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Edward Brooks: Death by delay — one man’s experience with the Veterans Administration

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Posted: Wednesday, June 18, 2014 12:00 am

The firing ranges ran out almost to the bay it seemed, sandy, incongruous in the semi-tropical Monterey setting. Was this preparation for war or the ideal vacation spot?

It was Fort Ord in the 1960s, where we National Guard reservists trained for six months with light weapons. These included the legendary Browning Automatic Rifle, or BAR, a machine gun intended for one man carry, at a mere 19 pounds, not counting ammo. The usual complement of ammo was four 20-round magazines.

The range qualification involved a team approach — one man firing the gun in the prone position, with his buddy acting as assistant gunner, handing him the magazines.

It is well-known among shooters that a gun is loudest when you are to one side, not behind it. The assistant gunner laid next to the gunner, opposite the breech of the gun, ready to hand him a fresh magazine as each was emptied. This exposed the assistant to the very loud noise at the breech. The cartridge issued to us in those early days before U.S. direct involvement in Vietnam was the 30-06, a much heavier round than the one used in that war.

When my turn came to take the assistant gunner position, the gunner had the BAR auto selector switch set to slow, so he could squeeze off single rounds. I felt a physical pain in my ears as each round went off. That was the beginning of my VA disability.

I received some VA evaluation in the ‘70s. The VA was a small-town department in those days. It was only recently that I experienced a new VA, a grimaced face of winding federal corridors, bureaucratic obstructions and armed federal police. I discovered the VA’s scandalous treatment of vets before the news hit of dead veterans at its hands.

My experience began with the arrival of an impressive packet from the VA individualized to me (my name and some of my personal information is printed in the text!). Most impressive. It described a wonderland of free government medical benefits. I imagined dropping my insurance coverage and enjoying these wonderful government services as a reward for my service and my service-connected disability.

Only later did I learn it is all show. Then I realized the fullness of the offer of benefits was an inverse measure of the time it would take to get the services.

The truth of it all arrived when I met my primary care physician at the Livermore VA facility. Unlike before, now I had to have a PCP before I could receive a referral to the audiology clinic for upgraded hearing aids. I made the initial appointment, which was set out some two months.

The appointment rolled around. Check-in was a new experience. I showed my VA photo ID, but that wasn’t enough. The clerk wanted my address, phone number and Social Security number.

When the address (I have two) didn’t match the records, he insisted on the correct one. It was clear that if I didn’t jump through the hoops, I wouldn’t get the long-awaited appointment.

I showed the clerk the impressive plastic VA ID card again, with my recent photo on it, and “service connected” at the bottom. Wasn’t that enough? No. The correct address was required. I dug it up.

The physician had earned her M.D. from an institution rated 88th among medical schools, and unranked in primary care or research, according to evaluating organizations. She spent her time at a computer during the “exam.” She said she would give me a referral to audiology as requested, but if I had my own insurance, I should keep it. I shouldn’t expect to get much more than audiology treatment from the VA — about 20 minutes a year with a physician.

She gave me a welcome kit in a light canvas bag containing various booklets. The heaviest was a 500-plus-page bound volume, “Veterans’ Health at Home.” It later occurred to me that it is so comprehensive because it is intended as instructions for self-treatment. Don’t expect much VA treatment in the yearly 20 minutes allotted.

After the treatment limitation advisement, I made the obvious choice to retain my existing insurance. The physician, who had been waiting poised for that decision, entered the information on her computer. She told me to expect the referral to arrive in audiology in a couple of days. Call after it arrives and make the appointment, the PCP told me.

I realized the physician’s VA script has been followed. One less on the case load.

A week or so later I called audiology to make the appointment, but no referral. I had to contact the physician’s office again with another request. I did this. No record of the first referral. A new one would be requested, the PCP’s clerk told me.

I waited a few days, then called audiology again. Repeat.

I called the physician’s office, this time with a request for an expedited referral. That wasn’t possible. I had to make the same request a third time.

“Can you put me through to the doctor?” I asked.

Not possible. OK, who is her supervisor? Muffled gasp. I wanted the doctor’s supervisor! Do doctors have supervisors? Pause. It would have to be the hospital Chief of Staff! Alright, what’s his name? Uh oh.

The physician’s clerk, now in damage control mode, sent the referral directly to audiology herself. I promptly got a call from audiology and an appointment (another two months ahead). But the appointment was good for an audiogram only. The hearing aids would come later. Wasn’t the VA audiogram from only a few months earlier at another VA medical center sufficient? No.

The next appointment came a couple of months after the audiogram. I finally got the hearing aids.

Total time from request for services to provision of services? More than six months. And this is for a service-connected disability, which should get priority handling. The delay can’t be directed to the provider, audiology. It is all about access through layers of artificial wait times, failure to perform at levels (the PCP), and delays at each step.

Of course, my experience is as nothing compared to that of the veterans with life-threatening conditions who died because of delays. The VA bureaucrats we see in the legislative hearings, blandly and slickly sidestepping questions, should have these deaths on their consciences — if they have any.

When normal citizens, say nursing home caregivers or their managers, cause, countenance or even fail to prevent gross negligence resulting in the deaths of patients in their care, they stand to be prosecuted for various levels of homicide, up to and including murder.

That’s what happens to regular folks. But for some reason government bureaucrats seem to be granted immunity. I fear we are creating a government elite as a first step down a slippery slope to yet more loss of freedom. One recalls the lives of the privileged elite in that old, Eastern Bloc federation of nominally autonomous states, who were rewarded for their commitment to state policy with dachas and automobiles, at a time when ordinary citizens waited in line 10 years for a car, and in other daily lines for food for the evening meal. Immunity from liability for ordinary crimes and misdemeanors could only follow.

I’d say it’s time to level that playing field, and hold the big-shots to the same standards as the rest of us. The criminal law is a great motivator. A criminal investigation will be likely to stop the lies and get the veterans the services the law requires — and even hold the perpetrators to account.

Just my opinion.

Edward G. Brooks, J.D., lives in Victor.

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