Team Infidel
Forum Spin Doctor
Boston Globe
March 11, 2007
Pg. 1
Backlogs, long waits plague VA hospital system
By Charles M. Sennott, Globe Staff
Jeffrey Lennon returned from Iraq to his hometown of Plymouth a broken man. Soon enough, he would also be a very angry man.
A sergeant in the US Army Reserve, Lennon was racked by nightmare visions of fellow soldiers and Iraqi civilians killed during his tour of duty. Almost anything could trigger the memories, particularly smells of garbage and gasoline that steer his mind back to the roads of Iraq.
He abandoned his dream of being a police officer. He took refuge in alcohol. He contemplated suicide.
And he waited, and waited, for the Department of Veterans Affairs to help him make his way back.
Diagnosed with severe post-traumatic stress disorder in March 2004, it may take months, he said, to get an appointment for mental health counseling at the VA Medical Center in Brockton because of staffing shortages. It took more than a year before he began receiving his $348 monthly check for partial disability.
"The people at the VA want to help, but the system is broken. They are just so overwhelmed," Lennon, 30, said.
Veterans Affairs is a vast agency that makes a vast promise, one literally etched in bronze at the entrance to its headquarters in Washington -- "To Care for Him Who Shall Have Borne the Battle and for His Widow, and His Orphan."
But the VA is straining, and, many Iraq and Afghanistan war veterans say, often failing to live up to those words.
Much as military planners failed to adequately account for the enormous cost -- in lives, money, and time -- of securing Iraq after toppling Saddam Hussein, the VA failed to plan and sufficiently staff for the wave of casualties, and the kinds of injuries that have flowed from the combat zone.
The VA has a standardized care system ranked among the best. D1
A Globe review of hundreds of pages of VA memoranda and planning documents, and interviews with present and former agency officials, legislative analysts, and veterans, shows that the VA planned for a short and relatively bloodless war in Iraq, and then was slow to react when the war dragged on and casualties and other claims mounted from 14,000 in 2003 to a projected total of 206,000 this year.
The backlog of disability claims is up to more than 400,000 by the VA's count and climbing. Wait times to process claims are running nearly seven months, on average -- quicker in some places and much longer in others, as Lennon and other veterans have found. In cases where the extent of disability is disputed and an appeal is filed, resolution can take more than two years.
The rising number and complex nature of medical needs among Iraq and Afghanistan veterans are severely testing the VA's sprawling healthcare system. More than a third of all veterans of the Iraq war who seek care at the VA do so for mental health issues. The agency's spending on mental healthcare has increased but not commensurate to need, some VA officials say. The spending per patient has dropped, from $557 in 2000 to $438 last year, according VA data.
Paul Sullivan, who worked at the VA as a senior researcher for five years, is one person who saw the crisis coming and says his persistent warnings to superiors about the need to prepare went unheeded.
"Not only is there proof that they knew of increased demand [for services at the VA] and did nothing. They knew and were actively trying to conceal it," said Sullivan, who left the agency in frustration, taking with him a trove of unclassified documents that he provided to the Globe.
Stephen Meskin, who from 2000 to 2006 was chief actuary for the VA in charge of projecting the agency's client caseload and claims, said the failure to plan was rooted in an overly optimistic outlook on the war -- a bullish view widely held in the Bush administration in the early going.
"There was no apparent risk analysis being done about the impact of a war on the system even while we were at war," Meskin said, in an interview. "There were just assumptions that it would be a slam dunk and not strain the system."
Meskin, who retired in early 2006, said the VA's budget projections were rooted in the assumption that the caseload would ease as the population of World War II veterans aged and died. But the numbers grew, driven by many factors, including WWII veterans living longer, and veterans of Vietnam and Korea finding themselves without private healthcare and relying more heavily on the VA system. And then there are the newly wounded and injured returning from Iraq and Afghanistan.
"We saw the tip of the iceberg in 2005, and it was clear it was going to be hard to steer clear of that," Meskin said. "The VA's mission, and the veterans who rely on its care, are going to face significant problems as a result."
Steve Robinson, director of veterans affairs at Veterans for America, the advocacy group where Sullivan also has worked, has seen those problems up close, talking to hundreds of veterans with stories similar to Lennon's.
"Delays in claims and delays in treatment lead to lives falling apart. He [Lennon] is a classic example of what's going on out there. Soldiers who are wounded just like Lennon are not getting the treatment they need and they deserve," Robinson said.
For Lennon, the memories of war are not fading. Particularly searing is the image of a child strapped with explosives who detonated in front of his convoy.
The mental anguish was enough that he volunteered to surrender his badge as a Plymouth County deputy sheriff, a job that was a stepping stone toward becoming a police officer. Unemployed, and drinking heavily, his life has spun out of control.
"There's this wait zone," he said, describing the delays in treatment and benefits at the VA, "and that is where you fall apart."
A 'big ship' slow to turn Inside the imposing VA headquarters, the view is decidedly different. Yes, the agency is a "big ship" that can be slow to turn, as Dr. Alfonso Batres , the chief of Readjustment Counseling put it. But the VA provides and will continue to provide superior care for the nation's 24 million veterans, 1.2 million of whom live in New England, agency officials say.
The secretary of veterans affairs, R. James "Jim" Nicholson , is especially emphatic on that point.
"We are delivering a damn good product to a satisfied group of customers," Nicholson said in an interview last month.
A Vietnam War veteran, real estate developer, and former head of the Republican National Committee, Nicholson was appointed by President Bush to head the VA in 2005. He describes himself as the chief executive of what is, with 235,000 employees handling a million healthcare visits a week, the largest healthcare system in the country.
And he said he is confident that his proposed budget for next year of $86 billion -- up 8 percent from this year -- will adequately fund services for the growing number of veterans seeking them.
"I feel wonderful about the way we are treating the nation's veterans and that is exactly what they deserve," he said. "This is the largest healthcare system in America and arguably the best. . . . We used to say growing up in Iowa that it ain't a boast if it's true. And it is."
Nicholson's upbeat assessment has much to support it. There is no question the VA has many areas of excellence, delivering top-shelf medical treatment to amputees from roadside bombs and soldiers with brain trauma from the blasts. World War II and Korea veterans speak highly of a system that has been reconfigured in the last 10 years to address the needs of the aging demographic of veterans of those wars.
The VA is also praised by many -- from Business Week to Harvard Business School -- as an efficiently run healthcare organization, conscious both of quality and cost. But it is also an agency that has earned some caustic critics, particularly among Democrats in Congress who have launched investigations into what Representative Mike Michaud, Democrat of Maine, has called "a state of denial" within the VA.
"We are tired of hearing this administration say things are fine. Things aren't fine if you talk to veterans," said Michaud, who has served on the House Veterans Affairs Committee for the last five years.
Killed-to-injured ratio For every soldier killed in this war, there are 16 wounded, a ratio that exceeds any conflict in the history of the US military.
In World War II, for example, two soldiers were wounded, on average for every one killed. (The US military prefers to calculate only those wounded in direct combat, which would make the ratio in Iraq 1 dead to 8 wounded, and still place it as the highest killed-to-wounded ratio in American history.)
March 11, 2007
Pg. 1
Backlogs, long waits plague VA hospital system
By Charles M. Sennott, Globe Staff
Jeffrey Lennon returned from Iraq to his hometown of Plymouth a broken man. Soon enough, he would also be a very angry man.
A sergeant in the US Army Reserve, Lennon was racked by nightmare visions of fellow soldiers and Iraqi civilians killed during his tour of duty. Almost anything could trigger the memories, particularly smells of garbage and gasoline that steer his mind back to the roads of Iraq.
He abandoned his dream of being a police officer. He took refuge in alcohol. He contemplated suicide.
And he waited, and waited, for the Department of Veterans Affairs to help him make his way back.
Diagnosed with severe post-traumatic stress disorder in March 2004, it may take months, he said, to get an appointment for mental health counseling at the VA Medical Center in Brockton because of staffing shortages. It took more than a year before he began receiving his $348 monthly check for partial disability.
"The people at the VA want to help, but the system is broken. They are just so overwhelmed," Lennon, 30, said.
Veterans Affairs is a vast agency that makes a vast promise, one literally etched in bronze at the entrance to its headquarters in Washington -- "To Care for Him Who Shall Have Borne the Battle and for His Widow, and His Orphan."
But the VA is straining, and, many Iraq and Afghanistan war veterans say, often failing to live up to those words.
Much as military planners failed to adequately account for the enormous cost -- in lives, money, and time -- of securing Iraq after toppling Saddam Hussein, the VA failed to plan and sufficiently staff for the wave of casualties, and the kinds of injuries that have flowed from the combat zone.
The VA has a standardized care system ranked among the best. D1
A Globe review of hundreds of pages of VA memoranda and planning documents, and interviews with present and former agency officials, legislative analysts, and veterans, shows that the VA planned for a short and relatively bloodless war in Iraq, and then was slow to react when the war dragged on and casualties and other claims mounted from 14,000 in 2003 to a projected total of 206,000 this year.
The backlog of disability claims is up to more than 400,000 by the VA's count and climbing. Wait times to process claims are running nearly seven months, on average -- quicker in some places and much longer in others, as Lennon and other veterans have found. In cases where the extent of disability is disputed and an appeal is filed, resolution can take more than two years.
The rising number and complex nature of medical needs among Iraq and Afghanistan veterans are severely testing the VA's sprawling healthcare system. More than a third of all veterans of the Iraq war who seek care at the VA do so for mental health issues. The agency's spending on mental healthcare has increased but not commensurate to need, some VA officials say. The spending per patient has dropped, from $557 in 2000 to $438 last year, according VA data.
Paul Sullivan, who worked at the VA as a senior researcher for five years, is one person who saw the crisis coming and says his persistent warnings to superiors about the need to prepare went unheeded.
"Not only is there proof that they knew of increased demand [for services at the VA] and did nothing. They knew and were actively trying to conceal it," said Sullivan, who left the agency in frustration, taking with him a trove of unclassified documents that he provided to the Globe.
Stephen Meskin, who from 2000 to 2006 was chief actuary for the VA in charge of projecting the agency's client caseload and claims, said the failure to plan was rooted in an overly optimistic outlook on the war -- a bullish view widely held in the Bush administration in the early going.
"There was no apparent risk analysis being done about the impact of a war on the system even while we were at war," Meskin said, in an interview. "There were just assumptions that it would be a slam dunk and not strain the system."
Meskin, who retired in early 2006, said the VA's budget projections were rooted in the assumption that the caseload would ease as the population of World War II veterans aged and died. But the numbers grew, driven by many factors, including WWII veterans living longer, and veterans of Vietnam and Korea finding themselves without private healthcare and relying more heavily on the VA system. And then there are the newly wounded and injured returning from Iraq and Afghanistan.
"We saw the tip of the iceberg in 2005, and it was clear it was going to be hard to steer clear of that," Meskin said. "The VA's mission, and the veterans who rely on its care, are going to face significant problems as a result."
Steve Robinson, director of veterans affairs at Veterans for America, the advocacy group where Sullivan also has worked, has seen those problems up close, talking to hundreds of veterans with stories similar to Lennon's.
"Delays in claims and delays in treatment lead to lives falling apart. He [Lennon] is a classic example of what's going on out there. Soldiers who are wounded just like Lennon are not getting the treatment they need and they deserve," Robinson said.
For Lennon, the memories of war are not fading. Particularly searing is the image of a child strapped with explosives who detonated in front of his convoy.
The mental anguish was enough that he volunteered to surrender his badge as a Plymouth County deputy sheriff, a job that was a stepping stone toward becoming a police officer. Unemployed, and drinking heavily, his life has spun out of control.
"There's this wait zone," he said, describing the delays in treatment and benefits at the VA, "and that is where you fall apart."
A 'big ship' slow to turn Inside the imposing VA headquarters, the view is decidedly different. Yes, the agency is a "big ship" that can be slow to turn, as Dr. Alfonso Batres , the chief of Readjustment Counseling put it. But the VA provides and will continue to provide superior care for the nation's 24 million veterans, 1.2 million of whom live in New England, agency officials say.
The secretary of veterans affairs, R. James "Jim" Nicholson , is especially emphatic on that point.
"We are delivering a damn good product to a satisfied group of customers," Nicholson said in an interview last month.
A Vietnam War veteran, real estate developer, and former head of the Republican National Committee, Nicholson was appointed by President Bush to head the VA in 2005. He describes himself as the chief executive of what is, with 235,000 employees handling a million healthcare visits a week, the largest healthcare system in the country.
And he said he is confident that his proposed budget for next year of $86 billion -- up 8 percent from this year -- will adequately fund services for the growing number of veterans seeking them.
"I feel wonderful about the way we are treating the nation's veterans and that is exactly what they deserve," he said. "This is the largest healthcare system in America and arguably the best. . . . We used to say growing up in Iowa that it ain't a boast if it's true. And it is."
Nicholson's upbeat assessment has much to support it. There is no question the VA has many areas of excellence, delivering top-shelf medical treatment to amputees from roadside bombs and soldiers with brain trauma from the blasts. World War II and Korea veterans speak highly of a system that has been reconfigured in the last 10 years to address the needs of the aging demographic of veterans of those wars.
The VA is also praised by many -- from Business Week to Harvard Business School -- as an efficiently run healthcare organization, conscious both of quality and cost. But it is also an agency that has earned some caustic critics, particularly among Democrats in Congress who have launched investigations into what Representative Mike Michaud, Democrat of Maine, has called "a state of denial" within the VA.
"We are tired of hearing this administration say things are fine. Things aren't fine if you talk to veterans," said Michaud, who has served on the House Veterans Affairs Committee for the last five years.
Killed-to-injured ratio For every soldier killed in this war, there are 16 wounded, a ratio that exceeds any conflict in the history of the US military.
In World War II, for example, two soldiers were wounded, on average for every one killed. (The US military prefers to calculate only those wounded in direct combat, which would make the ratio in Iraq 1 dead to 8 wounded, and still place it as the highest killed-to-wounded ratio in American history.)