Quacks: Two years as a patient in a Veterans Administration nursing home
Produced courtesy of U.S. Department of Veterans Affairs - 810 Vermont Avenue, NW - Washington, DC 20420 Updated: November 10, 2009Noun: quacks kwaks
1. Charlatans who pretend to have medical expertise.
Verb:
1. The harsh sounds of a duck.
2. To act or do business as a quack.
by Fred Dungan
May 9, 2009
3749 Myers Street
Riverside, CA 92503
(951) 688-1396
fdungan@fdungan.com
Dedicated to the memory of my parents, Chief Russel Alonzo Dungan, U.S.N. (Retired) and Blanche Marie Dungan, whose selfless, God-fearing, caring natures were not lost on their son. Although you no longer walk this earth, your footsteps remain, suspended by good deeds in the sands of time. May your descendents continue to display these social attributes for innumerable generations to come.
Preface
Dr. Reipzig slid the x-ray of my right knee out of the large manila envelope and slapped it onto the backlit screen that hung on the examination room wall. Scowling at the negative, he pronounced the verdict: “kaput,” which pretty much summed up its condition. Bone on bone, no cartilage left, it was time for me to get an operation.
Artificial knees usually last twenty years or more. When they wear out, they are relatively easy to replace. How do I know? It says so in the pamphlet the VA gave me to read.
The clerk at the front desk scheduled a pre-op appointment for me with the VA hospital’s orthopedic surgeon. I drove home, wrote the pertinent information on a wall calendar, and gave the matter no more thought. Three months later, I received a phone call from a robot phone calling machine reminding me of it.
Chapter 1
Pre-op
After taking my temperature and blood pressure, the nurse directed me to one of the 50 or so identical examination rooms in 3NW Ortho and told me to sit down on a stainless steel piano stool. I waited for what seemed like eternity and it crossed my mind that they might have forgotten about me. I was about to stand up when the door opened and in stepped a flaxen haired young fellow in khaki trousers and a polo shirt. He looked as if he belonged on the 18th green. All that was missing was his titanium putter. I thought a white lab coat and stethoscope were de rigueur for Veterans Administration doctors. But this wasn’t just any old doctor. Surgeons tended to be prima donnas. They comprised the top echelon of the VA medical hierarchy and were pretty much free to say and do what they pleased.
“Hi, I’m Dr. Harold Gustafson. I’ll be leading the surgical team that is going to replace your—he paused to scroll up and down a file on a flat screen monitor—right knee.”
The creamy white right hand that he extended to me was frighteningly pale—as if it was regularly kept tucked away and had only been brought out now because manly tradition demanded it. Obviously, it was a hand adverse to physical labor—no calluses here—with carefully manicured nails and cuticles. For a nanosecond I searched in vain for a trace of clear nail polish, but none was to be found. At least he’s not gay, I thought.
My grizzled right paw took hold of his cold, clammy hand and pumped it up and down as if to wring out the excess moisture. No question about it, this guy had the grasp of a dead fish and I was sorely tempted to squeeze some life back into it when it occurred to me that this was the hand of a skilled surgeon who would shortly be cutting apart my knee with a glorified saber saw. Best to keep on his good side.
Then I noticed the Rolex on his wrist. It too was limp. Strange, why would someone buy an expensive watch and not have the metal band adjusted? Perhaps it wasn’t his watch after all. Or maybe he had lifted it from a corpse after an unsuccessful operation. It took me back 30 years to a distant jungle where I used my bayonet to mine gold nuggets from the teeth of the enemy dead. It certainly wasn’t anything I was proud of. But my sergeant was doing it and I desperately needed the money to get drunk enough to forget what I had become—a predator who was loathe to let morals and ethics interfere with the instinct to survive. Having pumped the limp appendage dry, I released it, half-expecting it to fall off the body and flop around on the floor. But then those kind of things almost never happen in real life. Kind of a shame, isn’t it?
But I digress. My right knee was a real mess. For 10 years I had been walking stiff-legged with a knee that would not bend. The cartilage had worn away and calcification had fused what remained of the knee cap to the upper and lower leg bones. Bone on bone is about as painful as it gets—stabbing pain that wouldn’t go away even when I wasn’t walking. I was getting two to three hours sleep at night and popping far too many pills.
“So, how do you go about giving me a stainless steel knee,” I asked.
“It’s titanium,” he corrected. “We use titanium because it is stronger than steel and weighs less than aluminum. They normally cost $50,000, but the VA gets a good price on them by purchasing in bulk. Your new prosthetic will last 20 years or more. And it will be easy to replace because it’s crenellated.”
“What’s ‘crenellated?’” I interrupted.
“It’s like the battlements atop a castle wall. We will notch your leg bones to mesh snugly with the ridges of the prosthetic, much like the gears in a transmission. After a while, you won’t even notice that it’s there.”
Dr. Gustafson smiled a bit too smugly for my tastes. Did I really want to put my life in his hands? The answer was a resounding no, but I couldn’t come up with any other option. A private surgeon would cost more than I could afford. Besides, the VA was going to do it for free plus pay me a monthly check until I completely recovered. What could go wrong? Knee replacement was commonplace. It was so safe that the VA didn’t hesitate to replace the bum knees of World War II vets who weren’t in the best of health. The government was offering me an outright gift and it didn’t seem right to dig too deeply into the details. I didn’t want to appear ungrateful, however, there were a few questions for which I lacked answers. Seeing as how there is no time like the present . . .
“What’s your rate of success? I mean, does anything ever go wrong?”
His eyes narrowed and he wet his lips. Unwittingly, I seemed to have struck a nerve, but it only took a moment for the smug smile to return.
“My team has the best statistics at this facility or any other VA hospital in this region,” he bragged. “More than 99 out of 100 knee and hip surgeries are successful. I’m very good, in fact, I’m the best.”
That was exactly what I wanted to hear. In my youth I had been a boxer. Statistics made sense to me. You are either a winner or a loser. I had seen enough winners to know that they oozed confidence from every pore. If you’re going under the knife, the last thing you want is to have a loser perform the operation. I nodded my head up and down in approval.
Dr. Gustafson seemed relieved. He checked his surgery schedule and tentatively penciled me in for the first of three operations he would be doing on a Thursday three weeks from now. His assistant would provide the details. Like a fool, I signed a VA form authorizing surgery without bothering to read it. One more perfunctory handshake and I went out the door. Total face time with the man who would be sawing me apart had been less than five minutes.
Instead of shoehorning myself into a crowded elevator, I went down the stairs to the main lobby and exited the hospital through a side door. On my way back to my truck, I stopped to gather my thoughts at the manmade duck pond which encircles the facility in much the same manner as a moat encircles a castle.
This was elective surgery. Nobody was putting a gun to my head. Other options were available to me. Loma Linda Medical wasn’t the only VA hospital in Southern California. I could have said “no” and went elsewhere. There were VA hospitals in Long Beach, Los Angeles, and San Diego—all of which had skilled orthopedic surgical teams that had put artificial knees and hips in thousands of veterans. That was exactly what bothered me the most. No matter where you went in the VA system you ended up getting factory-style surgery. Gone was the close relationship between doctor and patient that was standard in private practice. I really didn’t trust that limp hand to wield a scalpel.
So why had I signed the authorization form? As I was watching a pair of snowy egrets stand stiff-legged at the edge of the pond, the answer came to me. It was a piece of philosophy that had kept me sane when Uncle Sam snatched my conscientious objecting teenaged ass out of the University of California at Irvine and thrust me into the role of a shotgun toting, .45 caliber semi-automatic pistol equipped United States Army Military Policeman some 35 years earlier: “Oh well, what the hell?”
Chapter 2
Op
Just because I signed the authorization form, did not necessarily mean I was going to have an operation to remove my frozen right knee and replace it with an artificial factory-built gizmo that was guaranteed by Johnson & Johnson (the baby wipes people?) to last twenty years. But what if it broke down before that? Was I supposed to unzip my skin, rip out the bloody thing and send it via Federal Express overnight delivery to their plant in Dearborn, Michigan (or wherever—if you have seen one dilapidated Rust Belt city, you’ve seen them all).
Before the VA would pay the $50,000 plus surgical cost, I would have to prove that I was worth that much. After all, if I dropped dead during surgery, the government would lose a bundle of money. I mean, no matter how good the guarantee was, one could hardly expect a manufacturer to restock an artificial knee that had been salvaged from my decomposing corpse. Not that my corpse would be any different from any other veteran’s corpse in the identical graves that flow row upon row like some horrendous crop that war has grown in our national cemeteries. No, it is simply that once you drive it off the lot, that knee is only worth a fraction of its original value. Think of it as a new car after it has lost that new car smell.
Everybody got a piece of me. There were EKG’s to perform, blood tests to be taken, urine to be sampled, and countless forms to fill out in triplicate (had Congress met in secret and repealed the Paperwork Reduction Act while we weren’t looking?). Somewhere there is a set of rules and regulations that govern the VA. Veterans aren’t permitted to see it, but we are nevertheless expected to abide by it. We refer to it as the VA Bible. In Genesis, it says that “an appointment begets another appointment which begets yet another appointment” and so on until there are enough appointments to give everyone in its bloated bureaucracy full employment with no danger of layoffs. And, should the budget shrink, benefits to the veterans are cut while medical personnel continue to enjoy their Garden of Eden lifestyle. Veterans function as guinea pigs unnecessarily sent to specialist after specialist with little or nothing ever coming from it. The primary purpose of an appointment is to schedule the next appointment. Frequently the physician is overloaded with patients to the point where there is hardly time for anything else. On busy days doctors are rushed to the point where they diagnose patients with diseases and ailments they do not have and for which they are prescribed drugs they would probably be better off not taking. Veterans are regularly kept busy running in circles with little or nothing to show for it. Most instinctively know better than to attempt to change the VA bureaucracy‘s attitude that they are dispensing a charity, rather than providing an entitlement. Besides, an overworked physician soon learns that it is easier to prescribe “feel good” pills than to determine the actual source of an ailment. It should not surprise anyone that even the most idealistic physicians eventually succumb to the regimen of a system of public healthcare that is substandard to that of private practice. This phenomenon is by no means limited to the Veterans Administration. Even in Honoré de Balzac’s day, government employees who valued their jobs learned to go with the flow and got along to get along. The primary difference between then and now is one of degree in that the more money that the public pumps into the VA in an effort to help injured vets, the more bloated the VA becomes. Top VA administrators want nothing more than to add to the size of their fiefdom in order to aggrandize their personal standing. The objective is to further the image of the VA and thereby perpetuate the bureaucracy. All else, including healthcare is secondary. Thus, the construction and maintenance of buildings and grounds receives priority over healthcare for veterans. This can assume ridiculous proportions, e.g. at the Jerry L. Pettis Memorial VA Hospital in Loma Linda, California, disabled vets bide their time waiting for a walker or a wheelchair while duck ponds, valet parking, and state-of-the-art, motion-sensing self-flushing toilets receive priority. Or as the veterans say, it’s all show and no go, with the emphasis placed on what VIP’s see when they tour the place.
The ideal situation would be to have the VA run by veterans for veterans. If it was staffed with veterans, the agency would be sensitive to the needs of veterans. Most of the medical personnel were recruited from overseas countries such as South Korea and the Philippines ostensibly because immigrants will work larger caseloads for lower wages. No matter that many of them have a hard time learning English and/or tend to stick to themselves—to the detriment of veterans. There is nothing in this world as rude and disheartening as going to the VA clinic for a checkup and having a couple of Filipino nurses discuss your condition in their native language, Tagalog, in front of you. Why are they being so secretive? Could it be that they know something that you don’t—like maybe you have leprosy or AIDS? It’s just plain bad manners to talk about someone who is present in the room as if they are too dumb to understand what you are saying. If they must hire their employees from the dregs of foreign cultures, the Veterans Administration should at the very least give them an idea of how they are expected to act. There is a lot more to being a good nurse than processing the maximum number of patients in the shortest time.
Forgive me for going off on a tangent, but I’m an old man and I tend to ramble. That’s the only nice thing about getting old—people make allowances for your age, so I can get away with quirky behavior. When you are young and poor and you do outlandish things, people call you crazy. But as you get older and acquire some wealth, they either shut their mouth or refer to you as eccentric. You are the same person behaving just as badly as before, but somehow your age and money makes a big difference.
As I said earlier, I had to have my blood tested and my urine analyzed. That takes place at the Laboratory where you have to take a number and wait. A cylindrical device on a stand spit a scrap of paper with the numbers 069 at me. There was row after row of government issue dingy orange fiberglass bucket chairs in the waiting room and each chair was bolted to the others in the row by means of a heavy metal bar. Evidently they were afraid that the veterans were going to steal their ugly beat-up chairs. I tried to picture myself going down the stairs with a chair under each arm and a VA police officer closing in on my tail while shouting “halt or I‘ll shoot,” but it was overly melodramatic and ridiculous; no such thing had ever taken place and none ever would. On the far wall an electronic board flashed the number 003. That meant there were 66 people ahead of me. Sixty-six people waiting to be checked in by one of the clerks at the front counter. And after that I would have to wait to have my blood drawn by a technician. Long waits are commonplace at the VA. I might as well get used to it because it is the only healthcare I have. Anything is better than nothing.
After waiting for what seemed like forever, my number came up. Oh, happy day! There is a God and he has heard my plea and delivered me from suffering the humiliation and pain of this accursed ergonometric bucket seat. My butt had gone numb and my back throbbed. I was stiff all over. Because my right knee could not move, I had to rock back and forth to stand up. Meanwhile, the clerk at the counter had seen nobody coming and had gone on to number 070. A beer belly fellow in a white “I LOVE NY” t-shirt had handed over number 070 just as I got to the counter. Brazenly reaching around in front of him, I placed number 069 on top of the pile of numbers on the counter and said “I believe I come first.” I realize now that Miss Manners might not have endorsed my boarding house reach, but I had been waiting for almost four hours and I wasn’t about to start over again. I had pushed Number 070 and was about to find out what happened when you shoved a plug-ugly Marine out of the way. He wasn’t about to take crap from the likes of me and said it so loudly that a VA policeman was summoned. The officer stood between us as a phlebotomist drew a tube of blood from each of us and he subsequently escorted us to the parking lot. He had given us a break, but somehow neither of us was feeling grateful. Nobody should have to wait four hours to have their blood drawn. There is nothing like wasting a half day in line at the VA to bring out the righteous indignation in a well-meaning, God-fearing veteran. Standing in line waiting for the government to begrudgingly give you something is a socialist disorder that has no place in the United States. In the Soviet Union people had to stand in line for a roll of toilet paper. We won the Cold War, didn’t we? Then why are our veterans standing in line? I see no reason why the Veterans Administration cannot function in an organized and efficient manner. One blood test that took less than five minutes to perform was made to kill an entire day of my time. If such an inefficient rate is deemed desirable, why not go back to making house calls? The technician’s time is valuable, but so is everybody else’s.
The following morning I returned to the hospital for an electrocardiogram. This time there was no waiting. My dear departed mother couldn’t have treated me better. I had no sooner checked in then the cardiology technician called my name. I was done in a few heartbeats. Afterwards, she had me hand carry the test results to the surgeon’s office to make sure the paperwork couldn’t get lost in the interoffice mail. Why couldn‘t the Lab be like this? It’s not that difficult to do the job right. Was it a morale problem? The clerk at the Lab simply went through the motions without even bothering to look up. 069, 070, it was all the same to him. Three hours to Miller time, two more days till payday. What happened to the poor unfortunate patients wasn’t his concern. After all, things were looking up. Only two hours and fifty minutes to Miller time. He could close his eyes and feel the cold beer massaging his throat as it went down. Two hours and forty-seven minutes to go. God willing, he will choke on his beer and the next time I come to the VA hospital for a blood test, the slacker that used to work at the counter will be toasting his tootsies in Hell.
The next stop was the Radiology department where I was scheduled to get some x-rays of my right knee. They had me strip and put on a gown. Then they wanted me to climb up on a cold slippery stainless steel table that stood three feet off the floor. Ever try to jump on a table without bending your knee? It simply cannot be done. Besides which I am flatfooted and don’t have an arch from which to spring. Nevertheless, the radiologist encouraged me to do it. Of course, the two people on duty could have helped me up, but then where is the fun in that? Much better to comment on how I didn‘t seem to be trying hard enough. They were being paid by the hour and could afford to wait all day if necessary. Eventually, they tired of their sport and took the x-rays with an older model (old enough to have been used by Madame Curie) vertical axis machine. They weren’t happy with the results, but hustled me off anyway. Having an x-ray done with black and white film is about as close as I will ever get to film noir. Did James Cagney have a bad knee or was it George Raft? Call me a gimp, but I’m in good company.
I don’t mean to belittle x-rays. Far from it. If it weren’t for x-rays, doctors would be in the dark. However, it wasn’t so very long ago that children’s shoe stores used x-ray machines to convince mothers that their child had been properly fitted with shoes. You put your feet under a vertical box while your mother observed an x-ray image in bright green and black through a metal stereoscope on the top of the box. Lord only knows how much dosage we got.
The runaround is almost over. All of the specialists on the checklist that Orthopedics gave me have examined me and declared me fit for surgery. I guess that means I’m 100 percent USDA—or VA—Grade A choice beef. Oh happy day! I’m good enough to butcher. Surely, I am truly blessed.
A week later, the mail carrier delivers a letter from Ortho informing me that I am going to undergo surgery. I will be the second of three veterans who will be fitted with an artificial knee on the appointed day. I should come an hour early and deposit my valuables with the clerk. No eating after midnight the night before the operation. Nothing to drink on the day of the operation. No smoking. However, nary a word about sex. Although the instructions didn’t say it, I gathered that the thing to do was to shack up the night before so that if they slipped up and slashed me to death with a scalpel, I would at least die happy. Be prepared for the worst case scenario. That way you will be pleasantly surprised when you don’t end up on a cold slab of stone with a tag on your big toe and embalming fluid in your veins.
The medical profession would like for us to believe that operations are routine; there is no need to worry. Make no mistake about it, being cut open is always a big deal. If you don’t die on the table, there is still a risk of infection. There are no guarantees. Getting a second opinion should be mandatory. For all you know, you might be getting an operation so that the surgeon can make the next payment on his boat. Never trust someone who wears deck shoes to cut on you.
Why am I so wary? A year ago quackery (the unrestrained business of medicine) had been responsible for murdering my father, a retired United States Navy quartermaster, who had survived numerous World War II landings in North Africa and Europe, only to be brought down by a two-faced heart specialist who made more money by treating him with pills for ten years than he would have if he had referred him to a surgeon to get the heart bypass he needed. In the end, my father, who was covered by three different health plans (Champus, Pacific Care, and Medicare) was sent to a county hospital to die because the HMO’s were being run by administrators who argued over how much of the bill each should pay. After the funeral, I went to Pacific Care’s offices to complain. They could have cared less. I had to pound my fist into his keyboard to get the administrator’s attention. Accountants aren’t qualified to make medical decisions. Why wasn’t there a physician in charge? Profits take priority over patients’ lives. No wonder we are plagued with assisted suicide and late term abortion. When religion, morals, and ethics are brushed aside, there is nothing left to hold society together. Our forebears had the courage of their convictions. How far must we fall before we are willing to take a stand? Nobody gives anyone anything. The price of liberty is eternal vigilance.
Nor am I ungrateful for the services that taxpayers are providing me. I am simply mindful that bureaucracies often have hidden agendas. This is not a modern phenomenon, nor is it peculiar to our form of government. In the early 19th century, Honoré de Balzac wrote that in dealing with bureaucracies “you cannot prevent the buying and selling of influence, the collusions of self-interest.” Has my surgeon accepted gifts from a prosthesis manufacturer or drug company? Surveys show that healthcare professionals who don’t are an exception rather than the rule. Corruption is rampant and pervasive. Don’t be naïve; your chances of surviving surgery could be influenced by such factors. The Hippocratic Oath is not what it used to be. When the American Medical Association conducted an in-house investigation, they found that of the medical schools that were still administering some form of the oath to their graduates, only 43 percent had them vow to be accountable for their actions. How pathetic! Moreover, a mere three percent prohibited sexual contact with patients.
We pay more for healthcare than anyone else. In 2006 the United States paid 15.7 percent of its Gross National Product to the medical industry, which is over five times the amount we spent in 1950. In the last eight years alone, insurance rates have doubled. Something is definitely amiss.
The day I am to have knee replacement surgery finally arrives. There is nothing left but to do it. Before I leave, I say goodbye to my faithful dog, Speedo. Although neither of us are aware of it, we will not see each other again for two years. I will miss a lot of things, but I will not miss anything as much as I miss him.
I walked into the VA hospital under my own power. That is important because I came out in a wheelchair two years later, worse off than when I went in. The Hippocratic Oath says “above all, do no harm.” Society has a right to protect itself; no oath, no license. I have no use for abortion and assisted suicide. Margaret Mead wrote that “throughout the primitive world, the doctor and the sorcerer tended to be the same person.” Surely, we have evolved beyond that. We need to rid ourselves of the rotten apples who give medicine a bad name.
We cannot expect doctors to be perfect. Anyone can make a mistake, but mistakes have to be acknowledged and corrected. Otherwise, they will no doubt be repeated.
The nurse asked me to undress and put on a hospital gown. It had evidently been designed for double-jointed patients because it tied in the back. Besides which it was far too flimsy to provide any protection from the cold. Breathing cold, stale, processed air makes people sick. They need to turn off the air conditioning, open the windows, and get some fresh air in here.
The two orderlies who are wheeling me on a gurney towards the operating room think I’m joking. Goosebumps aren’t funny. If the sheet wasn‘t tucked in all the way around me like a mummy, I would scream “Airborne” and hit the ground running (or stumbling in a rapid manner).
The double doors of the operating room slam shut behind me, signifying that there can be no turning back. Ahead lies the brightly lit faces of the sardonically smiling surgical team.
Stainless steel instruments are being arranged on stainless steel trays. The surgeon takes a ballpoint pen from his pocket, clicks it open, and draws a line down the center of my right knee. A nurse asks me to remove my dental bridge and eyeglasses. I hand them to her and she puts them on a tray. Down comes a rubber mask that covers my mouth and nose. I am instructed to breathe deeply and count backwards from ten. Ten, nine, eight . . . .
Chapter 3
ICU
The anesthesia wore off slowly. I was drifting in and out of consciousness. When I finally opened my eyes, I found myself in a white windowless room with tubes and wires coming out of my body, feeling terribly alone.
But I wasn’t alone. There was a rather muscular fellow standing nearby who was wearing a wide black elastic contoured back support belt like those worn on the job by stevedores, warehousemen, and other workers who routinely do heavy lifting. How strange, I thought, what’s there to lift in here?
The mystery man turned out to be Stan, a physical therapist assigned the mission of being there when a patient first woke up following surgery.
“Get up,” he ordered after introducing himself.
“No can do,” I said, gesticulating towards the tubes and wires attached to my body.
“You either get up now or your knee will freeze up,” Stan asserted with an air of authority that set off a drill-sergeant alarm in my head. “Take a couple of steps and you can go back to bed.”
Could I trust him to keep his word? I sincerely doubted it. Nonetheless, it seemed futile to resist.
It took me a while to inch to the edge of the bed. My new knee felt like it was on fire. The pain was unbearable. I tried and failed to stand up. More than anything else, I wanted Stan to go away. However, it was his job to start me walking. He suggested I transfer to a chair by sliding down a wide plank he referred to as a transfer board. Since the slope was steep, it should have worked. Only it didn’t. Perhaps I can’t slide because I don’t weigh enough, or maybe my skinny butt acts like a suction cup. Who knows? I sat at the top of the board and probably would be there still if Stan had not grabbed me in one hand (like King Kong did to Faye Raye) and dropped me on the seat. One thing is for sure. I now know what the belt is for.
It took awhile, but Stan eventually tired of bullying me and wandered off to torment some other poor veteran. I thought I was rid of him, but Stan returned fifteen minutes later with a vigor that told me he had made short work of his victim. Fortunately for me, Stan’s shift was nearly over. I imagined him hurrying home to beat his wife and kick the dog. Perhaps that didn’t happen, but I wouldn’t be surprised if it did.
Later that night, I cajoled a nurse’s aide into getting me a PVC potty chair on wheels from an empty room down the hall where she had seen it on her rounds. Anything is better than a cold metal bedpan. She helped me to get down off the bed and walk a couple of steps to where she had it parked. Somehow a few encouraging words from her accomplished a lot more than a litany of unspoken expletives from Stan.
Despite spending more than two years as an inpatient at the VA hospital, I never saw Stan again. But I often heard about him. Since there isn’t all that much an inmate (excuse me, I mean inpatient) can do (especially when confined to bed), gossip and rumors are rampant. Although there were more than a dozen physical therapists, none of them even came close to matching the chutzpah of Stan. But I’m not worried. Guys like Stan usually end up as a notch on someone else’s belt.
The Intensive Care Unit (ICU) resembles solitary confinement. I was in a room by myself tethered to a glucose intravenous drip and several monitors. No doubt it was necessary for the first few days, but I ended up stayed in ICU for three weeks solely because the nursing home on the first floor was full and, according to them, they had no other place to put me.
I used the phone on the nightstand beside my bed to make a few inquiries. What they said was true, but they didn’t bother to say why. It was painfully clear that more veterans were admitted than discharged. The surgeons were performing more knee and hip replacements than the recovery and rehabilitation system could absorb. Unlike private hospitals, the VA hospitals preferred to do this with inpatients (perhaps because much of their rehabilitation resulted from war wounds). The process was lengthy and effective, albeit extremely slow. Pack too many patients into the wards and the risk of spreading disease and infection goes up. But the surgeons weren’t concerned. Surgeons cut and stitch and call it a day. Dealing with the aftereffects isn’t what they like to do. In a private hospital the doctor who admits you closely monitors your progress throughout your stay. Perhaps the VA hospitals could learn something from them. Nobody wants assembly line surgery. Chickens are butchered in that manner. I’m not meat. I demand to be treated with dignity. Whether a human being lives or dies should be a matter of importance to everyone, including the surgeon. Quacks don’t care what happens to their patients. No matter how skilled the surgeon, he’s a quack if his sole reason for doing his job is the money.
During my three week stay in the intensive care unit, my intravenous drip was being laced with morphine by a machine that injected the drug whenever I pressed a button. However, it would only do so once every ten minutes. It worked perfectly in the ICU but would later malfunction, resulting in me becoming severely addicted to morphine. How could the VA fail to notice that a malfunctioning machine had been injecting far too much morphine for more than a year? Morphine is a controlled substance. Are VA records kept so sloppily that no one takes notice of how much morphine is being dispensed? Although it could happen conceivably under combat conditions, such negligence should never be allowed to happen in a domestic hospital administered by an agency of the United States government.
At least I’m in good company. I read somewhere that Hermann Goering, the Nazi founder of the Gestapo, was also addicted to morphine. Do birds of a feather really flock together? Since Hermann Goering died three years before I was born, I guess we can only speculate.
I don’t particularly like alcohol; I don’t even drink coffee. I stayed away from drugs in my youth. Now, here I am, at 61, addicted to morphine. My long, curly hair hasn’t been cut in five years and I’m stuck in a wheelchair. Once I was a Military Policeman. You might say I was a role model. Then the VA covered up by telling my son, a Major in the U.S. Army, that I addicted myself to morphine and that led to me losing his respect. I’m surprised that they could pull it off. You can’t buy morphine on the street. Only the VA and the military have morphine in significant quantities.
Nothing could be further from the truth. But I have no recourse because veterans can’t sue the VA. I sincerely hope that the people who read this book will strive to make changes in the system. I believe that the good citizens of the United States cheerfully pay for the VA, thinking that the money is well spent on caring for veterans. They deserve to know what’s really going on: quackery, waste, and corruption.
Since morphine isn‘t very common, I probably should say a little more about it. Morphine is derived from giant poppies whose sap is collected and dried to make opium. Processing opium farther produces morphine which with farther processing produces heroin. It’s sort of like refining sugar:
Sugarcane - molasses - raw sugar - granular white sugar
Opium poppies - opium - morphine - heroinWhat is it like to be on morphine? First, let’s get something straight. Morphine pills mess up your stomach and won’t get you a good high. In order to get high on morphine, it must either be injected or administered intravenously. Within minutes all pain vanishes and the patient feels comfortably numb. An increase in dosage may make the patient a bit queasy. With time, constipation ensues, but that can be corrected by drinking milk of magnesia or taking a laxative.
How many patients in ICU are on morphine? Automatic injection machines are pervasive. Morphine (at least at the VA) is fast becoming the "feel good" drug of choice. Keep them high on morphine and they won’t cause trouble. Happy patients are not constantly ringing for a nurse and consequently require less care. So what if they are temporarily vegetables? If they survive, they can be taken off drugs before leaving the hospital. And, if they die, at least they die happy. What’s wrong with that? What is wrong is me and guys like me who continue to crave morphine long after we get off of it. I don’t just like morphine, I LOVE it. Thank God it isn’t available on the street because I cannot remember a time I felt better than when I was on morphine. Administrators who addict veterans in order to save money should be fired. Instead, they are promoted.
For 66 consecutive Sundays, a group called the Veterans Revolution has protested outside the Los Angeles Medical Facility at Wilshire Boulevard. They are demanding that the VA administrators quit making policy about what is best for veterans and start asking veterans what they want. This is the United States of America. Because we fought for you, you are free to do as you choose. It is only fair for veterans to demand freedom, too. Get rid of the administrators and let the physicians and veterans determine policy. Dr. Feel Good can go take a flying leap. I want to walk. I want to drive. I want to live as well as everybody else. If an administrator needs someone to take morphine and be a gimp, he is welcome to have my wheelchair. There is nothing wrong with me that cannot be fixed. All I need is surgery minus the quackery.
Enough negativity. From what you have read or heard about the VA, you may have gotten the mistaken idea that the VA is rotten and corrupt. Though that may be the case for a few bad apples, the vast majority of VA employees (including healthcare professionals) go out of their way to assist disabled veterans. If they are off the clock and they see a veteran in a wheelchair struggling to open a door or not being able to reach something, they drop what they are doing and cheerfully come to his assistance. I have found this to be true of almost everyone both in the VA and the public at large. Taxpayers provide a generous pension to service-connected disabled veterans like myself along with free medical care and benefits.
I am extremely grateful to the public for all they have done for me. I went to school on the G.I. Bill. Later, I enrolled in the veterans’ writing project which gave me an award for one of my short stories. Overall, the VA has been very helpful. My primary purpose in writing Quacks is to expose the inefficiency, waste, negligence, and redundancy which plague the VA, so as to improve performance and assist the accomplishment of mandated objectives. Constructive criticism is an essential part of the feedback process which government uses to determine how well it is doing its job. Quacks is intended to function like a report card; nothing less, nothing more. I apologize in advance for any connotations that are perceived to be destructive.
Etched into the entrance of the Department of Veterans Affairs (VA) in Washington D.C. is a phrase from Abraham Lincoln's Second Inaugural Speech: “To care for him who shall have borne the battle, and for his widow, and his orphan.” President Lincoln obligated the nation to care for the men and women who have honorably served this country. More than 140 years later that promise still stands. My father and my mother served as President and Vice-President of the Fleet Reserve Association, Long Beach, for more than two decades. As a youth, I watched them visit disabled veterans in VA hospitals, comforting those who needed it. I was born at the VA hospital in Long Beach, California, in 1948 when it was a Navy facility. Of course, I had no idea then that I would come to depend on this and other VA hospitals for my healthcare. My parents were selfless role models of whom I’m justly proud. To the extent possible, I have followed in their footsteps in my support of veterans and enlisted military personnel. What my parents used to do on an individual basis, I now do online and in books so as to reach a far greater number of people.
Since ICU is akin to solitary confinement, it should never be used as interim warehousing of recovered patients awaiting further processing. The cost is enormous; my extended stay in ICU cost almost a thousand dollars a day. If the decision maker had to pay for it out of his own pocket, this wouldn’t be happening. But he is paying for it out of your pocket and the pockets of everyone else who pays taxes. A few seconds of thought might have solved the dilemma. Administrators are paid to think. Those who cannot need to be transferred to menial positions commensurate with their skills and abilities.
The ICU physicians and nurses gave me drugs to suppress my immune system to keep my body from rejecting the artificial knee. Consequently, I was more susceptible to infections and similar disorders. The housekeeping staff did an outstanding job of combating germs, mopping the floor with disinfectant three or four times a day. But the sheets were changed on an infrequent basis and I have been told that they are laundered at a central facility that fails to ensure that the water temperature meets or exceeds 180 degrees for one rinse cycle so as to eliminate staphylococcus.
The Government Accounting Office should investigate and determine the rate of infection in VA hospitals and whether taxpayers are getting enough bang for their bucks. Is the rate of infection higher than in private for-profit hospitals? If it proves higher, the VA must be made to improve its standards and procedures. Care and treatment for veterans should not be permitted to slip to slipshod substandard quality. When the Inspector General finds out that something is amiss in the standard operating procedure of the Department of Defense and/or its hospitals, heads begin to roll. This should also be the case with the VA. Regular examination of VA hospital statistics needs to be undertaken by the GAO and compliance with standards strictly enforced.
Jerry L. Pettis Veterans Administration Memorial Medical Center, Loma Linda, California, featuring the duck pond, nursing home, emergency room, eye care facility, dental, and 4 floor hospital
11201 Benton Street, Loma Linda, California 92357
Toll free phone: 1-800-741-8387
(photograph courtesy of Jerry L. Pettis VA Memorial Hospital, Loma Linda, California)Got a nasty habit? You can’t get by for two weeks in ICU without a stiff drink and a pack of Camel cigarettes? Anything can be had for the right price. Usually, a patient or a nurse will offer to serve as a go between. Smuggling liquor and cigarettes into hospital wards is a time-honored VA tradition. Formerly, manufacturers gave away cigarettes to veterans in VA hospitals. Currently, smoking has gone out of style, but at one time field rations came with cigarettes and matches. If I remember the ads correctly “more doctors smoke Camels than any other brand of cigarette” because “there isn’t a cough in a carload.” The Surgeon General can put that in his pipe and smoke it.
Give the guys in ICU a big one finger salute and be glad that you aren’t them. Who wants to be tethered to an IV and/or a catheter? Want to piss in a bag that hangs from the side of your wheelchair? Hell no! The best care is prevention. Don’t wash down your viagra with a shot of tequila, don’t flavor your beans with bacon grease, and keep out of unlit brothels and dark alleys. Believe me, ICU in a VA hospital isn’t for you. Your elected officials get to go to Water Reed. You get Loma Linda. They’re smart and you aren’t. But don’t worry about it. If you fail to survive, the VA will bury you for free and mark the site with a solid brass plaque, commemorating your military service. That’s right, you get to rot along with your military buddies. There is no finer way to go. A copy of your DD214 form gets you a deed to eternity.
I was born in a VA hospital and someday they will bury me in a VA cemetery. How about that? I am getting cradle to grave coverage and I am a confirmed capitalist. Oh happy day!
If you are going to be admitted to ICU, take everything you will need with you. Take your laptop along and it is liable to get stolen. Besides, you won’t be able to get on the internet with anything other than a Blackberry. The structural steel in the walls interferes with cell phones and the VA has yet to discover Broadband. The food is atrocious. Bring cash with which to bribe the kitchen staff into providing you with edible fare. Otherwise, a taste bud transplant should be scheduled with your surgery. Ever try toasted cardboard? Bon appetit gastronome.
When you find yourself feeling far too frisky for an ethical man in his golden years, when your spirit surges and overflows its banks, when life’s cornucopia threatens to overwhelm you, a short stay in ICU might just be the reality check you need. Watching other veterans space out on mind-numbing drugs, watching people die before their time due to quackery, negligence and incompetence, and listening to the whir, beeps, and clicks of monitors that mostly monitor the best time to pull the plug, will certainly bring you back to your senses. Nothing is more illustrative of the human condition than pain and suffering.
Chapter 4
1 Southeast (1SE)The vast majority of patients are discharged from the hospital when they finish ICU. But I chose to complete the six month physical therapy rehabilitation program so as to gain full use of my titanium prosthesis. Dr. Gustafson had told me that I was not likely to get more than 70 percent usage. However, the physical therapists thought otherwise. Their bonuses were based on performance. They said that if I worked hard enough, I could be restored to 100 percent. I wanted to be a whole man, not a pitiful gimp in a wheelchair. A ray of hope was all I needed.
There are three nursing homes on the first floor of the VA Loma Linda hospital. We don’t talk about them. They are tucked away beyond the “employees only” kitchen and can best be reached via a passageway between the eye clinic building and the main hospital. Please refrain from calling 1 South, 1 Southeast, and 1 Southwest the funny farm or the cuckoo’s nest because someday you might end up there, too, vegetating through marathon reruns of Jerry Springer and Maury Povich. Feel like killing your wife? Fancy a career as a rapist or a serial killer? Does Osama bin Laden ring your bell? If you answered yes to any of these questions, then you are a candidate for 1 Southwest where they test the latest tranquilizers and hallucinogens on veteran guinea pigs. My neighbor came back from Vietnam with all sorts of flashbacks. The Emergency Room admitted him for observation and subsequently wheeled him past the double security doors into a fantasy world called 1 Southwest where they shot him full of happy juice and strapped him to a gurney. He emerged from there as a different man, totally devoid of will. His family now has to lead him around by the hand because the VA gave him the chemical equivalent of a frontal lobotomy.
This poor veteran also got a heavy dose of Agent Orange while fighting in Vietnam. Dow Chemical could care less. They should be held responsible for the effects of their dioxins. Hundreds of children in Vietnam and the United States have been born with birth defects. God rendered a rainforest which Dow Chemical tore asunder. There is no justification for defoliation. Why has the World Court at the Hague in Holland failed to adjudge this a war crime?
1SE is the entry port for the nursing home. It is primarily for rehabilitation and recovery, the average stay being four months. They admitted me for six months of physical therapy, but I caught a staphylococcal infection and wound up spending two years there. Infections have always run rampant in hospitals. If you don’t want to get sick, don’t go to a hospital. Put diseased people together with patients with suppressed immune systems and you have a prescription for disaster. It is not in the patients’ best interest to conduct healthcare from a central facility. Far better to have doctors make house calls. Black bags are back in style among médecins compétents. Long term doctor/client relationships don’t just happen, they have to be developed. Recluse physicians are a thing of the past. Today’s doctors are built to last. They are part of the communities in which they live. Thus, they cut down on stress and anxiety. Responsible physicians do not accept gratuities from drug manufacturers and insurance companies. They sell their services, but not themselves. A true professional has character and integrity. By bringing back the Hippocratic Oath, doctors will regain respect by the public for the medical profession. One spots a quack by how it mucks around. Stop mucking and do the job right. God grants the physician the power of life and death, do not abuse it.
My respite in 1SE was organized and disciplined. At 7 AM, five days a week, the nurse at the front desk handed me a computer printout with my schedule on it. I was required to go to everything on the printout. Here’s a typical schedule:
8 - 11 AM Physical Therapy
11 - 12 Noon Recreational Therapy
1 - 3 PM Physical Therapy
3 - 5 PM Audiology
Our cafeteria serves lunch at noon. Each patient had a tray that came from a compartment in one of the two stainless steel slop wagons that the orderlies wheeled in at mealtime. No matter what is served, it is lukewarm, including the salad and ice cream. Everything tastes the same; no salt, no pepper, no seasonings whatsoever. Cardboard is king. The food is so bland that the rats refuse to eat it. Here, try my strawberry rhubarb fruit cup. The VA buys it from Vietnam. I guess it’s payback for waging war against them. The Marines splatter it on the wall when the nurses aren’t watching. The spots and stains closely resemble the fly specks found in real military mess halls. Our two obese nutritionists claim that the food is good for us, but you won’t see them eating it. Once a week, I pay one of them to bring me a cold bottle of Pepsi from the PX. I treasure it because it is my last link with civilization. If Margaret Mead was still alive, she would most likely do an anthropological study on it. But she is long dead. Nobody cares. What is needed is a sign at the entrance similar to the inscription Dante saw on the seven gates of hell: “Abandon hope, all ye who enter here!” As in Hades, many enter, but few return. Disease, infection, and negligence take their toll.
I can honestly say that the food that is served in VA nursing homes is worse than the food served in military mess halls. Patients who had money and weren’t bedridden bought their meals at the food court on the second floor. It wasn’t just that the food wasn’t seasoned, it wasn’t prepared properly. Many of the processed food items were offbeat and ended up in the trash can. Anybody for strawberry rhubarb fruit cup? Of course not. Why it constantly came up on the menu is beyond me. Evidently, the nutritionists know what is best and are determined to give it to us whether we can stomach it or not.
With such atrocious conditions prevailing, one must wonder why a veteran would want to enter a VA nursing home. Most have no other option. Some are dumped by their families. A select few view it as a way to hornswoggle an assisted suicide complete with burial and flag. If you are bound and determined to go, you might as well go for free like Sol Roth in the 1973 science fiction classic, Soylent Green, who was given a comfortable bed prior to having been prescribed a lethal dose of opiates and happy juice. Thank you, VA. People’s Temple leader Jim Jones could have learned a thing or two from you.
And, Josie, the reservist Staff Sergeant head nurse of 1SE is uniquely qualified to teach it. Every morning she bumped against my sore right knee as she made her rounds. “Oh, did I hurt you? I’m so sorry,” she feigned while savoring my excruciatingly painful involuntary reaction. Make no mistake, Josie is by no means a sadist. Rather, she believes it is her job as head nurse to maintain order and discipline in the unit. Although I made no overt effort to challenge her authority, she had heard me interpreting regulations for others, the gist of which she feared because she did not understand. Supervisors are promoted to the level of their incompetence. Torture is an ineffective tool whose use cannot be excused. No doubt the fires of hell burn in eternal vengeance for those who knowingly tormented their fellow men.
Having been designed in the early 1970’s, the double occupancy rooms are quite spacious and have all of the amenities found in private facilities including a handicapped bathroom with a sliding door that is shared with the room next door (knock before entering). Rumor has it that it came into being as a result of the Sylmar earthquake in which 35 people were killed when two wings of a VA hospital collapsed. But please do not worry as there is not much chance of it happening again. Loma Linda VA hospital was built of steel reinforced concrete. However, if by some weird quirk of fate, it pancakes in an earthquake, the worst place to be is at the rear of the ground floor where the nursing home is located.
Most patients eventually succumb to infection. The infection begins as a small yellow dot that when left untreated expands into a pressure sore. If the sore is discovered and treated, it goes away. Otherwise, it becomes infected. Shifting bedridden patients helps to prevent bedsores. In fact, there are hospital beds available that automatically turn the patient as he or she sleeps. But the VA has yet to authorize the upgrade. Could it be that a burial plot in a national cemetery costs less than a decent bed? Sol Roth had it better. I suspect this also explains why unsuspecting wheelchair bound veterans get foam egg crates to sit on rather than thick gel cushions. What it doesn’t explain is why physicians permit this to happen. I recall a young Air Force veteran, a well-respected and well liked long-term resident of the nursing home who over the course of several decades received a number of skin grafts for pressure sores on his rear. Following each procedure, he had to lie on his stomach until he healed. Obviously, it wasn’t a joy for him, the VA, or the plastic surgeon. But this is what happens when medical schools teach by rote. Physicians who can’t think are incompetent. Far too many doctors fall into this category. Next time you are in a medical school, watch an instructor and his students walk single file down a hallway with the teacher in the lead. This works fine for a mother duck, but a system based on privilege can’t teach a physician to think. Those grueling 24 hour shifts that interns are forced to work do little to stimulate their brains. Zombies don’t think and zombies are prone to make mistakes. Zombies don’t belong in the medical profession.
The last hour of a nurse’s shift is devoted to handwritten reports, none of which makes its way into patients’ digital records. During this time, the ongoing shift is supposed to cover for them, but in my experience it rarely happens. I know of patients who have waited over an hour for assistance after pressing an emergency alarm. What’s wrong is that the alarms are visual rather than audible and can consequently be ignored. Most nurses have come to regard the last hour of the shift as “their time.” Once the reports are written, they sit in the nurses’ lounge and gossip. How do I know? Like President Bill Clinton, they occasionally leave the door open.
In addition there are potlucks, sports pools, and other events, most of which take place on paid time and all of which serve to distract nursing personnel from taking care of patients. I got the distinct impression that the sale of handicrafts and jewelry provided a substantial source of income for many of the nurses. Patients were largely an inconvenience that they would rather do without. The solution is to give them drugs and tranquilizers so you don’t have to deal with their problems. As far as much of the staff is concerned, the sooner they can pull the plug on you, the better.
Think I exaggerate? The turnover is so fast that names are written on masking tape before being placed on a room’s door. Here today, gone tomorrow. How sad. Veterans don’t rate a label maker. A former Command Sergeant Major (E-9) in 1 Southeast wrote a history of his service (numerous tours in Vietnam, etcetera) and attached it to his room’s door. Most of us thought it added a humanistic aspect, but the administrators were afraid it was going to get out of hand. They eventually evicted him. The last time I heard, the Sergeant Major was living on the street in his truck. During a robbery, he was hit over the head, suffered a severe concussion, and the surgeon put a metal plate in his skull. It seems to have affected his balance as he now walks using a hand carved staff. Anyway, it made me wonder. How many combat tours does it take to gain the respect of VA administrators?
Doctors sometimes provide referrals to private specialists with the implication, spoken or unspoken, that the for profit specialist does a better job than the one that the VA provides. Are there kickbacks involved? This is something that needs to be looked into by the VA’s Inspector General.
In VA healthcare veterans are assigned a general practice doctor who acts as a gatekeeper, deciding when a specialist is needed. The only way anyone can get an appointment with a specialist is through his primary physician. Patients in the nursing homes are not assigned a primary physician. The only way they can see a specialist is if the director of the nursing home refers them. In practice this rarely happens. In other words, nursing home inpatients living on the first floor of the VA hospital have a harder time seeing a specialist than they would if they were outpatients living at home. When, following an infection, my artificial knee was removed, I was constantly trying to obtain an appointment with the surgeon, but couldn’t get one. In fact, I wasn’t able to see him until after I went home. What good does it do to live in a VA hospital nursing home if you cannot be seen by a specialist when you need one?
I should mention that all of the rooms are exactly the same. Once you’ve seen one, you’ve seen them all. I confess that Stalinist construction does not appeal to me, nor do Daly City and federal housing projects. Just because something is egalitarian does not mean it has to be monotonous. In my opinion, long term residents should be encouraged to redecorate as long as it doesn’t interfere with the staff’s routine. For instance one of my roommates was a World War II Marine with a Purple Heart who had a large family. During visiting hours, our small room was packed with his relatives, most of whom had to stand because there is a rule against taking chairs from other rooms, even when they are vacant for a long period of time.
The three nursing homes on the ground floor of the VA hospital share a large rehab center between them that is stocked with exercise machines, weights, mats and other gymnasium items. It is staffed by upwards of ten full and parttime rehabilitation technicians. Upstairs, on the second floor, there is an almost identical rehab center for outpatients. The 2nd floor rehab center also seems to be responsible for testing to make certain that the claims of the other center are not being fudged, which, together with the intensity of the rehab program, makes me think that rehabilitation technicians’ pay is to a great degree based on how well their patients progress. In most cases this is a great idea, but it should not be done without the aid of a doctor monitoring the patient’s overall condition. My rehabilitation technician worked hard on improving the arc of motion in my artificial right knee to the exclusion of everything else. Eventually, my calcified left ankle collapsed, erupting in a staph infection that spread like wildfire throughout the hospital and did not come under control until they sent me home to die. I didn’t ask for the role of Typhoid Mary. It could (and should) have been prevented. Now, the surgeons won’t fix me because they are scared to have me back in the hospital. I cannot walk or stand. Although I’m not to blame, they condemned me to spend the rest of my life in a wheelchair.
Rehabilitation was an arduous, albeit necessary, process in which atrophied muscles were toned and made to function. Rehab technicians chart your progress from the first faltering step to (ideally) full and complete recovery. My relapse was an anomaly. Rehabilitation is successful more often than not. I say this in all honesty; I am the exception that proves the rule.
Anyone who receives an artificial knee goes to rehabilitation. At private hospitals rehab is recommended but not required. At VA hospitals, however, there are no exceptions. Either one takes rehab on the second floor as an outpatient or on the ground floor as an inpatient. Because the taxpayers are paying approximately $50,000 for the operation, the VA makes certain that you do your part, i.e. rehabilitation, to make the outcome a success. It is either arranged as a package deal (artificial knee operation and rehabilitation) or it isn’t done. At least in theory, there isn’t any room for failure. I am living proof, however, that nothing is foolproof. Mistakes occur. Physicians are not immune from bad judgment. Surgeons must acknowledge and correct their errors. Attempted suppression only serves to exasperate the problem.
As previously stated, a patient’s day is scheduled by computer printout. An individual can have up to four hours of rehabilitation in two hour accruements interspersed with arts and crafts, recreational therapy, aerobics, work therapy, and a litany of assorted subject matter that the staff have devised over the years, much of it of questionable relevance. Schedules come down from on high with absolutely no patient input. The attitude is "we know what is best for you." While that may be true for a few slackers who do not want to be bothered by the details of their treatment, the majority are offended by the VA’s inflexible dictums. They appear to have been promulgated by an educator familiar with intermediate and high school scheduling in some bygone era when students automatically accepted the judgment of administrators in determining career choices. Why an adult veteran cannot be trusted to have a voice in his/her own treatment is beyond me. Big Brother has gone far enough. It’s high time for change.
At the time of being admitted to a VA nursing home, the patient is asked to fill out a form showing whether or not he/she wants extraordinary means utilized to maintain life should a life threatening situation arise. What comes to mind is pulling the plug on someone who is brain dead and comatose. What doesn’t come to mind is temporary dialysis, chemo and radiation treatments and an entire gamut of procedures that can be construed as artificially maintaining life. A roommate in 1 South became bloated and died because he had elected not to receive extraordinary treatment. Temporary dialysis might have taken the strain off his kidneys, but now we will never know. To my way of thinking, he deserved the chance he didn’t get. God alone should determine when we die. Who wants the VA to play God?
If you would rather not have the government make life and death decisions for you, check the extraordinary measures block when you fill out the form. You can still change it later. It simply keeps the government from pulling the plug against your family’s wishes. Don’t ever authorize the VA to determine when the physicians should give up on you. There are enough conflicts of interest going on at the VA without you adding to them.
Remember the old roach motel commercials, “roaches check in but they don’t check out.” That is how it is with a VA nursing home. I term it the Hotel California syndrome. Private nursing homes are populated by patients who check in and check out at will. Once you are admitted to a VA nursing home, you must stay until they discharge you. Remember, when it comes to decisions regarding your health, Big Brother knows what is best. Born with an independent streak? Then VA healthcare might not be for you. You call the shots for only so long as you pay the bills. Once the VA becomes involved, you no longer run the show, so think carefully about it before calling on the government to help you out. And don’t be surprised if they ask you to disclose your finances. You may have fought for freedom and capitalism, but now you are stuck with charity and socialism. It is best to stay with private healthcare if you can possibly afford it.
The chokepoint is at the front desk. Nurses determine at what point a specialist will be (or will not be summoned) for patients. Patients whose families ask about their condition and visit them regularly tend to receive better treatment. Moaning and groaning won’t get you anything more than a tranquilizer and some pain medication. Feeling queasy? You are not the only one. Between midnight and 6 AM there is a semicircle of wheelchairs behind the front desk of patients who cannot sleep for one reason or another. Don’t ask for a sleeping pill because you aren’t going to get one.
Recreational therapy has a few things to offer. Wheelchair bowling, however, isn’t one of them. Using ramps to play gutterball isn’t much fun. Much better to accept a dinner offer from a fraternal order such as The Elks or the VFW. I have gone to some that were prime rib affairs with baked potato and decent beverages. It doesn’t cost a cent. These guys will show you a good time. They genuinely care about disabled veterans. If nothing else, it’s a break from the nursing home grind. Recreational therapy also has books on cassettes with walkman style recorders. It kept me from joining the wheelchair semicircle in back of the front desk at night. When I couldn’t get to sleep, I listened to a John Grisham novel about evil corrupt lawyers and Wall Street Go-getters. Audio books kept me sane.
The packaged peanut butter and grape jelly sandwiches with no crust are nourishing. With luck you can subsist on them for days. Avoid brands other than Smuckers. Put 20 or 30 in the meds refrigerator near the front desk and you can get a snack late at night. Microwave popcorn is another good idea. Heat it for 15 seconds longer than it says on the packet. Get kettle corn or buttery flavor. Stash it with your socks or underwear and never do it while a nurse is around. Nurses are good for smuggling alcohol and cigarettes and little else. They are all look and don’t touch. Pontius Pilate didn’t wash his hands half as much as they do.
Want to leave for a while? Good luck. Your family must sign you out on a pass. Ask your son to give the front desk a number at which you can be reached. Be punctual or the nurse won’t ever give you another pass. It’s just like the military, only better. Remember to take a shower before you go because you will have to pass inspection by the nurse in charge at the front desk. Sick and tired of rules? Isn’t that just too bad? Without the VA, you would probably be pushing a shopping cart loaded with your belongings down the sidewalk. Try to be grateful.
I’m going to give you an idea of what your day will be like. At 4:30 AM a nurse shows up to administer my meds. She wakes me and my room mate from a deep sleep by turning on the bright overhead lights. She is positively bubbling over and couldn’t wait until we have something in our stomachs to absorb it. Ducosate on an empty tummy will trigger an acid reaction. You are permitted to wonder how this ditzy drug pusher airhead made it through nursing school, but please have the courtesy not to ask. When it is 6:30 AM, we shuffle to the cafeteria for breakfast. Oh boy, it’s strawberry rhubarb fruit cup for the fourth day in a row. And a great big helping of mush. Bet that will act like a catalyst on the Ducosate and the other meds the nurse made me take at 4:30 in the morning. Time to go to the restroom and get ready for the 7:30 AM lineup at the front desk. I even have time to go outside and feed the ducks the hard roll they gave me at breakfast. Last week the Director complained that our bread crumbs were making the pond turbid. That’s too bad because I don’t have a quarter to put in the gumball machine that dispenses duck food. Administrators who don’t like it can eat cake. Down with the Bastille and up with the ducks in the moat. Revolution is brewing albeit remote.
A revolution is the farthest thing from the mind of a per diem medical professional. Try to imagine these people in Cuba making $45 per month. They are dedicated to accumulating a sizable bank account and little else. Sin vergüenza. My ex-wife became a money hungry registered nurse. Only a money grubbing nurse would abandon her son. May she choke on someone else's sausage.
Ever had a turkey hot dog? Dry with a plastic skin. Almost inedible. The nutritionists like them, but you won’t. No matter how they are cooked, they taste like cardboard. Yum yum in your tummy. These things must be close to 90 percent fiber. The turkeys may have died of old age, but you won’t. Too much of this kind of food will most likely give you a colon or gastro-intestinal disorder. No more granola for you. Wouldn’t you rather have a shot of 200 proof rum and a crack whore? It’s only a matter of money. When you get rated at 100 percent, it’s like a cardinal’s robe in that it will bring out the best veal when you go out to dine in Los Angeles and/or Las Vegas.
Do you need a bed bath? Only student nurses give bed baths. The riper you get, the better the chance of disease and infection. Hello, I thought this was a hospital. I’ve seen cleaner kennels. These people need a bath or a shower. Please, give them one. What’s wrong with the night shift? The handicapped showers sit empty at night. Get on the ball. Where is the DAV and the VFW when you need them? This place is nasty. They claimed I got infected with staph by not washing my hands. My hands aren’t the only things dirty. Please, get rid of the filth and corruption.
Once a baby is born, you cannot reinsert it into the mother’s womb. The same maybe true of the elderly and disabled. Once you enter a nursing home, you will never reenter society in the capacity in which you left. You have become a marked man. Sooner or later disease is going to take you down. Pills and alcohol cannot solve the problem. Get a new lease on life by developing a raison de vivre.
If you are off balance and/or unsteady on your feet, the nurse is supposed to put a wireless perimeter alarm on your bed at night, but it never seems to get done. The nurse could care less if you fall because that would mean one less patient. Stan, my roommate died at night and fell on my missing knee, causing me to scream and wake up the other patients. That’s too bad. When you complain about waking up to witness a compatriot’s passing, you will probably pass without a whisper too because you have foretold your own death by being a magnificently insensitive jerk.
They used to have colonies of lepers, where people dare not venture. Am I diagnosed with a leprous disease? Or is it simply that nobody wants to come and visit me? It is Christmas and everyone else is having a feast. Here I am in a VA nursing home dining on coagulated macaroni and cheese. When I was in the Army, I did much better than this. The cook tried hard to cook us a hot ham Christmas dinner. The Holidays were full of cheer, why can’t it happen here? Scrooge must be in charge of Veterans Affairs and scrimping on the food as if it was being paid out of his own pocket. I barely weigh 116 pounds. I am emaciated and my ribs show through my skin. Is it too much for me to ask for a hot Christmas dinner?
Wheelchairs these days are made of plastic, one size fits all. But I had to lean over to grab the rim and brakes of a 20 inch wide wheelchair. Needless to say, I almost never got to go anywhere. In fact, it barely fit through the doorway in the bathroom. Worse yet, I couldn’t get into the meditation room of the chapel. Must I die for my sins before my time? Let me linger a little longer. I may yet surprise everyone by doing something stupendous with my life.
Ever had a catheter? You are in for a treat. A masochist will ram a tube up your penis. Your job is to scream. No Vaseline for you because you are a macho Marine. Look on the bright side; your male nurse is gay and he enjoyed every minute of it. Isn’t that a swell plastic bag? Please don’t spill it. Have yourself a Big Gulp and then you can fill it.
Do you like shoes? Are you aware that some kinky people have a fetish for them? I guess this explains why the VA has us wear green wool socks with black tread on the bottom. Socks without shoes makes a fashion statement. The VA asks you to wear the socks once and then throw them away. Don’t wash socks, Beau Brummell would never stoop to washing socks. Taxpayers have money to burn.
Aren’t you cute? You are wearing a flimsy gown. The ties are in the back to keep you from undoing them. Now you can squat to urinate. Isn’t that wonderful? The VA gave you a gender change without you asking for it.
Lost? Can’t find your way? That’s because all of the corridors in the hospital look alike. Formerly, veterans followed colored tape to get to various locations. That system has given way to one of naming the corridors. Ornately painted street signs on the walls of 1 Southeast denote the location. It isn’t GPS, but it’s the best the VA could do.
Need a copy of your medical records? All VA records are stored in digital format. You are entitled to a CD copy but must request it in writing. Even if you don’t want it, it is a good idea to get one just in case you are asked for it by a private doctor sometime in the future. It’s free. All it requires is time.
Men and women veterans are housed separately. There can be no conjugal interaction. The sick and the elderly don’t have sex.
Every evening there are DVD movies screened in the mess hall and the microwave popcorn is free. This is done by the patients and the movies are not censored by the staff. Overall, I enjoyed them.
The physical therapists do their work well. However, the doctors fail to monitor the patient’s overall condition. Infection often sets in without them noticing it. I know of at least three veterans who contracted staph infections without anyone noticing it. Spending time with nursing home patients should be a priority for doctors, but they seldom come downstairs to examine us.
In two years I was examined less than five times. VA physicians are negligent and incompetent. I am in a wheelchair because of them.
The first rule of the Hippocratic Oath is “to do no harm.” But the VA surgeons cannot be bothered by such trifles. They are much better than the rest of us. It must be nice to be able to get away with anything. Rules are for stupid people, not for prima donnas who have special skills.
Supposedly, a veteran has a right to have an issue investigated by the Inspector General. However, the Inspector General does not investigate the vast majority of complaints. Are you so naïve that you expect to obtain justice from an in-house investigation? You would probably do better to take the case to court or inform the media.
Likewise, patient representatives usually prove to be a waste of time. Nobody cares about veterans in nursing homes except for the veterans themselves.
Few deceptions are as cruel as those of in-house investigators. They are as liable to find fault with the agency that gave birth to them as I am to criticize my own dear parents. It does not make common sense, yet that is exactly the way it is.
I never saw nor heard of a patient stealing from another patient. However, my black leather jacket was stolen by a VA employee. VA hospitals have their own uniformed police departments. Still, I don’t think it is a good idea to bring anything valuable with you when you are admitted to a VA nursing home.
Most of the corridors have hardwood railings. If your wheelchair is too wide, they can greatly speed you on your way. Therapists recommend egg crate cushions, but if you can afford one, a gel cushion is less likely to give you a pressure sore.
The VA also has a drug recovery program for veterans that they recruit from the street. These “Silver Spoons” help feed patients who cannot feed themselves. They also do gardening and other forms of physical labor.
Football pools are circulated among the patients by the medical staff. The person starting a 10 x 10 pool may take three or more squares as his/her “rightful share” for organizing and circulating the pool. You should be aware that these pools are not officially sanctioned by the VA and sometimes turn out to be scams.
My ex-wife is a RN at a private hospital, but she used to work at Riverside County hospital on Magnolia in Riverside. I remember watching them load wheelchairs on a truck when they moved to Cactus Street in Moreno Valley six years ago. I never wanted to be in a wheelchair then and I definitely don’t want one now. The VA claims I belong in a wheelchair, but I know better. It is only a matter of time until I walk again. Keeping a positive attitude is a big part of recovery.
The nursing homes have an arts and crafts workshop located in a room at the rear of the mess hall. Though therapists refer to it as recreational therapy, it consists of making moccasins without hard soles and leather wallets without compartments by running rawhide strips through holes on the edges. If you enjoyed doing this kind of thing as a kid at camp, you might want to sign up for it here. Fortunately, it’s optional.
When someone leaves the nursing home, it is common practice for a junior nurse to cram their belongings in a clear plastic bag. Ask to have it double bagged as I have seen the bag punctured on the way out. Picking your stuff off the cement isn’t fun, so be forewarned and benefit from other patients’ mistakes.
When someone is authorized to pick them up, patients normally wait for them at the front desk. I have seen patients wait for five hours. I suggest you go ahead with what you normally do. They will tell you when your guest arrives and you won’t be disrupting your schedule any more than necessary.
Near the front desk is a big refrigerator that is meant to be used for medicines. However, a number of patients keep snacks in it. Because the VA hospital Food Court closes early, hiding food is almost a necessity. There aren’t many things worse than having your stomach growl at night and not being able to do something about it.
During the holiday season, private religious elementary schools handcraft greeting cards for veterans in the nursing homes. The ladies auxiliary from a veterans organization crocheted blankets for us. I got a red, white, and blue one. Everyone was given two phone cards. Several days before Christmas, the DAV gave me an electric alarm clock. A number of singing groups sang carols at night in the mess hall. The plastic Christmas tree looked a bit ragged, but we made do with it anyway.
There is one part-time barber for the nursing homes. She has a retail shop on the second floor of the hospital. In two years as a patient I only saw her come downstairs once. We got shaggy in between visits. I no longer bother cutting my hair. Many barbers will not cut the hair of disabled veterans who don’t have enough mobility to transfer into a barber’s chair. They claim it’s because of their insurance policies.
The amount of money you receive from the VA is determined by your percentage. Percentage is a function of how bad you were injured in military service and whether it was service connected.
Though the VA offered to get me an electric wheelchair, I chose to stay with a manual because the muscles tend to atrophy and you tend to put on weight in an electric wheelchair. Getting (and staying) in shape is an important part of survival. I use ramps to maintain my upper body strength.
Criticizing for the sake of criticism may be cathartic, but it isn’t a substitute for detailed analysis. Personally, I believe that the VA specifically and government in general are slowly strangling the private sector by knuckling under to pressure groups and failing to enforce discipline. Promulgating regulations does little unless those regulations contain a penalty for non-compliance. It is my observation that situational ethics are utilized to justify mistakes while the private sector must compete in order to survive. Thus, private business is forced to change with the times while the VA too often perpetuates errors in order to protect its image. Image is not nearly as important as transparency. There is no need for whistle-blowers when institutions function efficiently. Why cover up for quackery, negligence, and malfeasance? Doesn’t the VA have better things to do? The budget needs to be keyed to how well the VA does its job. Only then will there be true control over the VA.
Current patient representatives who necessarily depend on the VA for their salaries and advancement need to be replaced with real ombudsmen who are independent of the VA. I would prefer these to be supplied by veterans organizations and hired by the GAO to keep tabs on the VA’s performance. Giving the VA more money without making them accountable is a waste of taxpayer resources.
The VA hospital has a Credit Union which both veterans and VA employees can use. Although few inpatients make use of it, it is a way of receiving monthly electronic deposits without having to get a check in the mail. It made managing bills easier while sick in a hospital. I chose to award my son my power of attorney so that he could conduct my monetary affairs for me. I must say he did an excellent job of it.
Microwave popcorn is a staple in the VA nursing homes. It does not cost much and it is easy to make. Kettle corn is my favorite. Kettle corn is both sweet and salty. There are also varieties with butter and other flavorings.
You might as well resign yourself to it, fully ninety percent of the inmates will die while living in this place. Although escape is not impossible, it is highly unlikely that you will have the balls to pull it off. Remember, when you entered this institution you gave the administrators your power of attorney. They own you. How does it feel to be a slave? Your plastic wristband brands you a part of this nursing home. All that awaits you is a VA cemetery plot and a brass marker.
As you acquire more prescriptions, you increase the chances of the prescriptions not being compatible. The pharmacist will help you with this. Also, some prescription drugs deplete the body of certain substances such as folic acid. If you aren’t sure, you will have to check with the pharmacist in order to find out.
Those flimsy slippers they issued you will not get you anywhere outside of the hospital. They will most likely fall apart at the first puddle. Doom stalks you. You were sentenced to life for nothing in particular. Nonentities suffer a fate worse than death. You are wearing a gown and slippers. It’s Tinker Bell in drag. Stay in the hospital because the rest of the world is laughing at you. A joke, but not a very funny one. Feeling depressed? You have no inkling of how much you depress others.
You look like an experiment that went wrong. When did you last change your underwear? Take a shower and scrub your armpits with lye soap. Put on a fresh gown and join the party. Party until you puke. Scumbags like you don’t know when it’s time to call it quits.
You can vote in elections while you are in a nursing home, but it is your responsibility to register prior to the election. Even if you cannot get out of bed, you have the right to vote. I voted in both the senatorial and the presidential election. Most of the patients voted. It is important to remember that we are a democracy and we have the right to change the government by voting the bums out.
Remember, you must share the bathroom with others. I found it better to shave and brush my teeth before going to bed. Time in the bathroom is limited in the morning. Also, we had a man with an intestinal problem in the next room who sat on the toilet seat for a long time. There are also times when patients require help with transferring.
It is best to memorize your blood type. My doctors gave me two transfusions while I was in the nursing home. Your blood type is on your dog tags and also on your medical records. My blood is A positive.
Because I could not transfer very well, they gave me a bed bath using two basins of warm water and a bar of soap. I washed my genitals myself. Student nurses were usually designated to take care of the patients while the staff nurses disappeared and took care of personal business. Nurses should be rated on the basis of how well they take care of patients rather than how much the administrators like them. Many of them don’t speak English well and don’t get along with the patients. If you complain, they label you a racist and nothing gets done about it.
It takes money to survive in the nursing home. If you don’t bribe the nurses and orderlies, they will make your life hell. Interest is charged at the rate of 100 percent per day. Do your best to stay out of the way. Once you have been there you will never call it a rest home again.
Can anyone tell me what the surgeons did with my knee? Since the VA surgeons removed my knee, I haven’t been able to walk. If the VA refuses to give me another artificial knee, they can put back my original since I was able to walk straight-legged with it. The first rule of the Hippocratic Oath is “to do no harm.” The VA has a responsibility to restore me to my original condition. What can be done to get the surgeons to correct their mistakes? This is the result of treating surgeons like prima donnas. We have to answer for our errors. Why should surgeons be any different?
Because I can’t stand up on the scales, I haven’t been weighed by the VA in more than six years. Although the VA has a special chair that weighs patients that can’t stand, they hardly ever take the time to use it on me nor have I ever had water treatment for my pain. Warm whirlpool baths would definitely help.
Collectivized healthcare is a mistake. The VA would work better if it issued vouchers to veterans that made them responsible for their own healthcare. I would like to have healthcare as good or better than other Americans.
There was one PC for use by patients in the game room across from the cafeteria. A great time for utilizing the computer was at night. After several months of trying, I discovered how to upload files to the domain, fdungan.com, I bought prior to knee surgery when I was writing my first novel. With this I communicated with a number of people who were sympathetic to my plight. Without a website, I would still be lingering in 1 Southeast. Please, don’t underestimate the power of the internet to level the playing field to where anyone can expose government incompetence, waste and corruption. Truth is omnipotent. Injustices can be corrected provided you work diligently on them.
When Congress passed the Americans with Disabilities Act, the rationale was for individuals in wheelchairs to be able to access buildings, both public and private. However, most buildings built prior to the law have yet to be renovated. This is very frustrating to people like myself.
Chapter 5
Home IAfter a number of months went by, the rehabilitation technicians arranged to rate my artificial right knee’s utility at 102 percent, a remarkable figure, considering the 82 percent reading it had the week before.
Regardless of how the figure was obtained, I was released from the nursing home the next day without taking any blood or urine tests. My personal items were stuffed in a clear plastic bag by a nurse and they telephoned my son to pick me up.
But I was in pain. My physical therapist had told me to put most of my weight on my left leg. However, my left ankle was hurting. After being home for two weeks, I found my left ankle oozing an orange fluid. The surgeon on duty at the VA’s Emergency Room immediately used a scalpel to slice both sides of my ankle open to drain without giving me a shot to numb the pain. I yelled like I had never yelled before. It was loud enough to hear in the lobby and my son rushed in to see his father in agony.
Upon examining the fluid, they found that I had staphylococcus, which had entered my bloodstream and had caused my body to reject my artificial knee. In an operation that night, the surgeons removed my titanium knee and substituted a spacer that left my right leg in a permanently bent position. It would affect my sleep and I could no longer stand or walk.
Later, I was sent to ICU where I was given two transfusions, put on an intravenous drip with antibiotics, and attached to a device that gave me a little morphine every 10 minutes when I pressed a button.
I was in ICU for 9 days when they transferred me to the nursing home at 1 South on the first floor of the VA hospital. At the time, I was not aware that I would be there for over a year.
Chapter 6
1 South
Subsequently, I was transferred to the nursing home on the first floor, 1 South, where I was given a strikingly similar intravenous drip with antibiotics and morphine. A nurse inadvertently put the wrong settings on the morphine device and I received two times as much morphine than I was supposed to get. This went on for a long time and nobody noticed. Unconscious more than half of the time, I missed many meals and lost nearly thirty pounds. By and by, they found out their mistake and tried to blame it on me.The VA programmed its own television whereby the patients got to vote on most of what was shown. They opted for a mixture of Jerry Springer and Maury Povich shows. Three or four hours of back-to-back Jerry Springer Shows were followed by almost the same amount of Maury Povich Shows. I found it hard to believe that Jerry Springer had formerly been an alderman in Chicago.
Many of the patients in 1 South seemed to like watching people throw chairs at each other. Perhaps it’s because they didn’t see much action in the nursing home. The Jerry Springer Show was choreographed in the same sense that professional wrestling is not real. The Maury Povich Show featured welfare mothers and the men that fathered their babies. Five or six of the men would be DNA tested and often none of them came up positive. When this happened, derisive shouts would occur. I must confess that I, too, was upset by the outcome. Most mothers can identify the man who fathered their child. Surely, Maury Povich displays the extremes at the expense of the norm. Racially biased programs are not permitted on television. Unfortunately, the same doesn’t appear to hold true for shows that are derogatory to a particular gender. Evidently, exploitation remains the rule despite protests to the contrary.
1 South is one of the VA’s best run nursing home. Many private healthcare facilities do little more than warehouse their patients and string them out on tranquilizers. It’s a disgrace how invalids are treated in the United States. In Asia they have more respect for their elders than we have in our culture. At least, that is what I have been told.
The 1 South and 1 Southeast nursing homes on the first floor of the hospital share the same game room, kitchen, cafeteria, and rehabilitation center. There the similarities end. They each have their own administrators and the staff is different. Since 1 South is a tad more isolated, it has been designated to warehouse the long-term patients. I am lucky in that I survived to tell my story. I trust that you will learn from it and not make the same mistakes that I did.
1 South had an excellent administrator with an open door policy that kept things running smoothly. This man really cared. On his only day off he brought his wife and son to sing karaoke with us in the cafeteria at night. Instead of the usual popcorn, we had a barbecue that he paid for with his own money. It was not lost on the patients that this man led by example. Although I have been discharged for a number of years, I can still recall how much he cared. His exemplary behavior and judgment was a rarity at the VA. Why can’t the other people in authority be like him? Is it too much to ask for people at the VA to do a good job? It’s common knowledge that people regularly get away with sleeping on duty at the VA.
It is best to get along with your roommate. There is only one TV per room and which show to watch is not always agreed upon. I often went into the game room or the cafeteria when I started to feel frustrated because of my roommate’s inflexibility. Life is too short to be getting continually upset. If your blood pressure gets too high, it can hurt you.
1 South is connected to the new eye clinic building, but patients rarely travel from one building to the other because it is open to the elements in between. Perhaps the VA is planning to enclose the area. If they did so, it would make 1 South far less isolated.
While I was in 1 South, an anonymous donor gave some books on tape to recreational therapy plus walkman-style recorders on which we could listen to them. I went through a number of John Grisham novels that had been placed on cassettes. By the time I was discharged from the hospital I had gained an appreciation for modern novels.
Veterans tend to eat at tables with other veterans who served in the same branch of the military as they did no matter when they were discharged. This holds true in the retail food court upstairs as well as in the nursing home’s mess hall. All tables look pretty much alike and there are no signs marking them, but everybody tends to sit in the same place every time. You soon learn where to sit because if you sit in the wrong place, the others won’t talk to you. This is especially true of Marines. Despite a lot of empty chairs, nobody but Marines eat at the Marine table.
Most people are familiar with non-profit organizations that serve as advocates for disabled veterans, such as Disabled American Veterans (DAV) and Veterans of Foreign Wars (VFW). They are either free or have small yearly fees and have offices which can help you with the paperwork and documents you will need. A lot of smaller organizations such as the Fleet Reserve also exist to represent you, however, only the big ones have representatives at the Loma Linda hospital. You can also get phone cards along with shawls, pens, and writing paper from them. The Red Cross dispenses donuts, bagels, and coffee to patients without charge (they take donations). The DAV contributes a van to the VA and a local auto dealership donates the hospital electric shuttle cars that pick up people from the parking lots. Volunteers operate an escort service that pushes manual wheelchairs and book carts.
Despite 1 South having an exemplary administrator, it wasn’t all that different from 1 Southeast. Due to regulations promulgated in Washington D.C., any one person in the bureaucracy doesn’t have very much latitude regardless of his/her position. Probably this explains why change comes so slow.
The VA’s nursing homes are run more for the benefit of the staff than for the patients. At least it seems that way. There are more cases of patients being treated as objects than I can relate. The elderly have feelings, too. We aren’t guinea pigs and we should not be used as test subjects without our permission such as the Tuskegee airmen were used in studies done by physicians.
Vouchers would be one way of putting veterans in control of the VA. That way veterans could choose their own services, making them competitive. However, if the vouchers were ever devalued by the government, they might not be sufficient to cover costs. I doubt that vouchers would provide a permanent solution. I don’t think dismantling the VA would be a good idea, but the veterans need to be in control and there must be some way of doing this.
The VA also has therapy dogs provided by volunteers that carry their ID cards on a thin chain around their necks and have been fixed. They entertain and interact with patients. It brings a touch of the outside world to the nursing home. These dogs are docile and are a great hit with the patients.
The VA nursing homes have too much paperwork. Forms aren’t as important as patients. The VA hierarchy keeps creating more forms as time goes on. This has got to stop. Burdening the staff with paperwork has gotten out of hand and patient healthcare is suffering from it.
It is rare for two doctors to agree on anything. They aren’t really different from the rest of us, other than they are better educated than most of us. Always get a second opinion on an irreversible diagnosis. It cannot hurt and most physicians encourage you to do so. I certainly wish I had taken the time and trouble to obtain a second opinion on my right knee before undergoing surgery. I was not aware that the surgeon was inflating his success rate.
The medical staff is scheduled with three shifts of eight hours, a day shift, an afternoon shift, and a graveyard shift. After 10 PM, half of the lights in the hallway are turned off while the late night shift is working and most of the patients are sleeping. There are bombproof heavy metal doors on the outside entrances that are locked at night. Also, the new Dell computers which the medical staff uses record the keystrokes so that administrators can view emails and other documents that have been written.
I once tried to speak to the hospital’s Director in his office about the warehousing of nursing home patients and was informed by the secretary that there was no permanent Director and that the position remained unfilled for upwards of three months. I ended up making the complaint to the secretary. How can anything get better when there is nobody in charge?
Toward the end of my stay the staff sold us kibbled duck food in an attempt to keep the patients from feeding the ducks the hard rolls the patients received at dinnertime. Because the rolls were almost inedible for old patients with few teeth, we soon returned to feeding the rolls to the ducks, along with the kibble. As far as I know, nothing has changed and the kitchen staff is still serving hard rolls with the dinners. But a parking structure will be taking the place of a large portion of the duck pond. The VA is going to tear down paradise and pave it with a parking lot. It reminds me that the VA had valet parking at one time and it failed miserably.
The State of California DMV has license plates and placards for the cars, trucks, and vans of disabled veterans, but the hospital has inadvertently obstructed the process by requiring additional paperwork. Disabled person plates are much easier to get.
If you are going to be admitted to the nursing home, bring some underwear because the gowns are flimsy and it is easy to catch cold because the temperature is kept low by the nurses in order to prevent disease. My thermostat was stuck and I almost froze with no underwear. It takes the repairman at least a week to act on a work order.
Very sick veterans belong in a nursing home, but the rest would be better off at home with medical surveillance. Nursing homes, due to their crowded facilities and vast numbers of patients with reduced immunity, tend to be hothouses for diseases. I became stronger when I went home. Why not care for elderly patients at home? It costs far less to assist them in their own home than to send them to a nursing home. If the VA implemented it, it would undoubtedly make budgetary sense.
Although doctors don’t know it, the Dell computers that they are supplied with are part of a central network which makes a dated record of each and every keystroke. That way if something is to be questioned an administrator can examine the record. Little is gained by it. There is something about getting a printed readout which an administrator finds it hard to resist. I believe that there is too much stealth going on at the VA. This is not the American way which countless veterans have given their lives to defend.
If you are in a wheelchair, like I am, you may be having difficulty reaching things. Most dressing sticks have a small cup hook on one end and a large clothes hook on the other that have proven helpful to me. However, don’t be embarrassed to ask a stranger to get an item for you from the top shelf at the market. A pipe or a long pole can also prove useful. Devices with suction tips can also help extend your reach and maneuverability.
As you accumulate prescriptions, there is a chance that one pill will conflict with another. If in doubt, ask for an opinion from one of the pharmacists. It is part of their job to inform the physicians of drugs that work at cross purposes. You can also renew drugs online, by mail, or by calling a toll-free telephone number. If you can possibly do so, please renew them 20 days prior to running out of a particular prescription. Reorder early as there may be a backlog during certain periods such as the holiday season.
The VA has gone electronic. Physicians now make entries via a Dell network computer. Nothing is handwritten. Congress wants healthcare providers, both public and private, to go digital.
Appendix A
2009 VA Co-pay Rates
(From VA Fact Sheet 16-1)
1. Outpatient Services
A. The co-pay amount is limited to a single charge per visit.
B. Services provided by a primary care clinician $15 / visit
C. Services provided by a clinical specialist (includes MRI, CAT scan, and nuclear
medicine studies $50 / visit
2. Medications
A. For each 30-day or less supply of medication for treatment of non service- connected condition $8
B. Veterans in Priority Groups 2 through 6 are limited to a $960 annual cap
3. Inpatient Services
A. Based on geographically-based means testing, lower income
veterans who live in high-cost areas may qualify for a reduction of 80% of
inpatient co-pay charges
B. Inpatient co-pay for first 90 days of care during a 365-day period $1068
C. Inpatient co-pay for each additional 90 days of care during a 365-day
period $534
D. Per diem charge $10 / day
4. Long-term Care
A. Co-pays for long-term care start on the 22nd day of care during any 12-month
period; there is no co-pay requirement for the first 21 days; actual co-pay
charges will vary according to financial information submitted on VA Form 10-
10EC.
B. Nursing Home Care/Respite Care/Geriatric Evaluation maximum of $97 / day
C. Adult Day Healthcare/Outpatient Geriatric Evaluation/Outpatient Respite Care
maximum of $15 / day
D. Domiciliary Care maximum of $5 / dayAppendix B
Facts Concerning the Department of Veterans AffairsThe Department of Veterans Affairs (VA) was established on March 15, 1989, a name change to upgrade the Veterans Administration which it had been called since the 1930’s. The VA is the second-largest of the fifteen executive cabinet departments and operates nationwide programs for health care, education, financial assistance, and burial benefits.
Of the 23.4 million veterans currently alive, nearly three-quarters served during a war or an official period of conflict. Approximately a quarter of the nation’s population is potentially eligible for VA benefits and services because they are veterans, family members or survivors of veterans.
The responsibility to care for veterans, survivors, spouses, and dependents can last a long time. Two children of Civil War veterans still draw VA benefits. About 184 children and widows of Spanish-American War veterans (circa 1898) still receive VA compensation and/or pensions.
The VA’s fiscal year 2009 spending is projected to be about $93.4 billion, including $40 billion for health care, $46.9 billion for benefits, and $230 million for the national cemetery system. There is more than a seven percent increase from the agency’s $87.6 billion budget for fiscal year 2009.
Compensation and Pension
Disability compensation is a payment to veterans who are disabled by injury or disease incurred or aggravated during active military service. Wartime veterans with low incomes who are permanently and totally disabled may be eligible for financial support through the VA’s pension program.In fiscal year 2008, the VA provided $38.9 billion in disability compensation, death compensation or pension from the VA. In addition approximately 554,700 spouses, children and parents of deceased veterans received VA benefits. Among them are 170,144 survivors of Vietnam-era veterans and 235,000 survivors of World War II veterans.
Education and Training
Since 1944, when the first GI Bill began, more than 21.8 million veterans have received $83.6 billion in GI Bill benefits for education and training. The number of GI Bill recipients include 7.8 million veterans from World War II, 2.4 million from the Korean War and 8.2 million post-Korean and Vietnam-era veterans, plus active duty personnel.Since the dependents program was enacted in 1956, the VA has also assisted in the education of more than 784,000 dependents of veterans whose deaths or total disabilities were service-connected. Since the Vietnam-era, there have been approximately 2.7 million veterans, service members, reservists and National Guardsmen who have participated in the Veterans’ Educational Assistance Program (VEAP). VEAP was established in 1977and the Montgomery GI Bill in 1985.
In 2008, the VA helped pay for the education or training of 336,527 veterans and active-duty personnel, 106,092 reservists and National Guardsmen and 80,079 survivors.
Medical Care
Perhaps the most visible of all VA benefits and services is health care. From 54 hospitals in 1930, the VA’s health care system now includes 153 medical centers, with at least one in each state, Puerto Rico and the District of Columbia. The VA operates more than 1,400 sites of care, including 909 ambulatory care and community-based outpatient clinics. 135 nursing homes, 47 residential rehabilitation treatment programs, 232 Veterans Centers and 108 comprehensive home care programs. VA health care facilities provide a broad spectrum of medical, surgical and rehabilitative care.Almost 5.5 million people received care in VA health care facilities in 2008. By the end of fiscal year 2008, 78 percent of all disabled and low-income veterans had enrolled with VA for health care and community-based outpatient clinics; 65 percent of them were treated by the VA. In 2008 VA inpatient facilities treated 773,600 patients. The VA’s outpatient clinics registered over 60 million visits.
The VA manages the largest medical education and health professions training program in the United States. VA facilities are affiliated with 107 medical schools, 55 dental schools and more than 1,200 other schools across the country. Each year, about 90,000 health professionals are trained in VA medical centers. More than half of the physicians practicing in the United States had some of their professional education in the VA health care system.
The VA’s medical system serves as a backup to the Defense Department during national emergencies and as a federal support organization during major disasters.
In 1996, the VA put its health care facilities under 21 networks that provide more medical services to more veterans and family members than at any time during the VA’s long history.
The VA has experienced unprecedented growth in the medical system workload over the past few years. The number of patients treated increased by 29 percent from 4.2 million in 2001 to nearly 5.5 million in 2008.
To receive VA health care benefits veterans must enroll. The VA health care system had nearly 7.9 million veterans who were enrolled as of October 2008. When they enroll, they are placed in priority groups or categories that help VA manage health care services within budgetary constraints and ensure quality care for those enrolled.
Some veterans are exempted from having to enroll. People who do not have to enroll include veterans with a service-connected disability of 50 percent or more, veterans who were discharged from the military within one year but have not been rated for a VA disability benefit and veterans seeking care for only a service-connected disability. Veterans with service-connected disabilities receive priority access to care for hospitalization and outpatient care. Veterans of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) are eligible to receive enhanced health care benefits for five years following their military separation date.
Since 1979, the VA’s Readjustment Counseling Service has operated Vet Centers, which provide psychological counseling for war-related trauma, community outreach and referral activities, plus supportive social services to veterans and family members. There are 232 Vet Centers.
Since the first Vet Center opened, more than two million veterans have been helped. Every year, the vet centers serve more than 130,000 veterans and accommodate more than a million visits by veterans and family members.
Vet centers are open to any veteran who served in the military in a combat theater during wartime or anywhere during a peiod of armed hostilities. Vet Centers also provide trauma counseling to veterans who were sexully assaulted or harassed while on active duty, and brereavement counseling to the families of service members who die on active duty.
The VA provides health care and benefits to more than 100,000 homeless veterans each year. Although the proportion of veterans among the homeless is declining, the VA continues to engage veterans in outreach, medical care, benefits assistance, transitional housing, and case management for veterans in permanent housing. The VA has made more than 450 grants for transitional housing, service centers and vans for outreach and transportation to state and local governments, tribal governments, non-profit community and faith-based service providers.
Indispensable to providing America’s veterans with quality medical care are nearly 127,000 active volunteers in the VA’s Voluntary Service who donated more than 11 million hours in 2008 to bring companionship and care to hospitalized veterans. These hours equate to 5,519 full-time employee-equivalent (FTEE) positions.
Research
VA research focuses on areas of concern to veterans. VA research has earned an international reputation for excellence in areas such as aging, chronic disease, prosthetics, and mental health. Studies conducted within the VA help improve medical care not only for the veterans enrolled in the VA’s health care system, but for the nation at large. Because seven in ten VA researchers are also clinicians, the VA is uniquely positioned to translate research results into improved patient care. VA scientists and clinicians collaborate across many disciplines, resulting in a synergistic flow of inquiry, discovery and innovation between labs and clinics.VA investigators played key roles in developing the cardiac pacemaker, the CT scan, radioimmunoassay, and advances in artificial limbs. The first liver transplant in the world was performed by a VA surgeon-researcher. VA experiments on veterans established the effectiveness of new treatments for tuberculosis, schizophrenia and high blood pressure. The "Seattle Foot" developed by VA technicians has permitted veterans with amputations to run and jump. VA contributions to medical knowledge have won VA scientists many awards, including the Nobel Prize and the Lasker Award.
Special VA “centers of excellence&rdquo: conduct leading-edge research in areas of prime importance to veterans, such as neurotrauma, prosthetics, spinal cord injury, hearing and vision Special VA “centers of excellence” conduct leading-edge research in areas of prime importance to veterans, such as neurotrauma, prosthetics, spinal cord injury, hearing and vision loss, alcoholism, stroke, and health care disparities. Through the VA’s Cooperative Studies Program, researchers conduct multicenter clinical trials to investigate the best therapy for various diseases affecting large numbers of veterans. Examples of current projects include testing whether intensive control of blood sugar can reduce cardiovascular problems for patients with type 2 diabetes; and comparing deep brain stimulation with other treatments for Parkinson’s disease.
Deployment health is a major priority for VA research. In addition to studies focused on recent veterans of operations Iraqi Freedom and Enduring Freedom, research continues on issues of special concern to veterans of earlier conflicts, such as the Gulf War and Vietnam War.
Home Loan Assistance From 1944, when VA began helping veterans purchase homes under the original GI Bill, through December 2007, more than 18.4 million VA home loan guaranties have been issued, with a total value of $967 billion. The VA ended fiscal year 2008 with almost 2.1 million active home loans, reflecting amortized loans totaling $220.8 billion.
In fiscal year 2007, the VA guaranteed 179,000 loans valued at $36.1 billion. During fiscal year 2008, the VA’s programs for specially adapted housing helped 550 disabled veterans with grants totaling more than $24.6 million.
Insurance
The VA operates one of the largest life insurance programs in the world. VA directly administers six life insurance programs. In addition, the VA supervises the Servicemembers' Group Life Insurance and the Veterans’ Group Life insurance programs. These programs provide $1.3 trillion in insurance coverage to 4 million veterans, active-duty members, reservists and National Guard soldiers, plus 3.1 million spouses and children.Traumatic Injury Protection program under Servicemembers’ Group Life Insurance provides coverage to active-duty personnel who sustain traumatic brain injuries that result in severe losses. Benefit amounts range from $25,000 to $100,000, depending on the loss. This program covers 2.4 million members.
In 2007, the VA life insurance programs returned $354 million in dividends to 1 million veterans holding some of these VA life insurance policies, and paid an additional $1.1 billion in death claims.
Vocational Rehabilitation
The VA’s Vocational Rehabilitation and Employment program provides services to enable veterans with service-connected disabilities to achieve optimum independence in daily living, and, to the maximum extent feasible, obtain and maintain employment. During fiscal years 1999 through 2008, 86,983 program participants achieved rehabilitation by obtaining and maintaining suitable employment. Additionally, during that same period 21,108 participants achieved rehabilitation through maximum independence in daily living.The VA’s National Cemeteries
In 1973, the Army transferred 82 national cemeteries to the VA, which now manages them through its National Cemetery Administration. Currently, the VA maintains 125 national cemeteries in 39 states and Puerto Rico.In 2008, VA national cemeteries conducted 103,275 interments. The number is likely to increase as VA opens new national cemeteries or markers for veterans’ graves. Since taking over the veterans cemetery program in 1973, the VA has provided more than 10.2 million headstones and markers.
Between 1999 and 2008, the VA opened 10 new national cemeteries. Gerald B. H. Solomon Saratoga National Cemetery near Albany, New York; Abraham Lincoln National Cemetery near Chicago; Dallas-Fort Worth National Cemetery; Ohio Western Reserve National Cemetery near Cleveland; Fort Sill National Cemetery near Oklahoma City; the National Cemetery of the Alleghenies near Pittsburgh; Great Lakes National Cemetery near Detroit; Georgia National Cemetery, north of Atlanta; Sacramento National Cemetery in California; and South Florida National Cemetery in West Palm Beach, Florida.
This year, the VA plans to open six new national cemeteries near Philadelphia; Jacksonville, Florida; Sarasota, Florida; Birmingham, Alabama; Greenville/Columbia, South Carolina; and Bakersfield, California. By 2009, these six new cemeteries will help the VA serve 90 percent of veterans with an open national cemetery or state veterans cemetery within 75 miles of their homes.
The VA administers the Presidential Memorial Certificate program, which provides gold embossed certificates to commemorate honorably discharged, deceased veterans. They are sent to the veteran’s next of kin and loved ones. The VA provided 511,353 certificates in 2008.
The VA also administers the State Cemetery Grants Program, which encourages development of state veterans cemeteries. The VA provides up to 100 percent of the funds to develop, expand or improve veterans cemeteries operated by the states. More than $344 million has been awarded for 72 operational veterans cemeteries in 38 states, Saipan and Guam. In 2008, state cemeteries that received VA grants buried nearly 25,000 eligible and family members.
VA Employees
As of September 30, 2008, VA had 278,565 employees on the rolls. Among all departments and agencies of the federal government, only the Department of Defense has a larger workforce. Of the total number of VA employees, 247,113 were in the Veterans Health Administration, 16,135 in the Veterans Benefits Administration, 1,549 in the National Cemetery System, 3,412 in the Veterans Canteen Service and 437 in the Revolving Supply Fund. The rest, 9,919 employees, are in various staff and facilities offices.Chronological History
In 1930, the Veterans Administration was created by Executive Order #5398, signed by President Herbert Hoover on July 21. At that time, there were 54 hospitals, 4.7 million living veterans and 31,600 employees. In 1933, the Board of Veterans Appeals was established.On June 22, 1944, a grateful President Franklin Roosevelt signed the “Serviceman’s Readjustment Act of 1944” (Public Law 346, passed unanimously by the 78th Congress), more commonly known as “The GI Bill of Rights,” offering home loans and education benefits to veterans.
The Department of Medicine and Surgery was also established, succeeded in 1989 by the Veterans Health Services and Research Administration, renamed the Veterans Health Administration in 1991.
In 1953, the Department of Veterans Benefits was established, succeeded in 1989 by the Veterans Benefits Administration.
In 1973, the National Cemetery System, renamed the National Cemetery Administration in 1998, was created when Congress transferred 82 national cemeteries from the Army to the VA. The Army kept Arlington National Cemetery and the U.S. Soldiers’ and Airmens’ Home National Cemetery in Washington, D.C.
In 1988, the legislation to elevate the VA to cabinet status was signed by President Ronald Reagan.
On March 15, 1989, the VA became the 14th department in the presidential cabinet.
Secretaries of Veterans Affairs
Eric K. Shinseki 2009 - Present
James B. Peake 2007 - 2009
R. James Nicholson 2005 - 2007
Anthony J. Principi 2001 - 2005
Togo D. West, Jr. 1998 - 2000
Jesse Brown 1993 - 1997
Edward J. Derwinski 1989 - 1992
Health care fraud and abuse occurs in every facet of the health care arena. Health care fraud is the intentional misrepresentation of a material fact on a health care claim in order to receive untitled payment. Health care waste and abuse describes practices that, either directly or indirectly, result in unnecessary costs to a health care program.
Some elements of fraud, waste and abuse may include:
• Misrepresentation or concealment of a material fact on a health care claim
• Knowledge that the facts on a medical claim is false or misrepresented
• Intent to deprive or harm the Health Administration Center (HAC) and its customers financially
• Unnecessary medical services or supplies
• Lack of conformity to professionally recognized standards
• Services or supplies rendered and billed at prices exceeding customary and usual charges
Who commits health care fraud, waste and abuse?
Providers who intentionally engage in any of the following are committing health care fraud, waste and abuse. This list is not all-inclusive:
• Bill incorrectly
• Bill for services you didn‘t get, inappropriate/unnecessary services, or “free services”
• Make false claims about qualifications, licensure and/or education
• Falsify records to suggest on-going medical services
• Forge a physician’s signature on plans of care
• Alter information on care plans, prescriptions, and/ or • Unnecessary medical services or supplies
• Lack of conformity to professionally recognized standards
• Services or supplies rendered and billed at prices exceeding customary and usual charges
• Falsify the diagnosis or procedure to maximize payments
• Change dates of service for double billing
• Waive the deductible and copays
Individuals who intentionally engage in any of the following commit health care fraud, waste and abuse. This list is not all-inclusive:
• Share health plan authorization cards
• Claim non-covered dependents
• Participate in doctor shopping (“Doctor Shopping” is a term commonly used to refer to a patient who may or may not have a legitimate physical ailment but goes from doctor to doctor with the objective of improperly obtaining multiple prescriptions for narcotic painkillers)
• Consent with providers to submit claims for services not received or not necessary
• Fabricate claims
• Alter submitted medical documentation of any type
• Use a stolen health plan authorization card to obtain health care services
• Use a deceased beneficiary’s health plan authorization card to obtain health care services
• Ineligible persons using a beneficiary’s health plan authorization card to obtain medical services or benefits HAC employees who engage in any of the following acts commit health care fraud, waste and abuse. This list is not all-inclusive:
• Fabricate claims
• Provide false application data
• Change a provider’s address to intercept provider payments
What are some things beneficiaries can do to assist in combating fraud, waste and abuse?
• Always protect your health plan authorization card
• Be cautious and know to whom you give your health plan authorization card or medical information to
• Immediately report a lost or stolen health plan authorization card
What should I do if I suspect fraud, waste or abuse?
Thoroughly review your Explanation of Benefits (EOB). If you note a service and/or supply billed to us that you did not receive, please report that immediately in writing. Please indicate in your letter that you are filing a fraud complaint and include the following facts:
• Name and address of the provider
• Name of beneficiary who was listed as receiving the service or item
• The claim number
• The date of the service in question
• The service or item that you do not believe was provided
• The reason and any supporting information or documentation why you believe the claim should not have been paid
Whom should I contact if I suspect fraud, waste or abuse?
Please contact:
VA Health Administration Center
Attn: Program Integrity
PO Box 469060
Denver, CO 80246-9060
• Phone: 1-800-733-8387 Monday – Friday
• Fax: 1-303-331-7804
• Email: To contact us by email, please go to this web link and follow the directions for submitting secure email: http://www.va.gov/hac/contact
• Website: www.va.gov/hac
Appendix D
Survivors Benefits
What the VA Offers
The Department of Veterans Affairs (VA) offers a wide range of benefits and services for the surviving spouse, dependent children and dependent parents of deceased veterans and military servicemembers.
Dependency and Indemnity Compensation (DIC) — DIC is a tax-free benefit for the surviving spouse and dependent children. A spouse's Survivor Benefits Plan (SBP) annuity is reduced by any DIC amount received. Note: A surviving spouse who remarries on or after December 16, 2003, and on or after attaining age 57, is entitled to continue to receive DIC.
VA also adds a transitional benefit of $250 to the surviving spouse's monthly DIC if there are children under age 18. The amount is based on a family unit, not individual children. It is paid for two years from the date that entitlement to DIC commences, but is discontinued earlier when there is no child under age 18 or no child on the surviving spouse's DIC for any reason.
To apply for DIC:
Usually an application for DIC benefits is completed by the Casualty Assistance Officer and submitted on behalf of the survivor. VA Form 21-534a, Application for Dependency and Indemnity Compensation by a Surviving Spouse or Child, is used for this purpose. This form needs special processing and should be mailed or FAXED along with DD Form 1300, Report of Casualty, to:
Department of Veterans Affairs Regional Office and Insurance Center P.O. Box 8079 Philadelphia, PA 19101FAX number: (215) 381-3084.
Parents' DIC -- Parents' DIC is a monthly benefit amount for the decedent's parents. It is based on income.
To apply for Parents DIC:
Download and complete a PDF version of VA Form 21-535 and mail to the VA regional office that serves the area where you reside.
Survivors' and Dependents' Educational Assistance (DEA) — Survivors' and Dependents' Educational Assistance provides payment of a monthly education or training allowance to the spouse and children of a veteran who died of a service-connected disability. Eligible persons can receive up to 45 months of benefits. Professional, educational and vocational counseling will be provided to eligible children and surviving spouses without charge upon request.
To apply for DEA:
Download and complete a PDF version of VA Form 22-5490. Follow the instructions on the form for more information on how to file the application for DEA benefits.
Work-Study Employment — This program is available to eligible survivors while pursuing a program of education or training under Dependent's Educational Assistance (Chapter 35).
To apply for Work Study Employment:
Download and complete a PDF version of VA Form 22-8691, Application for Work-Study Allowance. Follow the instructions on the form for more information on how to file the application for Work Study benefits.
Home Loan Guaranty — The surviving spouse of a veteran who died in service or as the result of a service-connected disability may be eligible for a guaranteed loan from a private lender. The loan may be used to purchase, construct or improve a home; to purchase a manufactured home and/or lot; or to refinance existing mortgages or other liens of record on a dwelling owned and occupied by the surviving spouse as his or her home. There is no time limit to use this benefit.
To apply for a VA Home Loan Guaranty:
Download and complete a PDF version of VA Form 26-1817, Request for Determination of Loan Guaranty Eligibility and submit it to the VA Loan Eligibility Center that serves your location.
Burial Benefits (Headstones, Markers Presidential Memorial Certificates)
Headstones and Grave Markers VA provides headstones and grave markers for the graves of veterans anywhere in the world and of eligible dependents who are buried in military post, state veteran or national cemeteries. Niche markers also are available for identifying cremated remains in columbaria and memorial markers if the remains are not available for burial.
Presidential Memorial CertificateA certificate bearing the President's signature is issued to recognize the service of deceased veterans who were discharged under honorable conditions. Eligible recipients include next of kin or other loved ones. A certificate can be issued to more than one eligible recipient. VA regional offices can help you in applying for certificates.
Life Insurance Settlement — Information on where and how to file for Servicemember's Group Life Insurance (SGLI) proceeds may be found at VA's Insurance Center Web site. You may also contact the Office of Service members' Group Life Insurance by phone at 1-800-419-1473, by email at osgli.claims@prudential.com, or by mail at:
Office of Servicemembers' Group Life Insurance 80 Livingston Avenue Roseland, New Jersey 07068-1733
Financial Counseling services are available at no cost to SGLI Insurance beneficiaries. This service provides a one-on-one counseling session, a detailed step-by-step financial plan, and access to financial counselors for one year. For additional information, call 1-888-243-7351.
Vet Center Bereavement Counseling — Bereavement Counseling is now being offered to parents, spouses and children of Armed Forces personnel who died in the service of their country. Also eligible are family members of reservists and National Guardsmen who die while on duty.
A new tri-fold brochure is now available for you to read or download. It is in a Power Point format but prints out nicely on two standard 8 1/2" by 11" sheets of paper. This is a 972 kb file.
Vocational Rehabilitation & Employment (VR&E) Services — VR&E can provide a wide range of vocational and educational counseling services to survivors and dependents who are eligible for one of VA's educational benefit programs. These services are designed to help an individual choose a vocational direction and determine the course needed to achieve the chosen goal.
Survivors and dependents should contact their local VA Vocational Rehabilitation & Employment program office for further information.
Education Program Refunds — The designated survivor of a deceased servicemenber will be refunded the service member's :
pay reductions for participation in the Montgomery GI Bill, less benefits previously paid to the servicemember
contributions to the Veterans Educational Assistance Program (VEAP).
VA Information and Assistance
Visit your VA regional office, or Call toll-free 1-800-827-1000, or Electronic Internet messaging at: https://iris.va.gov, or Visit the VA web site at http://www.va.gov. Information about State benefits may be found at: http://www.va.gov/partners/stateoffice/index.htm
Helpful Contacts
There are many veterans service organizations that offer assistance as well as other Federal and private organizations. For information on these organizations, refer to your telephone directory, contact your VA regional office, or visit the VA web site. Here is a list of the contacts available:
Direct Deposit (VA only) (877) 838-2778
VA Education Benefits (800) 442-4551
Service Member's Group Life Insurance (800) 419-1473
Benefits and Services Outside the U.S. (VA's Foreign Services)
Telecommunication Device for the Deaf (TDD) (800) 829-4833
Social Security Administration (800) 772-1213
Survivor Benefit Plan (SBP) (800) 321-1080
TRICARE www.tricare.osd.mil (800) 874-2273
Office of Personnel Management (OPM) www.OPM.gov (800) 767-6738
American Gold Star Mothers www.goldstarmoms.com (202) 265-0991
Gold Star Wives of America www.goldstarwives.org (888) 751-6350
Tragedy Assistance Program for Survivors (TAPS) www.taps.org (800) 959-8277
Bibliography
Pool, Bob, “Veterans with a Gripe Upend Stars and Stripes,” Los Angeles Times, June 27, 2009, A8.
(to be continued)