VApicFrom The American Prospect new blog post

Despite Assurances, VA Secretary Pushes Toward Privatization

Secretary of the Department of Veterans’ Affairs, David Shulkin, has pledged not to privatize the Veterans Health Administration (VHA). He understands, he says, that the VHA’s ability to provide care that, as studies document, is superior to those in the private sector is because veterans are treated in an integrated system that meets all their health needs. In testimony to the House Committee on Appropriations Veterans Oversight Hearing on May 3, Shulkin argued that unlike the private sector, the VHA “defines health far more broadly as physical, psychological, social, and economic.” Such a “unique national resource … often cannot be found in the private sector.”

In spite of this some of Secretary Shulkin’s recent decisions are very troubling. In March, Shulkin announced that the VHA would begin providing emergency mental health services to veterans previously ineligible for them. While that coverage is long overdue, the VA’s budget will likely push some already enrolled patients out of the VHA system and onto private providers. At the same time, Shulkin has proposed outsourcing optometry and audiology care to the private sector. In both cases, the changes threaten to jeopardize the kind of integrated services the VHA provides.  Read More

Must Read!! Doctors at War

80140100810940MAlmost two years ago, Mark De Rond, an ethnographer at Cambridge University in England, sent a manuscript to the Culture and Politics of Health Care Work series at Cornell University Press. As co-editor of the series, I reviewed the manuscript — Doctors at War — which has just been published . It was done in the form of a of field notes describing De Rond’s months embedding with surgeons in a field hospital in Afghanistan during what is euphemistically dubbed – in the US at least – Operation Enduring Freedom. In other words the US war in Afghanistan, which is being waged not only by the US military but also by allies from other countries like the British, who, with the Americans ran Camp Bastion. The British Ministry of Defense (MOD) had asked De Rond to go to Afghanistan to study teamwork among British and American surgeons in the field hospital at Camp Bastion. As he describes it in the book, Camp Bastion was “the most successful trauma unit anywhere in the world.”

From the moment I began reading, I knew how important this book was and the contribution it could make not only to the healthcare literature but also to the literature of war. The MOD agreed that De Rond had a great deal to contribute to our understanding of how people work together under stress and encouraged him to not only write a report but to turn his work into a book. Then when the MOD saw the book, the tune changed and the MOD tried to block its publication. De Rond was forced to get a legal opinion in order to proceed with publication.

When you read this book – and please, if you have any interest in the folly of war and its human cost, you must read this book – you will understand why we loved it and the MOD hated it.

In it De Rond follows a British surgeon whom he calls Jesus and his colleagues in their daily round of trauma surgery. As he reports, between 2006 and July 2013, “just short of 20,00 casualties to the field hospital.” These not only included military personnel but locals who were injured. These physicians had to treat enemy combatants as well as civilians, many of them children – collateral damage of the war on terror.

Which has produced its own terror. Day after day, they wade elbows deep into the blood and guts, veins, and limbs, of what this elective war has wrought. We see not only the amazing feats of modern trauma surgery – which thanks to modern technology and the skill of these surgeons, nurses, and other battlefield hospital personnel, save people who would have died immediately in other wars. We also see the horrific wounds and trauma with which they will have to cope for the rest of their lives. After only a short stay in Afghanistan, De Rond himself has to deal with the trauma of what he witnessed.

I urge you all to read this important book, which as Chris Hedges says in his foreword to Doctors at War, “shines a light on a reality we are not supposed to see. It is a reality, especially in an age of endless techno war, we must confront if we are to recover the human.”

 

If You Haven’t Read Niemoller Lately…

niemoller indexI was reminded of the famous quote by Reverend Martin Niemoller  when I read this front page story in The New York Times about Trump voters, who are suddenly worried because they are losing government benefits they apparently didn’t think Trump would touch.

 

“First they came for the Socialists, and I did not speak out—
Because I was not a Socialist.Then they came for the Trade Unionists, and I did not speak out—
Because I was not a Trade Unionist.

Then they came for the Jews, and I did not speak out—
Because I was not a Jew.

Then they came for me—and there was no one left to speak for me.

 

 

 

 

 

Silencing Employees? Is that Good for Patient Safety at the VHA?

From Beyond Chron

New Threats to Patient Safety at the VHA

by Suzanne Gordon on March 9, 2017

VA Hospital in Washington DC

VA Hospital in Washington DC

Ever since a physician at the Phoenix VA Health Care System reported that Veterans Health Administration (VHA) administrators had been gaming data on wait times for patient appointments, VA whistleblowers have been embraced on Capitol Hill. There may be disagreement in Washington about the future of the VHA, but there is bi-partisan agreement that VHA employees should be supported and rewarded when they act to protect their patients.

Unfortunately, not enough legislators and veterans advocates understand that acting to create real patient safety involves far more than being a traditional whistleblower, which, as Webster’s dictionary explains, is “one who reveals something covert or who informs against another.” Or as the Federal Whistleblower Protection Act defines it, involves reporting a “violation of a law, rule or regulation; gross mismanagement; gross waste of funds; an abuse of authority; or a substantial and specific danger to public health or safety.” 

As an extensive literature on patient safety documents, patient safety depends not primarily on the acts of heroic whistleblowers, but on the creation of a workplace environment where you don’t have to be a hero to voice concerns or criticisms, share insights, and make suggestions for change on a daily basis. READ MORE