City Journal Winter 2016

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Joel Zinberg
The Worst Available Care « Back to Story

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Trained at 2 different VA's and saw the same kind of thing. Surgeries were not allowed to start if they might go beyond 3pm. At night, 1RN and 1 LPN to care for an entire floor of 50 or so vets, and they still didn't do anything. Would routinely pass nurses station where they had their feet up on the break room table, but they called the medical student to take care of something that was their responsibility.
Noticed during my training that vital signs were recorded as 120/80 with pulse of 80 for the entire floor every four hours for the whole night for days on end. Best story I ever heard about that was a patient who died sometime after dark, had a holter monitor that showed his time of death( cardiac arrest) and the nurse recorded 120/80 twice after his death!
Here is the core of the VA: I requested some medical records, hard copy and discs. When the material arrived there was no disc but there was a post-it note (that would not be in the record)informing me that the records are not available on discs. I new this was wrong because I had received disc records previously. At the bottom of the letter there was this typed notation: This request was fulfilled by Sally Jones (name changed). The VA employees think it is all about them. And for the most part they are right.
Auntie Analogue June 09, 2014 at 8:10 PM
At my last biannual visit with my superb VA primary care doctor, I opined to him, "I've never had a problem with actual VA medical care administered by health care professionals, in fact their care - when the patient finally gets an appointment to enjoy it - has been excellent. It's the administrators, from bottom to top and back down to the bottom, who have been the source of every vexation I've had at the VA medical centers."

With a knowing smile and a sigh of exasperation, my doctor said: "You're not the only one who has that problem with administrators, I don't know any medical staff who haven't had your experience and who don't share your view of them."
I remember when my father was in the San Antonio VA hospital 15 years ago. There was a man whose legs had been very recently amputated above the knees. I remember him because he was tied to a wheelchair with surgical tape or gauze, and then tied to the railing in the hall where he spent an ENTIRE THREE DAYS pleading for someone to help him. He wasn't that old, but he seemed out of it, maybe he was waiting for a bed at a mental institution I don't know, but is this the way we treat anyone, not to mention a Veteran???!!! The story of my father's negligent care there is another story for later.
The story about not letting the surgical residents start a case after 1 PM reminds me of my days as a surgical resident at LA County hospital. Cases would start hours late and we would try to do two cases in one day. Never happened unless they were very short cases.
I use VA hospital on a regular basis. My injuries from 1965 and 1966 are cared for as well as can be expected with funds available. That is, I receive excellent care including discoveries of problems that might have killed me.

Prior to implementation of the computer VistA system, catching phony referrals and over prescription of drugs and other errors would have been difficult. Now everything is recorded. In detail.

WHEN WAS THIS: "At the New York City-area VA hospital where I served as a surgical resident, anesthesiologists routinely cancelled surgeries for personal reasons—they got paid regardless of how many procedures they performed. Some senior surgeons could not be coaxed out of their offices to do surgery. Operating room nurses refused to allow operations to start after 1 PM for fear of having to stay past 4 PM, when their shifts ended. "

Today with VistA those failures are impossible. I know how VistA works. I have installed OpenVistA.

And from the comments, what's with hating on postal clerks ??? Our USPS clerks are steady, accurate workers. Love 'em !! Nice people.
Reflect on the counter clerk at the post office or the TSA thug . Where in the real world would they be employed with their dull intellects and surly manner ?

I've actually never encountered trouble with TSA inspectors. The trouble I've had with postal clerks is simply their speed. They'd have little trouble in other venues and likely spent years in those venues 'ere landing government work, it is just that they would have different sorts of supervisor. The problem is the institutional culture of public agencies, in part driven by collective bargaining and functional tenure in employment.
We have in each department an inspector-general and we have a free-standing performance auditor in the comptroller-general. What are their excuses?
You all mistake a glitch for a feature . Does anyone think that the people you cite have any employment potential in the real world ?? Reflect on the counter clerk at the post office or the TSA thug . Where in the real world would they be employed with their dull intellects and surly manner ? But follow the money every one of the cited examples constitute a piece of the Democrat base , either as an organization , i.e. the teachers unions and SEIU or as individual voters .But as it is Sunday I would close on a note of Christian charity : As my father said to me 50 years ago after an encounter with a rather nasty toll collector on the Jersey Turnpike " Feel sort for them , son , if they could do anything else they would
For speaking up, Joel Zinberg is a hero-- both American and humanitarian. His name shall be remembered but that's not why he has spoken up, since he's invested in truth and integrity over vanity.

Thank you and God bless!
Benjamion W. Hartley June 07, 2014 at 5:51 AM
And just why is the inability of the Veteran's Administration "health" "care" system to function so very surprising? It's a perfect example of Pournelle's Iron Law of Bureaucracy: Every large organization is eventually taken over by those more interested in preserving the organization than in performing the jobs for which it was organized in the first place. Happens every time... NO exceptions.
Dr. Zinberg,
Perhaps you could look at the treatment of the members of the various Indian tribes under the "care" of the Indian Health Service.
Dr. Zinberg,

Thank you for this article. You and all the commentators are correct in how perverse and how long-lasting this structural problem was. In the 1970s, my father had a choice between a job at a VA hospital in a city he preferred and a non-profit institution in another town with lesser pay and benefits. He picked the latter. He said it was because providing medical care was important, and he wanted to work at a place where he knew the other people would be working as hard as he would be.

Since then, I have worked with friends and have seen what relatives have had to endure in half-dozen different VA facilities across the country. My reactions to their care have ranged from highly disappointed to appalled with issues being almost always those of nonfeasance or malfeasance –rarely misfeasance or well-meaning incompetence.

When I first read Longman’s book and Krugman’s pieces on the VA, I began to wonder whether I was being unfair and letting my assessment be driven by other people’s exaggerated horror stories and isolated incident I had witnessed first-hand. Now, I guess I should have picked my lying eyes over their analysis
This is a pervasive problem not just at the VA, but in virtually every mega organization, public and private. People do not know how to manage. Because they are afraid of conflict or controversy, unacceptable performance is never judged as such. When poor performance is never noted and has no consequences, there is no incentive to alter behavior. Where is the supervisor/manager of the doctor who cancels surgeries or the nurse who refuses to allow a surgery to begin? Where is the principal whose teachers do not have continuing lesson plans or whose classrooms are filthy and unorganized? Where was the oversight at GM when a part was known to be defective and not replaced? And how is it possible that an employee at the CA Dept of Motor Vehicles can say repeatedly to a tax-paying citizen "I only hand out numbers" when asked a question? Employees behaving in the aforementioned manners should immediately be called to task, put on notice, monitored to assure positive change and fired if this does not occur. Any supervisor/manager who cannot do that should be fired. Success/excellence is not accidental. It requires hard work, diligence and constant attention to detail. No one deserves a paycheck or worse, a bonus, for poor performance.
Absolutely correct. The entire system has been a doctored pyramid based on nepotism and cronyism, catering primarily to performance appraisals. Best care anywhere? It is found where caring comes first and not the end of the 8-4 tour.