For all the recent complaints and consternation about veterans’ care, little blame has fallen upon the hospitals themselves.
That may be because, by several independent measures, the civilian-run hospitals under the U.S. Department of Veterans Affairs — separate from military facilities like Walter Reed Army Medical Center for active-duty troops — are considered among the best in the country.
It wasn’t always so.
In the early 1990s, conditions at Veterans Health Administration hospitals were considered so deplorable Congress considered scrapping the entire system. It was a favorite target for opponents of universal health care as a prime example of why a governmentmanaged system could never work.
Today, VA hospitals are outscoring the private sector in patient satisfaction surveys, cost per patient, mortality rates and prescription drugs prices. The system’s electronic medical records and bar-coded medication dispensing has led to quicker diagnoses, reduced unnecessary tests and cut medication errors.
“This is not your grandfather’s VA anymore,” said Paula Pedene, public affairs officer for the Carl T. Hayden VA Medical Center and a patient there.
The transformation is largely credited to Dr. Ken Kizer, appointed in 1994 as the VA’s undersecretary for health, who computerized medical records and set up a managed-care model that gave veterans their own doctors for the first time, as opposed to the old “sick call” system of sitting and waiting all day for an appointment.
That brought in new patients, but funding didn’t keep pace and waits became unmanageable. So for the first time some veterans were denied care because they earned too much money.
Now, with a new influx of veterans from the conflicts in Iraq and Afghanistan, many with complex, devastating injuries, the VA may be facing its biggest challenge yet, both inside and out.
U.S. Army Cpl. Robert Bartlett is a case in point. On May 3, 2005, Bartlett was driving a Humvee south of Baghdad when an improvised bomb blew off half his face, destroyed an eye, punctured his chest and damaged both hands.
The blast killed his buddy, Staff Sgt. William Brooks, and injured two other men. He lost his left eye and parts of his jaw, lips and nose. He also suffered brain trauma and shrapnel injuries to his hands and chest.
The Gilbert man has undergone 29 surgeries so far. Twothirds of his jaw and parts of his skull have been replaced with titanium. He’ll probably need six to 10 more procedures before surgeons reach the end of their abilities. Some scars will remain.
Bartlett has nothing but praise for the medical treatment he’s received.
“It’s fantastic. I couldn’t ask for better,” he said. “I’ve had a lot of people really bust their asses for me and take good care of me.”
Initially evaluated at Walter Reed, Bartlett’s injuries were too severe for treatment there. In between procedures at Johns Hopkins Hospital in Baltimore, he’s been allowed to return home to Arizona and receive outpatient treatment at the Phoenix VA.
That’s where he met Pat Tuli, who coordinates care for Iraq and Afghanistan war veterans. Tuli’s job has evolved as those conflicts claim more casualties.
“We had a catastrophically injured vet, our first one who came in. We weren’t prepared for this and we really didn’t have anything in place,” Tuli said.
She assembled a team of doctors, nurses and other health care workers who spent the following Saturday examining Bartlett and planning his recovery. “When we were finished, my medical provider said, ‘Bring me more of these.’ It was the beginning of our team.”
It’s been a busy group. The war’s signature injury — traumatic brain injury — causes wide-ranging and often longterm symptoms.
And the conflicts have taken a huge toll on soldiers’ mental health. A recent study shows as many as one-third of soldiers who visited a VA hospital after returning from Iraq or Afghanistan had a diagnosed mental-health problem, particularly post-traumatic stress disorder. The more tours they serve, the worse it gets.
“Some of them are being sent back for more than one tour, and they don’t want to go,” Tuli said. “We’re seeing significantly higher rates of PTSD and readjustment issues.”
Bartlett, 33, who attends a traumatic brain injury support group to help “reconnect the dots,” described the injury as “like a speed bump inside my thoughts.”
He’s regained the use of both hands, though five fingers remain numb. His nose, jaw, left cheek and lips have been partially rebuilt, but he still needs more reconstruction, six teeth implants and greater function of his bottom lip.
“There are too many people complaining and not enough good people trying hard to do things for people,” Bartlett said. “We need less complainers and more doers.”