Quality of Care in Veterans Hospitals Questioned in Key Senator’s Report

The Department of Veterans Affairs cannot assure veterans that they are receiving the best health care possible from the more than 170 VA hospitals, warns the ranking Democrat on the Senate committee that oversees the VA.

Sen. John D. “Jay” Rockefeller IV (D-W. Va.) delivered his bleak assessment of the department’s health care system to VA Secretary-designate Togo West Jr. in a Dec. 19 letter. Along with the letter, the senator sent a Senate minority staff report that questions whether the VA is paying enough attention to patient-care issues.

“The sad truth is that we can’t accurately answer the basic question: ‘Do our veterans receive the highest quality of care in VA hospitals and clinics?’ ” Rockefeller told West. He said his 50-page staff report “shows clearly that the VA simply does not have the programs and systems in place to adequately monitor, track and analyze the quality of care provided.”

VA spokesmen said this week that West, currently secretary of the Army, is not due at the department until Jan. 2 and that VA officials have not yet reviewed the Rockefeller report. They noted, however, that Kenneth W. Kizer, the VA’s undersecretary for health, recently initiated a program with several large medical groups to address quality issues in the VA system.

Rockefeller’s report did not mention Kizer--the department’s top doctor--by name, but it charged that because of budget constraints and other issues the VA has dropped or curtailed many programs during Kizer’s tenure that could have had an impact on quality health care.

“VA has made many efforts to address quality of care delivered to veterans, but staff believes that many of these efforts were short-lived, poorly executed, poorly tracked and despite apparent value, often abandoned,” the report concluded.

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Referring to a Kizer-directed reorganization of the VA health system into 22 regions, the report said, “When the VA goes through an organization change, it is almost as if it declares war on its former self.” The regions have assumed many of the quality-control issues previously dictated by the VA’s central office in Washington, the report said.

The senator appealed to West to establish a national advisory board on quality-care issues to oversee the hospitals and clinics, reestablishing some measure of Washington control over quality issues in the hospital system. The number of staff workers assigned to VA’s central quality-management office has dropped to 11 from a high of 26 in 1990, the staff report noted.

Because Rockefeller is ranking Democrat on the Veterans Affairs Committee, his position will be difficult for West to ignore. The senator’s questions about the quality of VA health care are likely to provide even more controversy for West’s confirmation hearings, tentatively set for Jan. 29.

The hearings were expected to be dominated by Republican questions about the burial policies at Arlington National Cemetery, run by the Army, and burial waivers that West granted as Army secretary to non-veterans, including former U.S. ambassador to Switzerland M. Larry Lawrence, a major Democratic Party contributor.

Rockefeller’s questions are likely to put a spotlight on the long-standing but often-denied claims that VA health care is inferior to that of private hospitals.

The Rockefeller report is not based on any specific incidents of poor patient care, although it notes that the House Veterans Affairs Committee earlier this year held hearings on several such cases.

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What is needed in response, the staff report contends, is “strong, central leadership and the commitment from VA headquarters to develop a national system devoted to managing quality-of-care issues, with the resources and organizational prominence needed to carry out this important mission.”