Monday, July 21, 2014

We’re Giving Our Veterans Unacceptable Care

By Austin I. King, MD
President, Texas Medical Association

It’s an eight-hour drive from the Rio Grande Valley to my office here in Abilene. It takes just as long for someone to drive from Abilene to Albuquerque, New Mexico. And that’s just part of the problem that military veterans here in Texas face when they try to get health care from the U.S. Department of Veterans Affairs ― the VA.

We’ve all read and heard about the long waits our veterans must endure to see a doctor. A VA audit found that nearly 60,000 new patients nationwide waited up to three months for care. In Texas facilities, the average wait time for a new patient to get a primary care appointment ranged from 31 days in Amarillo to 85 in Harlingen and McAllen. “It was worse for specialty care patients at clinics in Harlingen and McAllen, where the wait was 145 days — the longest in the nation,” the San Antonio Express-News reported.

And what does that have to do with the eight-hour drive from Abilene to Albuquerque? The VA health system is divided into regions across the country ― and some of those regional lines don’t make much sense. We have a small VA hospital and clinic not far from here in Big Spring, Texas. It’s set up to handle routine care for veterans. But to see a specialist, or to have serious surgery or to undergo any in-depth testing, you have to go to Albuquerque. Out here in West Texas, even though it takes only a few hours to get to Dallas or Houston or San Antonio, our big VA regional hospital is in Albuquerque.

If you’re in a huge bureaucratic system like the VA and you’re assigned to a hospital 600 miles away, that’s just the way it is. There’s no logic to it, it’s just the system.

As an ear, nose, and throat doctor, how can I tell a 92-year-old World War II vet with a lump on the side of his neck that he has to go all the way to Albuquerque to get that lump looked at? Can he drive that far? Can he even afford the gas for the trip? It’s just heartbreaking.

The bottom-line problem is this: The VA just doesn’t have enough doctors to meet the demand for medical care. For decades, the U.S. Congress hasn’t given the VA the money it needs to hire those doctors. With about 2.5 million vets returning home from the wars in Iraq and Afghanistan, the demand has grown even larger ― further overloading the VA.

The news reports about the waiting lists ― and the veterans who died waiting to see a physician ― peaked last month just as doctors from Texas and around the country joined me in Chicago for the annual meeting of the American Medical Association. At the urging of Texas physicians there, the AMA voted overwhelmingly to ask President Obama to take immediate action to provide timely access to care for veterans using the health care sector outside of the VA system until the VA can provide that care itself in a timely fashion. AMA also urged Congress to enact long-term solutions rapidly so eligible veterans can always have timely access to entitled care.

Our veterans have stepped up and served our country, so physicians want to be able to step in and serve them. It is tragic that our veterans have been forced to wait for the health care they need and deserve, so Texas physicians and our colleagues across the nation want to help care for them until the VA can right the ship.

As part of this plan, the Texas Medical Association created a registry of private physicians across the state who are willing to see veterans in their offices. We share the registry with community groups that work with Texas veterans and with the medical directors of VA facilities in Texas.

More than 325 Texas doctors have already signed up. But even if we had every single Texas physician on that registry, it wouldn’t bring care to our veterans any faster without some action in Washington. Congress is actually working on a bill to bring some changes to the VA system, but it will take months before it passes, and even longer before it does any real good.

That’s why we asked President Obama to help. With the stroke of his pen, the president could issue an executive order establishing an emergency system where veterans could get the care they need from private doctors quickly and easily. Unfortunately, more than a month has gone by with no action by his administration and no response from the White House. Each passing day carries the real-life risk of death and worsening illness for the men and women who have served our country so bravely.

To be fair, the idea of local physicians helping to provide care for patients in the VA system isn’t exactly new. In fact, officials from the largest VA network in Texas reached out to TMA to try to patch some of the current holes in their system when they heard about our registry. (We haven’t heard from the other networks yet, though.) The VA has turned to private doctors in the past when they just didn’t have specific specialists they needed in certain communities.

It just hasn’t worked very well. At all.

Once again, it’s because we’re dealing with a closed, bureaucratic system that has trouble seeing beyond its own walls.

Consider, for example, San Antonio, a city with a long and proud history of military service and 150,000 veterans. More veterans live in Bexar County than just about any other county in the nation.

A physician friend of mine in San Antonio tells me there’s almost no interaction between local doctors and those who work at the South Texas Veterans Health Care System and the Audie L. Murphy Memorial VA Hospital. They don’t know each other, and they don’t often work together.

Doctors across Texas who have tried to contract to provide medical care that the VA needed tell me the same story. Here’s what they find:

  • The VA has a very large electronic medical record system, but there’s no way for someone outside the VA to get information into or out of that system. This means the doctors either have to wait for paper records to be printed and delivered or they have to repeat tests and procedures whose results are buried by the VA bureaucracy.
  • Getting clearance or approval to conduct a test or perform a procedure on a veteran is a mysterious and time-consuming process. It can take days or weeks to get the request to the right person inside the VA and get an answer back out.
  • Even something as simple as writing a prescription for medicine and having it filled is complicated. The VA only allows veterans to use a VA pharmacy ― which can be miles away.
  • Finally, getting paid for providing care for a veteran is maddeningly difficult. You have to fill out the right government forms correctly, make sure they get to the right office, and pray that the local VA has enough money left in its budget to pay the bill. And wait.

Former VA Undersecretary for Health Kenneth Kizer, MD, says this is not a new set of problems and the VA knows those problems are making it hard for them to do business with private physicians.

“Many of these private providers are happy to take care of veterans,” Dr. Kizer said in an interview this week with Kaiser Health News. “They feel an obligation, and they’re willing to do it for whatever the payment amount is. But it’s just getting it that is so difficult and frustrating for them.”

Monira Hamid-Kundi, MD, is a surgeon in Baytown, Texas, who saw an Iraq War veteran in the emergency room with severe pain from rectal cancer. She and the patient had to wait five days before they could transfer him to the VA hospital.

“I will never forget that gentleman’s face, and I never will forget how he looked at me and how he just wanted to be relieved of the discomfort that he had, and there was nothing much we could do except give him pain medication,” Dr. Hamid-Kundi told TMA. “If this had been a non-veteran, we would have been able to offer him more. But because he was a veteran, he actually fell down to the bottom of the line.”

As a professional who is trained to relieve my patients’ pain and suffering, this is unacceptable.

As an American who is so grateful that these men and women were willing to put their lives on the line to defend our freedoms, this is unacceptable.

On behalf of the more than 47,000 members of the Texas Medical Association, I once again urge President Obama to take immediate action to relieve this crisis ― to allow private doctors to provide care to veterans quickly and free from bureaucratic delay. And I urge Congress to move as fast as it possibly can to really fix this crisis.

Anything less is unacceptable.

Austin I. King, MD, is an ear, nose, and throat specialist (an otolaryngologist) in private practice in Abilene, Texas. He is the 149th president of the Texas Medical Association. 

Average Number of Days to Wait for an Appointment at a VA Facility
From VA Access Audit, June 9, 2014

Primary Care Wait Time
Specialty Care Wait Time
Mental Health Wait Time
New Patient Established Patient New Patient Established Patient New Patient Established Patient
Dallas 60.3 5.4 58.9 6.2 49.9 5.9
San Antonio 36.7 2.6 42.6 1.0 29.8 2.0
Temple 49.9 7.6 54.3 5.5 35.9 3.0
Valley 85.2 12.5 145.2 1.2 55.4 1.8
Houston 44.1 1.9 58.1 1.1 39.4 0.6
Amarillo 31.2 2.0 40.5 2.5 60.9 1.1
Big Spring 37.7 12.1 53.1 6.4 33.0 4.1
El Paso 35.1 1.7 89.6 4.7 60.1 16.0


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