Consumer Directed Healthcare

By Michael Coonan
100% Service Connected Disabled Veteran
Corpsman, 1st Platoon, Alpha Co, 1/9,  3rd Marine Division 1967/68

COMMON PROBLEMS EXPERIENCED BY VETERANS AT VA HEALTH CLINICS

The following is not an exhaustive list of problems with the VA health care system.  Other veterans could surely add their experiences to more accurately reflect the scope of the problems in the VA health care system.  The veteran receiving health care from the VA health care system does not have specific lists of “Patients Rights” relating access to care and a mechanism for enforcing these rights. 
 
1)  Access to specialty health care services beyond the VA’s primary physician is frequently delayed and/or denied.  VA administrators frequently stonewall the veteran as he/she requests answers regarding access to health care questions.  

2)  There are limited or no appeal rights when the veterans are denied treatment, or the treatment has lengthy delays before receipt.

3)  The VA’s Fees Basis system and the VA’s Clinical Manager system operate in the dark without any accountability to the veterans seeking health care.

4)  Veteran Administration health care administrators and Veteran Administration clinical managers rarely (if ever) respond to questions or issues raised by veterans seeking health care.

5)  The Veterans Administration health clinic’s P & T Committee is charged with making life and death treatment decisions about health care for veterans.  This committee is not held accountable for their actions.  This committee does not have minutes for these meetings, where vital decisions are made regarding access to treatment for veterans. 

6)  The Veterans Administration’s health care system is overly complicated and not well understood by veterans or the public.  Therefore, veterans, and those caring for them, do not know how to deal with the VA system as they struggle to get health care.

7)  The Veterans Administration’s “Patient Advocate” position is not able to function as an effective, independent, advocate for veterans, because the “Advocate” works directly under the authority of the VA’s health clinic/hospital administrator.  This organizational arrangement reduces the “Advocate” to functioning much like a “toothless eunuch” as they seek to advocate for Veterans.  The title “Patient Advocate” is a misnomer. 

A)  When the Veterans Administration’s Patient Advocate represents the rights of a veteran effectively, the advocate risks losing his or her job because the nature of advocacy is to “rock the boat”. 

B)  The VA administration “Patient Advocate” cannot make the problems they find with the VA health care system public.  This limits the “Advocate’s” usefulness in becoming a positive change agent to correct problems in the VA’s health care system.  Consequently, serious problems in the VA health system are buried in the bureaucracy, with no chance for public discussion and/or reform.  Because of the inertia of the current system, VA management and clinical staff who are incompetent, neglectful and indifferent to the plight of the Veterans are able to hide in plain sight in the self-protecting VA health care bureaucracy.  

A SUGGESTION FOR MAKING THE VA HEALTH SYSTEM ACCOUNTABLE
 
1)  With no additional cost in public funds, an independent Patient Advocate/Ombudsman function in each VA clinic and hospital shall be established. This Patient Advocate/Ombudsman will be responsible to independently investigate complaints from/on behalf of veterans.

2)  At no additional cost in public funds, an independent Planning and Advisory Council at each VA hospital/health clinic will be established.  This Planning and Advisory Council shall be composed of veterans who are receiving their health care at that hospital or clinic.  The Planning and Advisory Council members shall be elected by veterans who are receiving treatment at that hospital or clinic and shall not receive any compensation except travel expenses.

3)  The current in-house Veterans Administration “Patient Advocate” function will be terminated.  The money used for this function will be transferred to the US Department of Health and Human Services to pay for new Patient Advocate/Ombudsman position.  This Patient Advocate/Ombudsman will also staff the VA clinics or hospitals independent Planning and Advisory Council.

4)  The Planning and Advisory Council for each VA clinic and/or hospital will be responsible for hiring and supervising the Patient Advocate/Ombudsman.  The Patient Advocate/Ombudsman shall not have a conflict and they shall not be a Veteran, nor related to a Veteran, nor be an employee of the VA system, nor a relative of a person who works for the VA system.  The Patient Advocate/Ombudsman shall not be eligible for employment in the VA for one year from the time they terminate as the Patient Advocate/Ombudsman.  

5)  The Patient Advocate/ Ombudsman will be responsible for accepting and investigating all complaints from veterans, or persons representing a veteran, in regards to issues relating to health care at that VA clinic or hospital, including contracted services.

6)  With written permission from the Veteran or responsible party, the Patient Advocate/Ombudsman will have access to all records generated by the Veterans Administration, or contracted agencies, in their lawful investigation of a veteran’s complaint.

7)  Complaints will be resolved at the lowest level possible.  If the complaint is determined by the Patient Advocate/Ombudsman to have merit, this complaint (with permission of the veteran or responsible party), will be moved up to the chain of command.  If the complaint is not resolved within 30 days of receipt of the complaint, (with the veteran’s or responsible party’s permission), this complaint will be brought to the VA’s Hospital or Clinic Planning and Advisory Council.  The veteran’s identity will be protected while the complaint enters the public domain.

8)  The VA’s Hospital or Clinic Planning and Advisory Council will be responsible for reviewing the budget and policy matters for their respective hospital or clinic.  The Planning and Advisory Council will have access to all budgetary, demographic, policy and procedures manuals, as well as treatment data (not confidential medical records) generated by their respective VA Hospital or Clinic. 

9)  The VA’s Hospital or Clinic Planning and Advisory Council will be responsible for writing an annual plan which includes a summary of budgetary, demographic and treatment data that includes a description of any issue which relates to problems the veterans experience with access to treatment and quality of treatment.  Their plan will be updated quarterly, based upon findings from the Patient Advocate and from the findings of the Planning and Advisory Council’s committees.  There will be on unified internet web site that includes all of the plans, reports and other documents for all VA Planning and Advisory Councils in the US.  This web site will be open to the public.

10) The VA’s Hospital and Clinic Planning and Advisory Council is responsible for developing recommendations for resolving systemic problems by recommending to the VA Administration at all levels and the Congress, reforms that will streamline the administrative costs, identify cost cutting options, while improving the quality and access to health care for all Veterans.  The reports generated by the Planning and Advisory Council will be public records and available to the public via the internet.

11) The Veterans Administration will be proscribed from creating any rule or policy that infringes upon or impairs either the Patient Advocate/Ombudsman or the VA Hospital or Clinic Planning and Advisory Council from carrying out its mandated duties.

12) The procedures/rules for operation of the VA Patient Advocate/Ombudsman position and the VA’s Hospital Planning and Advisory Council shall be developed independently from the Veterans Administration.  The Veterans Administration function in this regard is merely to review and comment, only.   

13) The funds allocated for the VA’s “Patient Advocate function, will be transferred to the US Department of Health and Human Services.  These funds will then be distributed to each state’s Protection and Advocacy Office.  These funds will then be distributed to each VA’s Hospital Planning and Advisory Council.  This arrangement will assure that the Council and Patient Advocate/Ombudsman funding is secure.  The Protection and Advocacy will have not oversight responsibilities over the VA Patient Advocate/Ombudsman nor the VA Planning and Advisory Council.