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Problems piling up at VA hospitals call for better oversight, accountability

The problems at the Department of Veterans Affairs continue, in both their depth and breadth. This won’t be easily fixed.

It’s hard to tell what is the most shocking of recent revelations. A report by the Associated Press documents what the VA acknowledges: that the agency is failing to attend to the needs of rising numbers of women veterans. It’s been almost 13 years since the United States went to war in Afghanistan. What’s the delay?

Meanwhile, regarding Buffalo, Special Counsel Carolyn M. Lerner wrote to President Obama that while the Office of the Medical Inspector is investigating complaints that the Buffalo hospital is failing to follow sterilization procedures, the OMI denied that those failures affected patient safety.

Here’s what the OMI apparently found to be perfectly safe: According to one emailed complaint, some instruments in the catheterization laboratory were found to be dirty, with two sets containing blood. In another complaint, a VA employee reported that a sealed, supposedly sterile scope had “dried fecal material wedged inside the neck of the button.”

And, most recently, a report Tuesday by the office of Sen. Tom Coburn, a physician, concluded that more than 1,000 veterans may have died over the last decade because of malpractice or lack of care from VA medical centers. Coburn, R-Okla., called the VA a “broken system” and if even half of what he found was correct, the description would be accurate.

Where do you start? How can blood and dried feces not present a safety issue to patients and, for that matter, to doctors, nurses and other hospital employees? And why does it take an investigation by a special counsel to the president before VA administrators wake up to the disaster before them?

How is it that the VA knew that increasing numbers of women were being sent into war zones in Afghanistan and Iraq yet never prepared to meet their needs? According to the Associated Press, the 5.3 million male veterans who used the VA system in fiscal year 2013 far outnumbered female patients, but the number of women receiving care at VA facilities has more than doubled since 2000. Among the deficiencies:

• Nearly one in four VA hospitals does not have a full-time gynecologist on staff.

• About 140 of the 920 community-based clinics serving veterans in rural areas do not have a designated women’s health provider.

• Female veterans have been placed on the VA’s Electronic Wait List at a higher rate than male veterans.

• Female veterans of child-bearing age were far more likely to be given medications that can cause birth defects than were women receiving treatment through a private HMO.

And it gets worse because, according to Coburn’s report, Congress didn’t much care. “This report shows the problems at the VA are worse than anyone imagined,” the senator said. “The scope of the VA’s incompetence – and Congress’s indifferent oversight – is breathtaking and disturbing.”

The repair of this agency must begin with committed and demanding oversight, by Congress and the White House, and a group of administrators who care about performance and who will be held accountable for it. And that means performance in all aspects, including quality of care for male and female veterans, reasonable wait times and instruments without dried feces in them.