The Department of Veterans Affairs Continues to Excel

For some values of the word, “excel,” anyway. And one of the interesting things that’s happening is that not all the negative stories are true, and not all the true news is truly new. But there’s still some, because it is the VA.

Right now, the media is arrayed against the VA. (They’ll do a volte-face the moment the VA’s payroll patriots’ lifetime no-accountability jobs are threatened). But today, the media is in such a feeding frenzy that they don’t even check stories that put the VA in a bad light, and the VA’s army of scores (hundreds?) of six-figure PR flacks can’t even move themselves to defend the agency they’re overpaid to defend. (An aspect of VA underperformance that’s been undercovered is just how bad a team you get when you pay $40k/year talent $160k/year, and teach them that the paycheck is forever, and no one cares how they perform. That’s the VA’s PR people in a nutshell).

The Dilaudid and Deluded Affair

Case in point: a story making the rounds about a vet killed by VA malpractice. It’s not new news, as the vet in question, Jason Powell, died during relatively routine surgical prep in Asheville, NC on 6 Sep 2012. The family sued, and so the VA lawyered up and clammed up, before finally settling an unlawful death suit in 2015… and remaining lawyered up and clammed up.

The doctor in the case has been, in the way of all things VA, promoted.

But a look at the case makes you wonder if the guy didn’t die, not of the medication error the VA admits, but of the underlying medical condition — a perforated bowel that had been untreated for several days before presenting.

The medication error was to substitute, twice, 4 mg of Dilaudid for the scheduled 1 mg of that drug (a powerful opiate) that was being given every four hours. But the error only occurred twice, and the doctors, nurses and managers never covered it up (unusual for the VA). “Advocacy journalism” like this article, which smells as if it was spoon-fed by plaintiff’s attorneys to Nick Ochsner for WBTV (Slogan: “We’re on your side!”), does make it sound like the Dilaudid killed him. In the one deposition that Ochsner selectively presents (.pdf), the plaintiff’s attorney is really trying to get the doctor to say the Dilaudid error killed poor Powell.

But there’s a problem with that. That’s just not enough Dilaudid to kill a guy. Instead of 6 mg in 24 hours, the error gave him 10. It is enough that he was, no doubt, out of it in an opiate dream immediately after the 4 mg dose. But it seems highly improbable that it punched his ticket to eternity.

Table: acute toxicity of hydromorphone (Dilaudid). Source (.pdf).

Sometimes a fellow gets sick and dies young. Sometimes the hospital can’t catch it in time. Sometimes — often, really — a young, healthy guy doesn’t believe he’s really sick, and doesn’t present himself at the hospital until his failure to act has become their screaming emergency.

Hospitals strive to never make errors, but sometimes they do. And sometimes the errors are extremely consequential, and sometimes they’re not, but either way they’re a peg for some ambulance chaser to get his third of a settlement. Ochsner also reports that the VA has paid over half a billion in malpractice settlements since 2012…

The number of medical malpractice payments balloons to 2,483 when you look at all malpractice payments made on the VA’s behalf between 2012-2016. The total amounts to $554.19 million.

…which would make, assuming the standard 1/3 rakeoff for doing the paperwork and sitting in the depositions, that this was a transfer payment of about $185 million to the societal fleas and ticks of the legal profession.

Rather than address these points, VA Asheville’s overpaid, underworked PR flack issued a statement empty of facts and bloated with boilerplate. It’s amazing that Ochsner even bothered to put three paragraphs of it at the end of his story. Just to give you an idea what weak, warmed-over pablum it is, here’s the one that comes closest to addressing facts.

We take concerns about care seriously, and, in some cases, conduct internal reviews to ensure we provide the highest quality of care and identify opportunities for improvement. Our goal is always to do right by our Veterans.

The VA has doctors and nurses who may make the occasional error, but they sure hired a bunch of C-average English majors who do not add value to the agency.

It would not harm the hair on the head of a single veteran to let these useless people feel the cold winds of the Dreaded Private Sector. Is it time to disband this thing yet?

The Wait, Is That What “Suicide Help Line” Does? Affair

“Hey, they’re from the Government, and they’re here to help us!”

It would take the right writer to do it but it’s easy to imagine a wickedly funny story in which the purpose of a veterans’ suicide help line was to help veterans commit suicide. That’s the occasional outcome of VA’s well-funded suicide help line, which is euphemistically called the Veterans Crisis Line. (Do not call that line with any other crisis, because they think it’s a suicide line, and they’ll send a SWAT team to finalize the suicide if you hang up on them. Once you make the call, suicide is the crisis you have, whether you wanted it or not).

On 20 March, the DVA Office of Inspector General released a report of investigation into the Veterans Crisis Line. (There’s a press release and the full report, both in .pdf).

The IG has 16 new recommendations for the DVA’s Vet Crisis Line.

The last time they looked at it there were 7, over a year ago (.pdf again). They are not part of the 16 new ones, but the IG notes that no action has been taken on the last 7 squawks. As the VA OIG put it, rather mildly, “Failure to implement our previous recommendations impairs the VCL’s ability to increase the quality of crisis intervention services to veterans seeking help.”

That kind of tells you how seriously the VA takes criticism, even internal criticism. If you think all the platitudes about their mission actually mean anything to them, this would be alarming, but if you think of it as a make-work jobs program for the employees and managers, it all begins to make sense.

On the plus side, every time the Veterans Crisis Line gets it wrong, the taxpayers are saved a bunch of veterans’ health and disability expenses, so there is that.

“Welcome to the suicide help line. How can we help you kill yourself today?”

Yeah. Time to disband this thing.

The Symbolism Counts Affair

The VA, despite its army of overpaid, underworked PR payroll patriots, scored a rather gnarly own goal last week, as a recalcitrant VA hospital head refused to display the photograph of the man who’s not her president in her hospital. A photo provided by local vets was taken down. The press called this “a controversy.”

Congressman Brian Mast, an Army vet whose district is just north of the hospital and whose constituents are served there, came back with some vets and some ceremony to place photos of the President and VA Secretary. During his visit, the VAMC head made herself scarce.

As soon as Mast was gone, she ordered the portraits removed again.

It took an order from VA HQ in Washington for the pictures to be restored. Meanwhile, of course, the PR army (hardly any of whom are vets) took the part, as usual, of the VA’s employees against the VA’s victims veterans.

This occurred at the West Palm Beach VAMC, where none of the senior staff is a veteran (the VA generally accepts vets only as employees as physicians, or low-level janitorial shiftworkers).

What time is it, kids?

 

Update

It could be worse. In Canada, government-employee doctors now have the power of euthanasia… which in at least some cases they’ve used to accelerate organ and tissue donations. Nice liver you’ve got there, mate. Wouldn’t want anything to happen to it.

5 thoughts on “The Department of Veterans Affairs Continues to Excel

  1. Aesop

    Re: Dilaudid
    The dosage delivered in error won’t kill you outright — from the Dilaudid.

    But – the respiratory depression, and decreased oxygenation that results even from normal safe doses of Dilaudid will, with the certainty of holding a pillow over your face until you stop kicking.
    But you’ll probably go with a smile on your face.

    That, coupled with impending sepsis from the perf’ed bowel is like throwing an entire bunch of banana peels under a guy on crutches. On an icy sidewalk.

    Sepsis kills people better than napalm.

  2. Keith

    Not to surprised that the Peter Principle is alive and well at any government organizational. And that particular head of the one were she was telling them to take Trump’s photo’s down is a typical fellow traveler of the Progressive/Tranzi/Cosmo Pravda and yes I’d tell her that to her face. She and those like her are a clear and present danger to all of you who have served and sacrificed for this country and should be treated accordingly.

    Keep your powder dry and your faith in God.

  3. Larry

    No, absolutely no. The VA were terribly mismanaged under Bush. Then wonderfully managed under Obama. My mother-in-law has told me so. Not least because my father-in-law (twice-wounded Marine rifle company commander in Vietnam) only has to undergo 3-month waits now for MRIs or other now common procedures (outside Medicaid and the VA). That’s been wonderful, but now becoming horrible under the new regime. Sigh. I’m dreading the upcoming “visit”.

    1. Aesop

      Your observation window is too small.

      The VA has been horribly mismanaged pretty much non-stop since its founding in 1930.

      As one of a distinguished herd of FDR Progressive HUTA socialist boondoggles, that result was pretty much baked into the cake by design.

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