Veterans Agency Prepares for Grim Work : Casualties: The VA chief says everything from hospitals to insurance forms are ready. Some critics have their doubts.

The suppliers of grave-site headstones are on alert. Directors of the national cemeteries have been told to go out of their way to accommodate the wishes of next of kin, even if that means providing for rare weekend burials. “Casualty assistance counselors” are on standby to process life insurance and disability claims. Eighty hospitals are preparing to receive the wounded, perhaps directly from the killing fields.

With little notice, the Department of Veterans Affairs is grimly preparing for the decidedly unglamorous, heart-rending side of the Persian Gulf War.

“This probably is the biggest challenge for the VA since World War II,” said Edward J. Derwinski, secretary of veterans affairs. “Quite frankly, in the first month or two (after the U.S. deployment of troops to the Middle East) there was a lot of dust and sloppiness in the system. But now we’re ready.”

Once widely regarded as a bloated, mismanaged agency second in size only to the Pentagon, the VA is now a full-fledged Cabinet department bent on acquiring a new image. And it suddenly finds itself under enormous pressures.

“The challenge before us is enormous,” Derwinski said in an interview. “But we are prepared to meet head-on the awesome challenge presented by Desert Storm.”

However, others are not so sanguine. There are those who fear that the 250,000-employee department will not live up to the task should the casualties begin coming home in vast numbers after a bloody ground war against Iraq begins.

The Veterans of Foreign Wars, for instance, this week sent its own inspectors around the country to verify the VA’s claim that its hospitals and medical personnel are ready to receive more than 9,000 wounded American fighting men and women within 24-hours notice and up to 25,000 GIs with three-days notice. Rep. Les Aspin (D-Wis.), chairman of the House Armed Services Committee, has put the estimated number of U.S. casualties at 10,000 to 20,000 if a ground war breaks out.

“I hope the VA is ready, but I’ve got some serious concerns,” said Larry W. Rivers, a Vietnam veteran who now heads the 2.2 million-member VFW.

Whether the department, which acquired Cabinet status in March, 1989, can meet the challenge may well shape the department’s public image for years to come--and perhaps affect its ability to serve the 27 million veterans throughout the nation.

Aside from operating 113 national cemeteries in 38 states and Puerto Rico, the VA spends about half of its $30-billion annual budget administering compensation and pension programs to millions of veterans, spouses and children--including, even today, 2,700 surviving spouses of veterans of the Spanish-American War and six from the Civil War.

The VA also runs an independent, if much-criticized, health-care system, which employs 12,000 physicians and 60,000 nurses at 172 medical centers, 233 outpatient clinics and 119 nursing homes throughout the country. It treats about 4 million veterans a year.

It is these medical facilities, particularly 80 of the hospitals, that have been designated as the primary backup to Department of Defense hospitals in treating wounded soldiers right off the battlefields. The plan calls for all casualties to be transported directly to the military hospitals, but if the 16,000 military hospital beds are filled, the excess would be airlifted to the VA facilities.

Some VA critics, such as Rivers, worry that the department’s hospitals and medical personnel are ill-equipped to deal with what may become an avalanche of wounded soldiers. Because the VA has been “chronically underfunded,” he says, many VA hospitals are deteriorating and have antiquated equipment.

Even though the department has enjoyed modest budget increases in recent years, that funding has not kept up with the double-digit inflation in health-care costs. As a result, Rivers says, the VA has had difficulties attracting and retaining top-notch medical personnel, especially in specialties such as orthopedic surgery.

“That has created all sorts of problems that may undermine the VA’s role as backup to the Department of Defense,” Rivers said.

But Derwinski disagrees, saying that half of the doctors in training spend some time in a VA facility. He notes that more than 100 VA hospitals now are affiliated with medical schools. “So we have access to some of the best medical expertise in the country,” he said.

Another major concern, expressed earlier this month by Sen. Alan Cranston (D-Calif.), is whether the VA, in making bed space available for those wounded in Operation Desert Storm, might unnecessarily displace already hospitalized veterans, creating hardships.

“We want to know how they are going to deal with the veterans already there,” Rivers said. “Many of the hospitals are at capacity now. The VA says it’s ready. But we’re not really sure that’s the case.”

Derwinski says the capacity can be created simply by deferring elective surgeries and through arrangements with community hospitals to accept veterans who are now hospitalized. The hospitals would be reimbursed by the government.

“Should the need arise to make beds available for active-duty casualty patients,” Derwinski said, “veteran patients may be discharged if medically stable from primary receiving centers and/or transferred to other VA or community hospitals.”

During World War II, the Pentagon had 500,000 hospital beds for wounded GIs; today, it has only 16,000. As a result, the VA now serves as the backup medical system in times of war. During the Vietnam War, the Pentagon was able to rely largely on its own hospitals to provide first-line treatment because the casualties were spaced out over a decade.

Derwinski has designated the 80 VA hospitals as “primary” sites that would receive wounded soldiers either directly from a military hospital or directly from the battlefield. In addition, 79 “secondary” VA hospitals have been designated to receive any overflow from the primary hospitals.

The actual flow of casualties would be determined by the Armed Services Medical Regulating Office at the Scott Air Force Base in Bellville, Ill. To help that office keep track, Derwinski has set up a Desert Storm Emergency Facility Operations Center to monitor by computer the daily availability of VA beds--broken down into eight specialties, ranging from burns and surgery to psychiatric care to spinal injuries.

There is yet another backup system for the Pentagon, called the National Disaster Medical System, administered by the U.S. Public Health Service. On a voluntary basis, 1,600 hospitals covering 107 of the largest metropolitan areas would make 105,000 beds available in the event of a war or huge civil disaster. To date, however, the NDMS has not been activated, says Tom Reutershan, director of the public health service’s emergency preparedness system.

Over the years, the VA has pioneered many treatments for tuberculosis, alcoholism, spinal injuries, limb losses and diseases associated with aging. But more recently, it has been criticized for the general quality of care provided to veterans, including charges by the General Accounting Office that the VA conducts insufficient background checks on prospective medical personnel.

The agency also has been accused of failing to adequately track and monitor pacemakers implanted in veterans. And four cardiac surgery units were closed because of unsatisfactory performance results.

Three years ago, VA administrators also were criticized for having spent $386,000 to refurbish offices that gave them unobstructed views of the White House, a block away.

In addition, the VA’s home loan guarantee program has been plagued by accusations of fraud and mismanagement, most recently by the acting inspector general of the VA in July.

Separately, the House Government Operations Committee charged that the department had repeatedly published “inaccurate and misleading” data that under-reported mistakes the VA made in processing veterans’ benefit claims.

Most of these problems have been resolved, although the investigation of the home loan program is said to be continuing.

Derwinski believes that a sterling performance by his department in the weeks ahead would go a long way toward putting those public relations disasters behind.

“We very much hope that all this preparation will prove unnecessary,” he said. “But we’re ready for them.”