in attempting to find the proper care for her husband.

Kimi’s experiences with the VA are not dissimilar from my own and countless of others who have sought care from the VA. I agree with Kimi that it is a “national disgrace,” yet the VA continues to remain largely unaccountable for their callousness and disdain in treating our brave warriors.

I would encourage readers to watch these powerful videos to understand the frustration and agony of a loved-one in dealing with the VA.

Kimi’s YouTube videos are presented in a more or less chronological order, with limited commentary by me other than to clarify certain expressions.

Published on March 23, 2016. Kimi’s Initial PRIVATE Appeal for Help.

Published on March 10, 2016. Kimi’s Frustration on Getting VA Paperwork

Published on March 18, 2016. Eric in a VA Facility

Published on March 23, 2016. Eric is Coping, but Life is Still Very Difficult

Published on April 13, 2016. Eric at Independent Treatment Facility.

Published on May 15, 2016. Eric is Better, But Seeks Therapy Outside the VA

Published July 11, 2017. After Eric’s Suicide

While many will be shocked by these series of videos, it is far too commonplace within the VA.

Before Eric’s suicide he had been accepted into a program to receive hyperbaric oxygen therapy or HBOT.  I credit HBOT with saving my life and enabling me to begin the long road to recover my life.

It is sad that some uninformed doctor at the VA would shatter Eric’s dream of life-changing therapy by parroting the VA’s institutional bias against HBOT.

Dr. David Cifu and his cronies at the VA and the DoD have done their upmost to discredit HBOT and other alternative therapies to support the failed VA programs of Cognitive Process Therapy (“CPT”) and Prolonged Exposure Therapy (“PE”).

Failed VA therapy programs to treat PTSD have been documented numerous times by credible independent studies.   And yet, VA spokespeople still parrot the same stale party line.  Veterans with PTSD and TBI are not deceived and have abandoned the VA in droves.

It sickens me to watch these tragic videos of Kimi documenting her fruitless attempt to navigate the uncaring bureaucracy of the VA.  In my estimation, Kimi’s videos should be mandatory training for all employees at the VA.

While the VA provides much needed comfort to thousands of Veterans, those Veterans with PTSD and TBI need to look elsewhere for REAL therapy.

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Can Secretary David Shulkin Fix the VA?

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Can Secretary David Shulkin fix the Department of Veterans Affairs (“the VA”)?  The answer is an emphatic NO!

Department of Veterans Affairs

This is not a commentary on Dr. Shulkin’s inspired leadership or his vision for a vastly improved VA, but a consequence of competing ideologies and a dysfunctional institution.

As Stand for the Troops has stated several times over the past year: “THE VA IS SIMPLY TOO LARGE TO SUCCEED IN ITS MISSION.”

As suggested in last week’s article by Maj. Ben Richards, the care provided by the VA is far different than the “happy talk” its administrators disseminate to a gullible public and Congress.   The disturbing suicide of Veteran Eric Bivins can clearly be laid at the doors of the VA, but does anyone in authority really care?

Will the desperate pleas Eric’s spouse Kimi resonate in the corridors of power in DC?  Probably not.  And yet, Kimi’s description of the troubling treatment provided by the VA is far more accurate than the self-serving assurances that VA “change agents” dispense to the press.

Veterans are giving up hope daily and seeking treatment outside the VA.  If Congress truly wanted to know the extent of the problems in the VA, they would surely spend far more time seeking out the views of Veterans than blindly accept the assurances of its administrators.  Will this occur? Not likely – and even if it were to occur, not much is likely to change.

The VA is like an old automobile that is falling apart.  Sure, we can try fixing it with the same failed strategies that have been used in the past OR how about trying a different approach? Scrap the dysfunctional VA and build a responsive institution that truly attends to the needs of most Veterans?

How Can the VA be Fixed?

With an annual budget of over $180 billion and nearly 350,000 employees, things can easily get off-track.  More to the point, impassioned administrator can run about putting their fingers in the holes of a leaking dyke, but another leak will surface almost immediately.

As I stated previously,

NO AMOUNT OF MONEY or CHANGE IN LEADERSHIP or ENACTMENT OF NEW LEGISLATION will bring about A MORE RESPONSIVE VA.

The VA has become a bureaucracy that answers only to itself and is not responsive to the needs of Veterans.  Frankly, the VA has lost its way and very little will change unless the VA is broken down into far smaller manageable components.

While smaller components of the VA will invariably fail, A SMALLER AND LESS CENTRALIZED VA WON’T COMPROMISE THE FULL MISSION.  

The public seems relieved that Veterans now have a choice of service providers because the Choice Program has been extended by Congress, but for many thousands of Veterans like Eric Bivins and his family, there really is NO CHOICE!

Where the VA is Today

Personally, I believe that Dr. Shulkin has done a remarkable job in addressing some of the more urgent problems at the VA.  While one can argue whether he has done enough, the task he has been given is like being assigned to captain the Titanic after it has hit the iceberg.

The speed with which the VA will sink further into disrepute may be slowed, but SINK it will.

How many more reports do we need from the Office of the Inspector General (the “IG”) that the VA lacks effective governance and oversight?

How many more times to we have to fire ineffective VA employees when the Labor Union intercedes to protect  employee “rights”?

How many more infection risks do Veterans need to overcome at VA facilities?

These are just the latest “issues” that Dr. Shulkin and his staff need to deal with.  Despite evidence of much needed progress to overhaul the VA, these problems are likely to persist.

In fact, every local incidence of inefficiency or incompetence becomes magnified into a matter of national concern and raises further doubts about the VA’s ability to reform itself from within.  Frankly, there are far too many competing mandates for it to do so.

Sadly, our Veterans and their loved ones will continue to suffer until we stop posturing and enact real reform.

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SFTT Military Highlights: Week Ending Aug 11, 2017

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Found below are a few military news items that caught my attention this past week. I am hopeful that the titles and short commentary will encourage SFTT readers to click on the embedded links to read more on subjects that may be of interest to them.

If you have subjects of topical interest, please do not hesitate to reach out. Contact SFTT.

Tensions High over North Korea
“Military solutions are now fully in place, locked and loaded, should North Korea act unwisely,” President Trump said on Friday, in his latest salvo in the exchange of rhetoric with the isolated regime. “Hopefully Kim Jong Un will find another path!”  The statement, made via Twitter, comes one day after Trump wondered whether he had been stern enough in talking about North Korea earlier this week, when he promised to meet Pyongyang’s threats with “fire and fury.”  Read more . . .

Military Food Rations Amazon

Food Rations May Become a Military Profit Center
Amazon is using everything at its disposal to take on the grocery and food delivery business. The online retailer purchased Whole Foods Market in June for $13.7 billion, announced new meal-prep boxes that challenge Blue Apron in July, and now it’s turning to the military for its next move. According to a CNBC report, Amazon wants to use military food technology to create prepared meals that don’t need to be refrigerated. This would allow the company to store and ship more food more efficiently and to offer ready-to-eat, (hopefully) tasty meals at a lower price.  Read more . .

Is the VA Planning to Close Incomplete Healthcare Applications?
A well-known whistleblower in the Department of Veterans Affairs warned Wednesday that the VA appears to be getting ready to close tens of thousands of incomplete healthcare applications, even though it’s been clear for more than a year that the VA was failing to give veterans a chance to complete these applications. Scott Davis is a public affairs officer for the VA’s Member Services in Atlanta who has testified before Congress about problems within the VA.  Read more . . .

Deja Vu All Over Again at the VA
The Department of Veterans Affairs (VA) has been forced to employ the former Washington, D.C., medical center director for the time being after the employee was fired for failing “to provide effective leadership at the medical center.” Brian Hawkins was fired in July after it was revealed he had sent sensitive information to his wife’s personal email account. However, Hawkins appealed the termination and the federal Merit Systems Protection Board issued a stay on the decision on Aug. 2, allowing Hawkins to build a defense that he was wrongfully let go. VA Secretary David Shulkin pushed back against the stay and has prohibited Hawkins from working around patients.   Read more . . .

Opioids for Veterans with PTSD

Tighter Controls Over Opioid Prescriptions at the VA?
The U.S. Department Veterans Affairs Office of the Inspector General released a report Aug. 1 that recommended non-VA health care providers being paid by the VA to provide services to veterans be required to submit opiate prescriptions directly to VA pharmacies. According to the report, veterans are one of the highest risk pools of people to become addicted to opiates and that veterans could receive treatment in the form of opiates from non-VA doctors without regard for the possibility of co-occurring mental health problems. “Veterans receiving opioid prescriptions from VA-referred clinical settings may be at greater risk for overdose and other harm because medication information is not being consistently shared,” said U.S. Department of Veterans Affairs Inspector General Michael J. Missal. “That has to change. Health care providers serving veterans should be following consistent guidelines for prescribing opioids and sharing information that ensures quality care for high-risk veterans.”  Read more . . .

Link Between PTSD and Alzheimer’s Disease and Dementia?
More and more evidence is suggesting that developing post-traumatic stress disorder early in life can raise the risk of dementia in old age. New research finds a molecular link between the two conditions, which paves the way for new therapies. An increasing number of epidemiological studies have suggested that people who develop a neuropsychiatric condition such as post-traumatic stress disorder (PTSD) in childhood are also likely to develop Alzheimer’s disease later in life.  Read more . . .

How Combat Vet’s PTSD Affects Families
Soldiers who experience the horror and terror of conflict often return home far different people than they were when they left. Many are angry, suffer from depression, harbour suicidal thoughts or attempt to isolate themselves from the world, hoping to avoid triggers that can instantly force them to relive their experiences. While increasing attention has been paid in recent years to helping armed forces members cope with post-traumatic stress syndrome (PTSD), not as much attention has been paid to the experience and grief of intimate partners and families who experience trauma in trying to deal with the changes a loved one, coping with PTSD, goes through.  Read more . . .

Drop me an email at info@sftt.org if you believe that there are other subjects that are newsworthy.

Feel you should do more to help our brave men and women who wear the uniform or our Veterans? Consider donating to Stand For The Troops

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What do the NFL and the VA Have in Common?

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Like the Department of Veterans Affairs (“the VA”), the NFL has eloquently side-stepped the effects of brain trauma caused my massive or repeated concussive events.

In a most disturbing study, the Journal of the American Medical Association has concluded that “110 of 111 NFL players were found to have chronic traumatic encephalopathy, or C.T.E., the degenerative disease believed to be caused by repeated blows to the head.”

Chronic Traumatic Encephalopathy or CTE

This should come as no surprise to most anyone who has followed repeated denials by NFL officials and team owners that repeated concussive events on the field of play lead to permanent brain damage.

Why?  The liability is simply too great and public outcry might hurt the lucrative revenue stream of the NFL, which is currently exempt from antitrust laws thanks to the largesse of Congress.

Personally, I don’t believe that the risk of brain injury will deter rabid fans from attending college or NFL games anymore than residents of Rome passed up an opportunity to attend a bloody spectacle at the colosseum.

Nevertheless, there is a strong grassroots effort to cut back on football programs for young children.  A recent news report from Tampa, Florida highlights the dilemma faced by parents whose 9 and 10 year-old children want to play contact football.

NFL Players and our Military Heroes

While NFL players have the opportunity to walk away from the sport they dearly love, the brave men and women who serve in our armed forces don’t have quite the same options.

More to the point, Veterans suffering from from PTSD and TBI have few possibilities given the VA’s limited menu of therapy options: Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT).   As the VA acknowledges, neither of these therapies has produced significant improvements in the well-being of Veterans.

To mask the their failure in treating PTSD and TBI, the VA has resorted to potent prescription drugs with unsettling side-effects.   In effect, treating PTSD and TBI has largely been a “loss loss” for Veterans with equally devastating results on their families.

What the VA and the NFL have in common is a culture of arrogance and denial based on a concerted and prolonged effort to hide the truth from those it purports to serve and protect.   In effect, the VA has told Veterans that “it is the VA way or the highway.”

Sadly, far too many Veterans have opted for the highway.

Dr. David Cifu and the Culture of Doom

Nowhere is this arrogance of the VA more manifest than in the pompous and self-serving performance by Dr. David Cifu, a consultant for the VA on PTSD and TBI, at a 2016 Congressional subcommittee:

Scholars in attendance were revolted by Dr. Cifu’s anecdotal and silly justification for why the VA’s policies and procedures for treating PTSD and TBI are so far out of touch with the latest scientific research.

Sadly, Dr. Cifu’s opinions reflect entrenched attitudes at the VA and deprive tens of thousands of brave Veterans the treatment they deserve to combat this debilitating injury.

While Dr. David Shulkin is cleaning house at the VA, he would do well to look at those like Dr. Cifu to determine if they are up to the task in reestablishing the credibility of the VA.

Veterans that talk to SFTT believe that the VA is useless in helping to address their problems with PTSD and TBI.

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Secretary Shulkin Announces Electronic Health Records for VA

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In a rather unusual setting:  the White House press room – Department of Veterans Affairs’ Secretary, Dr. David Shulkin, announced that the VA “will be overhauling its electronic health records, adopting a commercial product used by the Pentagon that he hopes will improve care for veterans and reduce wait times for medical appointments.”

Dr. David Shulkin, VA Secretary

While many have been pressing for a complete overhaul of the VA’s inefficient medical record system, Dr. Shulkin has taken on the challenging task of dispensing with the VA’s current VistA system in exchange for the Department of Defense MHS Genesis system.

Without going into too many details, Secretary Shulkin showed courage by selecting the MHS Genesis system without competitive bidding, “citing a ‘public interest’ exception. He noted that when the Pentagon did competitive bidding on its system, it took 26 months.”

While I fully agree with his rationale for accelerating the implementation process, I am quite certain that others will question the bidding process.  After-all, Secretary Shulkin claims that it would be “unrealistic” to assume that the VA’s new electronic health record would cost less than $4 billion.

Congressional approval is required for this supplemental appropriation, but this overhaul of the VA electronic health records was a key recommendation of the June 30, 2016 Commission on Care Report.    I have no doubt that Congress will pass the required appropriation.

Electronic Health Records for Veterans and the VA

On the plus side, a “cloud-based” commercial solution is far preferable to internally-developed and internally-maintained VA legacy systems.  Outdated, clunky and inefficient legacy systems at banks and insurance companies have proved to be rather ineffective at keeping pace with technology.  Systems at the VA are probably not different.

There is no question, that the VA will be able to operate far more efficiently with state-of-the-art electronic health records.  Whether Veterans will benefit from this improved information technology remains a matter of conjecture.

Dr. Shulkin claims that the transition to the MHS Genesis system will take “about 3 to 6 months at the latest.”  Recalling the delays in the rollout of the Affordable Care Act online marketplace, I suspect that this is a very ambitious target.  I hope to be proven wrong.

Furthermore, I recall that it took members of the medical profession about two years to fully implement the transition to electronic health records to receive reimbursement from Medicare and Medicaid.

While the technology may be fully deployed and implemented within six months, I suspect that it is highly unlikely that 300,000 plus employees at the VA will easily transition to the new electronic health records.

Realistically, I suspect that it will be about 24 months before the first major efficiencies make themselves manifest at the VA.

Privacy and Electronic Health Records

While it makes sense to use the common elements of the Department of Defense (“DoD”) database to populate and communicate with a similar system at the VA, access to individual records creates privacy issues.

Veterans tell SFTT that they are reluctant to share health information with the VA because of privacy concerns.  Linking the DoD and VA databases seems – on the surface – to raise additional “privacy” issues.

While the VA can use any number of filters and access restriction to protect the confidentiality of electronic health records, it is evident that a human interface will at some point be required to get actionable medical information to “the right” caregiver.

Getting a person on the phone – let alone “the right person” – has always been a problem at the VA.  In fact, SFTT reported late last year that 1/3 of the calls to the VA Crisis Center go unattended.

Is it enough to assume that things will be different this time around?

Conclusion

While the move to electronic health records is yet another great decision by Dr. Shulkin, it remains to be seen whether he has sufficient tools at his disposal to mobilize the staff of VA to reach out to Veterans and help close the divide.

On behalf of our brave Veterans, SFTT certainly hopes so.

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Meet David Cox: Dr. “No” of VA Reform

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Meet J. David Cox, who many consider “Dr. No” of badly needed reforms within the Department of Veterans Affairs (“the VA’).

J. David Cox

J. David Cox

J. David Cox is President of the American Federation of Government Employees and is the person most likely to block any meaningful reform within the VA.  SFTT has had an eye on Mr. Cox who in the run-up to last year’s Presidential election, threatened the previous secretary of the VA with physical violence:

Cox was “prepared to whoop Bob McDonald’s a – -,” he said. “He’s going to start treating us as the labor partner … or we will whoop his a – -, I promise you,”

The new VA Secretary, Dr. David Shulkin, is rightly receiving favorable media coverage and support from both parties in Congress on his forceful new leadership.  In fact, the New York Times recently referred to Dr. Shulkin as a “Hands On, Risk-Taking ‘Standout.'”

The New York Times reports the following example of Dr. Shulkin’s responsiveness (and common sense):

After he first took the job, he grew concerned that the agency was not doing enough to prevent suicide after a news report showed high rates among young combat veterans. Suicide prevention leaders told him that they would put together a summit meeting to respond, adding that it would take 10 months.

Dr. Shulkin told them to get it done in one month. When his staff members pushed back, he pulled out a calculator and began quietly tapping, then showed them that during the delay, nearly 6,000 veterans would kill themselves. They got it done in a month.

“For me it was a very important day,” he said, remembering the meeting. “It taught our people you can act with urgency, and you can resist the temptation to say we work in a system that you can’t get to move faster. I think they learned that you can.”

Indeed, SFTT has greatly admired the decisiveness with which Dr. Shulkin has attacked two chronic problems with the VA:  A bloated infrastructure and the lack of authority to manage the VA’s large workforce.

While Congressional Republicans and Democrats have largely agreed on an “accountability” bill to support the firing of VA employees, J. David Cox argues that:

“Trampling on the rights of honest, hard-working public-sector employees is not the solution to holding bad employees accountable for their actions,” American Federation of Government Employees National President J. David Cox said. He said the bill would set up different standards for VA employees and other federal workers.

In fact, just recently it was reported that “a federal appellate court overturned the firing of Sharon Helman, who presided over a Phoenix VA Health Care System that left veterans waiting for weeks or even months for care while phony records were kept to show the agency was meeting its wait-time goals.”

Dr. David Shulkin, VA Secretary

While I hope that Dr. Shulkin has the fortitude to implement the bold changes he has outlined, the entrenched bureaucracy represented by David Cox and others, such as David Cifu, will continue to undermine his efforts.

The VA has simply grown too large to manage effectively.  Dr. Shulkin is right in arguing that the lives and well-being of Veterans are far more important than defending the rights of a few “bad apples” within the VA.  David Cox should embrace the vision of Dr. Shulkin and act in a manner which reflects well on the work ethic of the vast majority of VA employees.

Veterans, Veteran organizations and our elected officials should provide Dr. Shulkin with a clear mandate to bring about the much needed reform within the VA. Our Veterans, their family and friends and an appreciate public deserve no less.

J. David Cox would do well to join forces with Dr. Shulkin in this effort rather than taunt him.

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Whistleblowers and the Department of Veterans Affairs

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On April 27th, President Trump signed an Executive Order to create the Office of Accountability and Whistleblower Protection within the Department of Veterans Affairs (“the VA”).

According to the AP, VA Secretary David Shulkin said the office will help identify “barriers” that make it difficult for the department to fire or reassign bad employees. Another function of the office will be to help shield whistleblowers from retaliation.

To many, it may seem surprising that a new office within the VA is required to protect “whistleblowers,” since private and public whistleblowers have long been afforded protection under the Whistleblower Protection Act of 1989.

Clearly, additional protection is needed if doctors like Dr. Dale Klein can be relegated to an empty room for bringing VA abuse to the attention of the Inspector General.  Found below is a report for Fox News:

Dr. Dale Klein may be the highest-paid U.S. government employee who literally does nothing while he’s on the clock. A highly rated pain management specialist at the Southeast Missouri John J. Pershing V.A., Klein is paid $250,000 a year to work with veterans, but instead of helping those who served their country, he sits in a small office and does nothing. All day. Every day.

“I sit in a chair and I look at the walls,” the doctor said of his typical workday. “It feels like solitary confinement.”

A double board certified physician and Yale University fellow, Klein said the Department of Veterans Affairs (V.A.) took away his patients and privileges almost a year ago after, he alleges, he blew the whistle on secret wait-lists and wait-time manipulation at the V.A. in Poplar Bluff, Mo., as well as his suspicion that some veterans were reselling their prescriptions on the black market.

While one would like to be optimistic that the new “Whistleblower Office” within the VA would help improved efficiency within the VA, I suspect that there are far too many institutional barriers to be overcome in this mammoth organization.

Department of Veterans Affairs

Size Matters at the Department of Veterans Affairs

The VA’s simple mission laid down by President Abraham Lincoln is “to care for him who shall have borne the battle, and for his widow, and his orphan.”

Needless to say, each person has his or her interpretation of what that VA mission entails, but over time the VA has laid on layers of responsibility to fulfill that mission.   In the military, we often refer to that as “mission creep.”

In effect, the VA – whether pressured by Congress, the President or their own Administration – have taken on responsibilities that may or may not be what was originally intended under President Lincoln’s promise.

More importantly, the VA has centralized most functions under its umbrella to administer to the needs of Veterans.

Employing some 350,000 people and many outside consultants, the VA administers health and benefit programs to millions of Veterans.  In economic terms, one might characterize the VA as a monopoly.

While many of the services provided by the VA are excellent, it would be unrealistic to expect that ALL services are effective.

In fact, the IG, internal VA audits and the IG have reported many irregularities at the VA.  Unmanned Crisis Call Centers, unacceptable patient “wait times” and the heavy reliance on prescription drugs all contribute to public wariness and distrust of the VA.   More importantly, many Veterans reject the services provided by the VA.

SFTT has long argued that the VA is far too large to succeed on every front without compromising their main mission.  Shortly after Dr. David Shulkin was appointed Secretary of the VA, we wrote:

NO AMOUNT OF MONEY or CHANGE IN LEADERSHIP or ENACTMENT OF NEW LEGISLATION will bring about A MORE RESPONSIVE VA.

The VA has become a bureaucracy that answers only to itself and is not responsive to the needs of Veterans.  Frankly, the VA has lost its way and very little will change unless the VA is broken down into far smaller manageable components.

While smaller components of the VA will invariably fail, A SMALLER AND LESS CENTRALIZED VA WON’T COMPROMISE THE FULL MISSION.  

VA Whistleblowers and David Cox

Dr. Shulkin and others clearly realize that there are serious problems of accountability within the VA.  The April 27, 2017 Executive Order is designed to help “weed out” waste and inefficiencies within the VA.

J. David Cox

J. David Cox

Despite much needed reform within the largely ungovernable VA, I suspect that  J. David Cox, President of the American Federation of Government Employees, will continue to run a destabilizing campaign to block any meaningful reform.

We admire the courage of “whistleblowers,” but Veterans shouldn’t expect great changes considering the entrenched positions of David Cox and his henchmen.

It is reassuring to see Dr. Shulkin take action to confront the serious problems within the VA.  We wish him success in his endeavors and hope that he receives much needed support from our elected leaders to bring radical reform to the VA.

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VA Secretary David Shulkin: Glass Half Full?

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Department of Veterans Affairs (“the VA”) Secretary, Dr. David Shulkin means well, but it is not surprising that his leadership is being undermined by the same chronic conditions that have plagued other VA Secretaries.

Dr. David Shulkin, VA Secretary

THE VA IS SIMPLY TOO LARGE TO SUCCEED IN ITS MISSION

This week brings yet three more examples of the chronic problems facing the VA:

The VA still can’t FIX the Suicide Hotline

Secretary Shulkin Needs Senate Approval to Fire VA Employees

VA Dropping Veteran Caregivers from Their Rolls

Indeed, this litany of weekly crises is not dissimilar from scandals that have surfaced under the leadership of other VA secretaries.

What follows is a well-choreographed skit designed to reassure the public and Veterans that all is well in the Music Man’s River City.

“New Crisis” at the VA attracts national media;

VA Secretary assures Congressional subcommittee that problem will be fixed;

Congressmen get public facetime preaching to the converted;

– VA Secretary Shulkin sulks back to his office to prepare for next week’s Congressional hearing;

VA Labor Union blocks any constructive legislation that would allow the Secretary Shulkin to implement much-needed change within the VA.    Why?  Just ask J. David Cox, President of the American Federation of Government Employees, who once threatened a VA Secretary with “physical violence” for suggesting a change to the status quo.

For those who have followed this same tragic charade for many years, it is clearly evident that the VA is too big to succeed.  In the words of Nassim Taleb, the VA is fragile.

In my opinion, NO AMOUNT OF MONEY or CHANGE IN LEADERSHIP or ENACTMENT OF NEW LEGISLATION will bring about A MORE RESPONSIVE VA.

The VA has become a bureaucracy that answers only to itself and is not responsive to the needs of Veterans.  Frankly, the VA has lost its way and very little will change unless the VA is broken down into far smaller manageable components.

While smaller components of the VA will invariably fail, A SMALLER AND LESS CENTRALIZED VA WON’T COMPROMISE THE FULL MISSION.  

Will “change you can believe in” actually take place?  I think not, considering the entrenched political interest in maintaining the status quo and the patronage of a large block of voters represented by J. David Cox.

As presently configured, there is no possible way that the VA can fulfill President Abraham Lincoln’s promise: “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America’s Veterans.

As argued on several other occasions, the VA should be reconfigured to concentrate on those Veteran functions which require centralization.  All other activities should be assigned to smaller VA components or outsourced (with supervision) to the private sector.

For instance, the VA centralized suicide crisis line makes little sense.   Aside from the fact that the crisis line is currently non-responsive (and has been for a long period of time), it seems evident that we should allocate responsive resources far closer to a high-risk Veteran.

Let’s face it, few jumpers have been talked down off the ledge by a Call Center.  If you want to deal with high-risk Veterans in urgent need of support, get human resources to them as quickly as possible.  THINK LOCAL and COMMUNITY-BASED SERVICES.

While this more decentralized approach may not resolve the current Crisis Center problems, it would be far easier to manage and control at a local level.  Better yet, high-risk Veterans will benefit from a far more responsive human touch by local communities that truly care.

For Veterans, BIG IS NOT BEAUTIFUL!   Many Veterans see a largely unresponsive institution that seems more preoccupied with statistical adherence to protocol than positive patient outcomes. Wouldn’t it be wonderful if we could turn that perception around?

From the perspective of the VA, it is a lot easier to say that “we need more resources to deal with current shortcomings,” rather than face the reality that the VA has become a dysfunctional bureaucracy.

The Titanic

The ability to turn around the “Titanic” VA was lost many years ago.  Going forward, we must chop down the VA into far smaller component “passenger ships”  with accountability and leadership that can truly effect meaningful change.

Sure, one or more of these smaller components may fail, but not ALL Veterans will be held hostage by the continued failure in leadership of an INSTITUTION THAT IS TOO BIG TO SUCCEED.

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Will the VA Provide Better Service to Veterans?

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With much fanfare, Dr. David Shulkin, the new Secretary for the Department of Veterans Affairs (“the VA”), has moved quickly to address some of the recurring problems at the VA.

Dr. David Shulkin, VA Secretary

As the first VA Secretary without a military background, Dr. Shulkin appears committed to resolve several pressing concerns:

– Speedier processing of Veteran benefit claims and,

– Eliminate unnecessary bureaucracy and artificial constraints on “out-of-network” support for Veterans (Choice Program).

Indeed, Secretary Shulkin recently unveiled a 10 Point Plan to modernize the VA:

1. Firing bad employees

2. Extending the Choice program

3. Choice 2.0

4. Improving VA infrastructure

5. ‘World-class’ services

6. Better VA-DoD partnerships

7. Better electronic records

8. Stopping suicide

9. Appeals modernization

10. Internal improvements 

While there is little in these Powerpoint presentation bullet points that anyone would quibble with, implementing these broad goals tends to be far more complicated than listing the goals.   Unless there are rigorous benchmarks to assess progress toward achieving these goals, then this “goal-setting” exercise is rather fruitless.

In fact, it is difficult to reconcile the need for increased hiring within the VA unless one sees clear and conclusive evidence that “bad employees” are being fired.  In fact, the VA is recommending a hiring surge to deal with a backlog of benefit claims, a situation that has persisted for 4 years.

Are more employees needed or does the VA lack the “right” mix of employees to implement Shulkin’s 10 point plan?

For instance, State and Local VA coverage varies radically across the US.  For example, NPR reported in 2015 “that spending is nearly $30,000 per patient in San Francisco, and less than $7,000 per patient in Lubbock, Texas. Nationally, the average is just under $10,000. In places where more veterans are enrolled in VA health benefit plans, spending per veteran did tend to be higher.”   Why?  This is a huge variance that is not well explained.

Aligning the VA to Achieve Measurable Goals

As one looks at Shulkin’s proposed goals, it would be useful to determine their priority and the level of commitment (personnel and capital expenditure) that is required to attain them.  Furthermore, what are the benchmarks to chart progress toward achieving those goals.

For instance, “stopping Veteran suicides” is a goal that would find few naysayers.  Nevertheless, it is difficult to reconcile that goal with the sad fact that 30% of suicide watch calls are not currently attended by the Veteran Crisis Center.  Indeed, I find it disturbing that the Suicide Crisis Line has been centralized under the VA in the name of “efficiency.”

Perhaps, Dr. Shulkin and his staff have some measurable goals.  If so, they should be made public and both the Executive Body and Congressional Oversight Committees should receive regular updates from the VA on progress to date in achieving mutually agreeable goals.

Is this likely to happen?  Most certainly not!  This is an anathema to Big Government.

Is Firing Bad Employees Really Going to Occur?

With 365,000 employees, there are certainly going to be a few “bad eggs.”  While Dr. Shulkin praised the vast majority of VA employees, he told a cheering crowd  that “We’re going to make sure that the secretary has the authority to make sure that those (sic “bad”) employees … are leaving the VA system.”

J. David Cox

J. David Cox

Really?  It seems to anyone who has taken more than a cursory look at staffing within the VA, that David Cox, the President of the American Federation of Government Employees, will be calling the shots rather than Dr. Shulkin.

In most cases, distinguishing between a “bad” employee and an inefficient one is largely subjective.  Given the protection afforded by employees at the VA, it is highly unlikely that both the bad and inefficient employees will be “leaving the VA system” anytime soon.

In effect, this places a greater burden on both ” the good” and the many efficient and competent employees within the VA.  With little say or control on managing the workforce, I find it highly unlikely that Dr. Shulkin will be able to fulfill his promise to fire “bad” employees.

More importantly, it is unlikely that he will be able to realign staffing levels to implement his 10-point plan.

And Speaking of Bad Apples:  How About Dr. David Cifu?

If Secretary Shulkin is really serious about dealing with “Veteran suicides” and providing Veterans with alternative treatment for Veterans with PTSD, he would do well to question the credentials of Dr. David Cifu and others within the VA who continue to block Veteran access to better treatment alternatives.

When one looks at Secretary Shulkin’s complex agenda, one should focus on the signs that change is actually occurring.  Personally, I don’t expect to see much change over the next couple of years, unless there are clear bookmarks to measure that change.  Sadly, it seems likely that we will be looking at the same litany of complaints a couple years down the road.

Dr. Shulkin, I admire your bravado and enthusiasm, but question whether you have the right tools and authority at your disposal to bring about a much needed reform within the VA.

Veterans should be hopeful, but not too optimistic.

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