The Pipes proviso: The VA angle

A reader writes in response to the congressional testimony of Sally Pipes linked in “The Pipes proviso”:

As a former medicine resident and current cardiology fellow, I have spent more time working at various VA hospitals than all but those courageous physicians who make a career of working within its bureaucracy and unions. (As the joke goes, what’s the difference between a bullet and a VA nurse? You can fire a bullet. A bullet can only kill once. A bullet can draw blood.)

I encounter on a daily basis the rationing to which Ms. Pipes refers. Although we are generally able to see patients for an initial visit in a somewhat timely manner, repeat visits are much harder to come by. A patient that I might see on a biweekly basis in private practice, I will see every few months at the VA. And for all but local patients, driving dozens, if not over a hundred, miles is required in order to see a specialist.

For specialized procedures, the VA often only performs operations at one location across the country. One center in particular has a backlog of over 4 months and is essentially refusing to see new patients (fortunately, this same service is performed across the street at a local hospital).

Another patient of mine has been denied a life-saving procedure due to high operative risk (a reasonable assessment in this day and age of surgical mortality ratings). However, the VA bureaucracy refuses to allow an outside referral for a second opinion on the grounds that it has already been decided that the patient is not a candidate for surgery. I was reduced to telling my patient that the VA had failed him, and he should seek outside care. Fortunately, he had paid his Medicare premiums, and this was an option. Occasionally, patients will fail to do this, in the belief that the VA can take care of all of their healthcare needs.

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