General of The Army Omar N. Bradle
I appreciate the feedback. I would like to start with some comments about Veterans Helping Veterans. Our national veterans organizations are all attempting to do this. They have been our voice in Congress and to the press and without them the VA mess would even be worse. Most of our local ones are also trying hard. They have expertise in veteran benefits and areas such as transportation and help to agencies that in turn are helping veterans in need. There are, however, those veterans, who have "gotten theirs" - their benefits, their notch in healthcare assured, and their titles and offices - they are content and happy. They have all too often sided with the local VA management to the overall detriment to the veteran community. In the past, we have had some effective veteran healthcare advisory councils but they are gone. Why? VA management discouraging them. Only a few veteran "leaders" are speaking for the whole veteran community and this is not necessarily the best arrangement for you. Some have never been in the healthcare field, almost all others have never worked in the VA system. I think veterans organizations are in the process of changing that and that the VA will be required to again listen to veteran council.
Locally, if you really want VA to change for the better, start identifying those veteran members that can help you the most in areas you support.
Part I Unions. I have always thought that government unions were somewhat worthless. With my previous work experience and my wife's, it sort of proved true. I am wondering whether the problem lies with the Civil Service Commission. GA Bradley had to battle them to develop a corps of younger, military trained doctors in the VA over those with seniority that could only do well out in the pasture.
I grew up in a union family in the Bay Area. They had good health care plans and at that time provided job training for high schoolers and new citizens. Both parents had union health plans with Kaiser Permanente that were quite good. The latter training part was absorbed by the California Junior College System. One of the corruption problems the Teamsters and the Baker's and Confectionery Workers Unions had went like this. A a larger company buying off a couple of union members/officials who then sought work (or sent loyal members) to a smaller competitor and negatively impacted the smaller company. Of course tales of union corruption abound. This was one I knew about. In the government service this sort of corruption probably could not occur. What could happen is that some supervisors could buy immunity from union complaints.
Another good thing I can say about unions in that area was that they did try to help former incarcerated veteran and other inmates find work upon release. I thought this was true universally, but it was just in the Northern California area.
Some years back, local AFGE sat down with the previous VA director. The agreement gave the local union three positions - paid by the VA but were required to do only union work. A previous union head here was sort of thrown out by DOL after a phony election. The last one was thrown out for fraud. I have no knowledge of current union things here.
One can see perhaps an opportunity for union problems, but if they are happy, few complaints will be processed.
I sent a note to the VA asking why one of the full time positions was not dedicated to workplace safety. That guy had to do his VA job and union stuff concurrently. Worker safety is the primary concern yet gets a lower priority. Complaints by employees of pigeon colonies in the attic of H and Owens, electrical problems, latrines that wheelchairs could not maneuver in were all addressed but only the wheelchair thing was ever really fixed. Turns out, the union did help some lower level employees over the years but they were minor things, and were usually employee on employee. I tracked two complaints employees I knew asked me about. They were both caused by supervisors simply not knowing their jobs well and neither would listen to the rank and file. They were recently promoted from the rank and file without much merit.
My wife filed three separate complaints with the union against her supervisor for not providing an evaluation and discrimination in work assignments. There was no help from the union. They literally refused to help. My wife had to file an EEO complaint that although she won it, albeit with outside legal help, but in the end, the VA would never enforce their own judgement. So here is a possible case of management buying off the union leadership for plush jobs. I would imagine this is true VA wide. The AFGE in Washington DC spoke of employee intimidation as an ongoing problem in the VA but if that was known, why did it take so long for them to say anything in public about it?
When I was CSM at USA Communications-Electronics Command and Fort Monmouth, the boss calls me in one day and we talk about the impact of the Army's new policy of converting long-time facilities engineering and maintenance to a civilian contractor. Even in the mid-1980s, the Soviet threat was seen as diminishing and the Army was shrinking. I talked with union reps (no full timers) and several were retired military, and they were not thrilled but supportive. In the end, RCA Services got a one year contract that stipulated former DA Civilians would get first shot at jobs they did before. Some employees (WGS) retired from civil service on Friday and went to work as a contract employee Monday. The switch had problems but worked. Contractors of course do not have unions, health care or other benefits until a worker becomes a career employee. To the majority of former WGS employees, it meant a loss in job security and some benefits. They were offered work elsewhere in the government, some took it, others took the early retirement plans.
So summing up my experience with unions, good and bad, it seems that their original work of employee safety, fair pay and treatment, primarily in the blue collar areas are about extinct. Smart corporations treat employees well and negate the need for much of what unions do. There are some remnants of reasons unions grew - coal mining and a few others still haven't learned from the past. Look at the automobile industry. At one time, UAW and others enjoyed 65% union workers. Now they are down to under 10%. Those new plants and companies building cars have learned to treat workers fairly. What has grown in the union arena is the white collar area such as teachers unions. It is apparent to me that worker safety and equality issues are gone and with this particular group, are they simply in business simply to protect sub-standard teachers? I am not sure of the value of having a union when government law provides for ombudsman in most areas.
In industries that have some dangerous elements in them, unions can help with the safety stuff - this is how they are used in Japan. That is what I have to say about unions. The VA does not need them to make any difference in how veterans are, or are not, treated. Where the VA needs to reform is in the IG and Medical inspection arena. Like the military, the VA publishes directives and regulations that address most employee problems, if there are compliance inspections. In reality, VA unions are really irrelevant.
Part II The VA in 1945 and now. I was hoping to get across the point that GA Bradley had a staff identify the major problems. He knew or found out who the good guys were from the War, recruited them to recruit others to fix the problems. He used their suggestions and ideas and lobbied for them. As an example, Dr. Hawley, the ETO Chief Surgeon revolutionized VA medical care.
I believe the President these days is irrelevant to VA problems or reconstruction. It is Congress with the purse-strings that has always held power over the VA. Hopefully, they are past the pork barrel era and still want to be seen by the public as veteran friendly.
If McDonald is approved, the bills he needs for reform may not be passed due to recess for electioneering. I am hoping he looks around for proven talent. I do not believe he can reform an agency that resembles organized crime than it does a human services one, without a complete restructure and with new talent.. When the Army had some medical people - 2-star generals that showed weaknesses as the numbers of seriously wounded grew, they were retired. The Army appointed a Dentist to head up rehabilitation. Dentists live that area and it has improved greatly. There have been reliefs of MDs around the Army. Madigan, Womack are a couple. Complaints got rid of them. There are also a couple who have greatly improved battlefield medicine with innovation and forward thinking. These are the kind of guys McDonald needs to look for. He also needs a revamp of the inspection process. It has also been corrupt or they have worried so much of the VA image that they conveniently glossed over serious problems. I think this is what led to the previous VA Secretary's resignation. His deputy for healthcare, medical inspections and others simply withheld the bad news.
I would like to see McDonald take on the Civil Service Commission by appointing a military veteran as director of every VAMC. Veterans will most often answer to other veterans. By eliminating the civilian bottleneck to treatment, corruption, that single act would change the flavor of the VA overnight. No bonuses needed. Retired military Docs might be tapped for the big VAMCs. Let the current directors retire or become deputies. I think those are some of the things Bradley did, simply put out to pasture the under performers and brought in new blood. He also fostered active partnerships with civilian medicine.
The Congress, in all its lack of demonstrated ability, has finally drafted some workable fixes for the VA. MOST of the VA problems can be tracked back to them to start with. Pork barrel mostly but also politicizing veterans issues. Many good bills of the past simply died. They got good press for the writers, then they were put to bed.
McDonald will have a pool of talent to help him with the shrinking of the services that occurred after WWII. There will be proven talent available to perform miracles like they did with military battlefield and rehabilition medicine over the past decade. The Military TRICARE system could easily be expanded to take care of those veterans out in the hinterlands or where the VA has no services. This is not a big shift. Frameworks are there, just plug in more practitioners and patients.
He could reorganize the VA. Do away with the 22 VISNs. They are simply another layer of administration-management that does not provide direct care to veterans. An updated computer system could probably replace everything they do. Use the positions to staff clinics with primary care doctors and specialists needed by most veterans. Maybe hire a few OB-GYNs for the fastest growing veteran population, women.
Bradley faced upsizing the VA. McDonald should consider downsizing. Tell Congress, no more new white elephants like VAMC in Las Vegas. There is no Class A Med School to work with. Tell them I want to put my money in clinics, more of them, fewer hospitals. That is a growing civilian model. Small surgery clinics, contract where needed, even primary care clinics, contract operated. The Navy has expertise in this area. Get the veteran an emergency appointment right now. A primary care appointment this week and a specialty or follow-up appointment consultation in two. Recognizing the often backlogged specialty staff, a consult with a healthcare provider with knowledge of all that is available, would schedule the veteran into the outside medical world based on the primary physician's priority recommendation.
Merge the VA and DoD Medical Records system. VA is better than DoD but all need updating. Merge the many pharmaceutical supply systems into one.
I understand the demographics have changed dramatically since WWII but the sentiment of the American people has not. McDonald also has a couple of lobbies like the military-veteran alliance that were not around after WWII, and if he forms advisory boards like Bradley-Hawley did, he would soon have the support of the civilian medical sector. I believe this area is about 1/6 or 1/7 of our economy these days.
The single thing that Bradley had that made him a success in all his endeavors was character. In most cases, the whole of our military also has that trait. It is institutionalized and when violated, it is most often met with quick justice.
My final kicker is to put the VA professional health care providers into uniform. Much like the Public Health Service. They take an oath, and they serve the citizens of the United States. By putting the professional health care providers of the VA into this category, you immediately establish a chain of command that can function side-by side with civilian professionals and support workers as well. Here is something on the UCMJ:
"The UCMJ allows for personal jurisdiction over all members of the uniformed services of the United States: the Air Force, Army,Coast Guard, Marine Corps, Navy, National Oceanic and Atmospheric Administration Commissioned Corps, and Public Health Service Commissioned Corps." (from the Wiki guys)" Add: The Veterans Health Service Commissioned Corps.
This move simply eliminates the BS that exists in the hierarchy of the VA executive arena - immediately chargeable under the UCMJ, it helps prevent crime before it is enacted.
This would establish a commissioned corps of professionals. Sure, some of the old professionals would not fit into a uniform (or more to the point in a hat due to over sized egos) but they can simply be phased out until all are retired. Those young enough might think of the VA as a career rather than just getting some resume experience or some of the free conferences and training that is available. Right now, the turnover rate of healthcare professionals is pretty high in the VA. Most leave due to VA BS or what they see as veteran care denials. They vote with their feet. What the VA is today is a bit like the people the VA offered veterans after WWII. Over the hill, under the knowledge curve guys that are comfortable in their secure VA jobs.
As with the military, healthcare providers with proven skills in fields such as combat medics, corpsmen, licensed practical nurses, and other specialties could be given the opportunity for added training as Physician's Assistants and Nurse Practitioners. They could then be a part of the commissioned corps of the Department of Veterans Healthcare and Advocacy. A name change that is needed as well.
I worked for the VA for awhile. I helped out a physical therapist, Betsy. She went to work for the VA when she was discharged in 1945 from the Navy. She retired from the VA in 1990. Most of her time was spent helping amputees with the fit, use and care of prosthetic limbs; and exercise, treatment, education and simply talk with pain patients. She was an Angel. Dedicated to Veteran Care, she once remarked that the VA should be more like the Public Health Service. This stuck with me ever since.
To show how corruption could be reduced by a move like this, let me tell you about Tony. Tony is a retired US SF
Physician's Assistant. He lives locally. He served in Vietnam and Thailand, among the many overseas places USSF serves. SF Medic training is long and difficult. He then went through PA school, graduating as a WO, then retiring as a commissioned officer. He went to work with the Indian Health Service. The Indian Health Service (IHS)is an agency within the Department of Health and Human Services, and is responsible for providing federal health services to American Indians and Alaska Natives. Tony was working in Los Angeles. One day, there was a marked rise to hospitals of of patients, mostly homeless for unknown reasons. Tony looked at several and identified Bubonic Plague as the Culprit. A program was initiated for immunizations and hospital isolation. Tony prevented an epidemic. It was a disease he knew from his military medical experiences but the civilian sector did not.
Tony moved to Las Vegas, He was working at the old VA/USAF Hospital at Nellis in orthopedics. I had a fairly painful back, leg, and hip problem for many years and like many others, waited and waited for an appointment. The USAF had many people deployed and the VA could not keep a couple of orthopedic surgeons employed, The work was hard, pay low and facilities almost non-existent. The wait list for a Loma Linda ortho consult was at a year out. Tony was in charge. Tony saw me, measured my legs, referred me to the outside. I had hip replacement surgery at St Rose. It eliminated my back, leg, hip pain problem entirely. It was a new start in life after years of anti-inflammatory agents, strong opiates, and injections. I was walking the day after surgery. In rehab there were 11 other veterans who also just had surgery. Knee, hip, ankle, etc. Tony got them in. In the long run, Tony saved the VA money. Most importantly, he helped many veterans in pain.
The sad part of the story was that when Human Resources found that Tony missed an exam retake by one point, they fired him. Being the boss for months in ortho did not give him much time to refresh in other areas he had not worked in for a while. Although he retook the test (three tries allowed) and passed it with a higher than average score, they would not rehire him. With all his experience, the real reason one of my sources told me was that Tony cost the VA here too much money for veteran treatment. Doctors of course only need CEUs to keep a license up.
I hope that the former chief of human resources and the former director are enjoying their golf in Utah, partially paid for from unearned bonuses. We know how they were gotten - some of it at veteran care denials. You will be documented in history. I hope that others like those in charge of staff, fee basis, and their admin officers who really run the VA, are sweating possible investigations.
Lou
On Tuesday, July 8, 2014 4:45 PM, John Gilbert <johngpi@hotmail.com> wrote:
Sergeant Major -
We could certainly learn from the past, unfortunately we usually fail in this.
Thank you,
John
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