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  • Unacceptable Performance by the Veterans Affairs Department

    Posted by David Foster on December 29th, 2012 (All posts by )

    Here’s a Rudyard Kipling poem which isn’t as well known as some of his other ones:

    There were thirty million English who talked of England’s might,
    There were twenty broken troopers who lacked a bed for the night.
    They had neither food nor money, they had neither service nor trade;
    They were only shiftless soldiers, the last of the Light Brigade.

    They felt that life was fleeting; they knew not that art was long,
    That though they were dying of famine, they lived in deathless song.
    They asked for a little money to keep the wolf from the door;
    And the thirty million English sent twenty pounds and four !

    They laid their heads together that were scarred and lined and grey;
    Keen were the Russian sabres, but want was keener than they;
    And an old Troop-Sergeant muttered, “Let us go to the man who writes
    The things on Balaclava the kiddies at school recites.”

    (read the whole poem here)

    What reminded me of this poem?

    This story.

    Apparently, in 2012 the average time to complete a VA disability or pension claim was 262 days, up from 188 days in the prior year and far above the official target of 125 days. More at Nextgov.

    I’m not very impressed with the excuses offered by the VA for this situation:

    VA officials attribute the backlog, defined as claims in the system for more than 125 days, in part to higher demand by veterans returning from 10 years of wars in Iraq and Afghanistan with severe and complex injuries.

    A Texas Veterans Commission official noted that the agency is caught in a “perfect storm” of claims from veterans of recent wars and those from aging Vietnam and Korea veterans whose disabilities are worsening.

    But wasn’t this all predictable? Obviously wars cause injuries, and better battlefield medical attention means that more wounded soldiers will survive and hence need extended care. And wasn’t the higher claims rate “from aging Vietnam and Korea veterans” largely predictable from simple demographic analysis? I’m reminded of the saying about a British railroad from several decades ago:  ”Despite its frequency and general regularity, Sunday morning seems to consistently catch this railroad by surprise.”

    The above remark about the railroad notwithstanding, private enterprises generally seem to be able to deal with fluctuating demand and other problems quite well. There is almost always food in the supermarkets, despite droughts, crop failures, logistical problems, strikes, etc etc. The electricity is almost always on despite storms and electrical failures. And while businesses generally do a better problem than government at dealing with daunting arrays of problems, some government agencies do manage to deal with demand increases and fluctuations far better than the VA seems able to do with these disability claims. Somehow the FAA manages to conduct air traffic control safely and effectively despite the increased demand that occurs in holiday seasons and the varied and often nefarious effects of the weather. The military itself often manages to quickly deploy forces and equipment to far-distant locations. Why has the VA been unable to modify its processes to provide resolution of disability claims in a timely manner?

    Sad and disturbing.

     

    10 Responses to “Unacceptable Performance by the Veterans Affairs Department”

    1. Mike K Says:

      There is an interesting story about care of the veterans of the Civil War. No provision had been made by Congress. There was even no provision for the wounded. The post war care and provision for veterans was organized by two amazing people. One was “Mother Bickerdyke” who began as a civilian nurse with Grant’s, and later Sherman’s army in Tennessee. She marched with Sherman through Georgia to the sea. Among many other things, she discovered that blackberries would prevent scurvy just as citrus does. Sherman’s army insisted that she accompany them on the Grand Review in Washington at the end of the war.

      Mother Bickerdyke became the best known, most colorful, and probably most resourceful Civil War nurse. Widowed two years before the war began, she supported herself and her two half-grown sons by practicing as a “botanic Physician” in Galesburg, Illinois. When a young Union volunteer physician wrote home about the filthy, chaotic military hospitals at Cairo, Illinois, Galesburg’s citizens collected $500 worth of supplies and selected Bickerdyke to deliver them (no one else would go).

      She stayed in Cairo as an unofficial nurse, and through her unbridled energy and dedication she organized the hospitals and gained Grant’s appreciation. Grant sanctioned her efforts, and when his army moved down the Mississippi, Bickerdyke went too, setting up hospitals where they were needed. Sherman was especially fond of this volunteer nurse who followed the western armies, and supposedly she was the only woman he would allow in his camp. By the end of the war, with the help of the U.S. Sanitary Commission, Mother Bickerdyke had built 300 hospitals and aided the wounded on 19 battlefields including the Battle of Shiloh and Sherman’s March to the Sea.

      Among other things, she collected the freed slaves who accompanied Sherman’s army as they moved through the south. The army resisted feeding and providing quarters for them but she enlisted them in her hospital and kitchen building. She actually constructed large baking and cooking facilities, in addition to hospitals. The freed slaves did much of the work and were fed by her kitchens. Many of them accompanied her and the army as they advanced.

      “After the war ended, she worked for the Salvation Army in San Francisco, and became an attorney, helping Union veterans with legal issues. She ran a hotel in Salina, Kansas for a time.”

      The Wiki article does not describe her efforts, aided by Sherman who became the commanding general after Grant, to organize a system to care for veterans. Part of this was arranging for land grants and jobs for vets associated with the railroads.

      From Sherman’s Memoirs: At the close of the civil war there were one million five hundred and sixteen names on the muster-rolls, of which seven hundred and ninety-seven thousand eight hundred and seven were present, and two hundred and two thousand seven hundred and nine absent, of which twenty-two thousand nine hundred and twenty-nine were regulars, the others were volunteers, colored troops, and veteran reserves. The regulars consisted of six regiments of cavalry, five of artillery, and nineteen of infantry. By the act of July 28, 1866, the peace establishment was fixed at one general (Grant), one lieutenant-general (Sherman), five major-generals (Halleck, Meade, Sheridan, Thomas, and Hancock), ten brigadiers (McDowell, Cooke, Pope, Hooker, Schofield, Howard, Terry, Ord, Canby, and Rousseau), ten regiments of cavalry, five of artillery, and forty-five of infantry, admitting of an aggregate force of fifty-four thousand six hundred and forty-one men.

      All others were mustered out, and thus were remanded to their homes nearly a million of strong, vigorous men who had imbibed the somewhat erratic habits of the soldier; these were of every profession and trade in life, who, on regaining their homes, found their places occupied by others, that their friends and neighbors were different, and that they themselves had changed. They naturally looked for new homes to the great West, to the new Territories and States as far as the Pacific coast, and we realize to-day that the vigorous men who control Kansas, Nebraska, Dakota, Montana, Colorado, etc., etc., were soldiers of the civil war. These men flocked to the plains, and were rather stimulated than retarded by the danger of an Indian war. This was another potent agency in producing the result we enjoy to-day, in having in so short a time replaced the wild buffaloes by more numerous herds of tame cattle, and by substituting for the useless Indians the intelligent owners of productive farms and cattle-ranches.

      I have a chapter in my book on history of medicine about her and several other women who created the profession of the female nurse. Until 1863 or so, all nurses in the military were men.

      The Veterans Administration was a creation of the Wilson administration and World War I.

    2. dearieme Says:

      It’s the sort of thing that happens in a country in decline. A Thatcher might reverse it for a decade or two but there’s always a Blair waiting in the wings.

    3. Mike K Says:

      ” A Thatcher might reverse it for a decade or two but there’s always a Blair waiting in the wings.”

      The fact of Obama’s re-election is the most dispiriting event I had endured since my divorce. I see no hopeful signs but am open to the possibility.

    4. Sgt. Mom Says:

      I had read in passing about ‘Mother’ Bickerdyke as a Civil War-nurse and hospital organizer, and always thought it kind of odd that Clara Barton should be the one which everyone has heard about … and yet Mrs. Bickerdyke had done every bit as much good.
      And knowing of 19th century formidable ladies such as those two, the abolitionist Grimke sisters, and many, many others – I’ve always wondered how manyone could think of Victorian women as fragile, timid, ‘angel-of-the-house’ snowflakes in dire need of shelter from the world in general.

    5. Mike K Says:

      Clara Barton was a teacher, like many of her peers who made major contributions. She was in Washington on the day of the battle of Bull Run. The army had made no provision for ambulances or transportation of wounded. There was surgery at the battle scene, WW Keen was a young surgeon at the battle but there was no hospital or provision to get the wounded back to the city. Clara Barton saw men staggering into the city after the battle and organized some way to help them. It took days for all the surviving wounded to make their way to the city.

      I have a lecture on civil war medicine I have given at several places including the Royal Army Medical Corps. I’ll have to figure out how to make it a post.

      The Wiki article on Keen wrongly makes him a pioneer in brain surgery. In fact, he recruited Harvey Cushing to write the chapter on brain surgery in his “American Textbook of Surgery” that was published in 1905. The chapter on appendicitis was written by John B Murphy, both pioneers. Both chapters were the first to describe those fields in surgery textbooks.

    6. Sgt. Mom Says:

      Mike K – I will so have to pick your brains about this – and I would love to see your post about Civil War medicine.
      In the current work-in-progress, I have a situation with a character having to be operated on for the results of a kick to the skull by a panicked horse, round and about the late 1870s. I want the details to be medically accurate – and the operating surgeon will be a real person, who actually did a lot of surgery of this sort; Dr. Ferdinand Herff. Would you mind being a tech expert on this kind of thing? I can PM you with the basic details.

    7. Mike K Says:

      There were no craniotomies in the Civil War. Most head injuries were fatal or the victim recovered without aid. There were cases of elevation of a depressed skull fracture, even in pre-columbian America. By 1870, anesthesia and anti-sepsis were available in a few places. I looked for Dr Herff and found an account that said he had elevated depressed skull fractures. That was certainly possible. Whether he used anti-sepsis is a matter for more research. The account I saw said he used chloroform on a case. In 1870, not many surgeons were using anti-sepsis in the US. The Germans were and he might have picked it up in his training if it was late enough. Lister’s paper on anti-sepsis was 1867. In the Franco-Prussian War that year, the French had a 70% mortality with amputations because they did not use anti-sepsis or even hand washing. The Germans did better and Billroth studied the casualties on the Prussian side.

    8. Sgt. Mom Says:

      Thanks, Mike – according to what I know about Dr. Herff is that he did insist on a scrupulous level of cleanliness when he operated; boiled and cooled water for irrigation, etc. A lot of his patients survived after pretty invasive surgery, so my assumption is that he had hit upon the practice and noted good results without being aware of the formal theory.
      More to follow, when I get up to writing that part.

    9. Mike K Says:

      Hand washing and cleanliness were a matter of personal choice and, with no indoor plumbing since the Romans, cleanliness was more an eccentricity than a policy. Ephraim McDowell removed a 22 pound benign ovarian tumor from Jane Todd in 1809. She lived to old age after the surgery, done on McDowell’s kitchen table. He was successful in a total of 12 cases over the next few years. In other hands, it was performed with a mortality of 25%. Somebody was washing hands although there is no record about it.

      James Marion Sims devised a successful repair of vesico-vaginal fistula, a communication between bladder and vagina, which was a fairly common complication of childbirth at the time, 1853. His first successful case took 33 operations before the fistula did not recur. He moved to New York and opened a Womens’ Hospital. A statue of him stands in New York City, no doubt a mystery to those who see it. His success resulted from a new position, Sim’s Position, in which the woman lay face down and head down, and his rediscovery of the speculum.

      The operation was successful because it could be done through the vagina, not opening the abdomen. Joshua Chamberlain, hero of Gettysburg, spent the rest of his life with a bladder fistula draining urine from a gunshot wound in another battle. All of his later accomplishments were made with this fistula draining constantly. Those people were tough. They had to be, including the woman who underwent 33 surgeries without anesthesia to cure her fistula.

    10. Norm Says:

      In the late 1970′a early 1980′s the Canadian federal government began a process to decentralize government administration, a worthy goal (spread the operating expenditures including jobs to all the taxpaying areas and not just the caital city). Of course the bureaucracy fought it tooth and nail as they didn’t want to be moved to some tiny town away from the centre of action. Anyhow, Veterans’ Affairs was to move over 1,000 miles from Ottawa to Prince Edward Island (the Veterans’ Afairs Minister was from the Island and 1,000 well paid jobs in a province of 130,000 was huge). After six and a half years of the move one bright opposition Member of Parliament asked the Minister in the House why it takes Veterans’ Affairs longer to relocate its administrative functions than it the took the Veterans it serves to fight and win the Second World War? i.e. don’t say it is a complex situation as winning the largest war in history was a wee bit more complex. The move was completed within the next year!