Update on VA response to wait times recalls Shulkin’s #AHCJ16 comments

David Shulkin, undersecretary for Health at the Department of Veterans Affairs, spoke to Health Journalism 2016 attendees.

David Shulkin, undersecretary for Health at the Department of Veterans Affairs, spoke to Health Journalism 2016 attendees.

In a conversation with Renee Montagne on Morning Edition last week, David Shulkin, undersecretary for Health at the Department of Veterans Affairs, gave an update on the VA two years after a cover-up about long wait times made the news.

Shulkin was a Spotlight Speaker who gave a news briefing at Health Journalism 2016 in Cleveland, where he told journalists that same-day appointments were now available for veterans at some centers and would be available at all of them by the end of this year.

But his interview with Montagne revealed more problems. As he talked about the Veterans Choice program that allows veterans to see private doctors, he had to answer to NPR’s investigation finding “that, by and large, it has not been working as planned.” Doctors are waiting for payments, the provider network is too small and some veterans are waiting even longer than they were before for serious conditions, Montagne said.

Shulkin offered some of the same talking points he gave at the conference: “Well, I can tell you there is no issue the VA is more focused on than fixing this. That’s why we’ve put in legislative proposals to fix it. And we’re not going to stop until we get this right.” Shulkin took the opportunity to point out that the VA is “the only system in the country that delivers care to every corner of the country. And so it’s a very, very big system.”

Those who attended the AHCJ conference session on Saturday afternoon, “Taking Care of the Changing Veteran Population,” also heard about the challenges of caring for veterans, but an undercurrent to the conversation suggested things were being held back. What wasn’t being said may indicate opportunities for digging into the VA story even more and a variety of ways to localize this national story.

The session panelists included Murray Altose, M.D., chief of staff at Louis Stokes Cleveland VA Medical Center; Joseph Calabrese, M.D., coordinating principal investigator at Ohio Army National Guard Mental Health Initiative at Case Western Reserve School of Medicine and University Hospitals Case Western Medical Center; Will Brown, a service officer now with the American Legion; and moderator Tony Leys, a staff writer at the Des Moines Register. Below are a handful of highlights pulled from the subsequent extensive Storify of tweets.

  • One key goal of post traumatic stress disorder (PTSD) research appears to be identifying those soldiers most susceptible to developing PTSD to offer resilience training during standard military training.
  • About 85 percent of veterans with PTSD also have another mental health condition, but PTSD increases the risk of suicide five times. Adding another two conditions to PTSD increases that risk eight times.
  • PTSD is the only psychiatric illness requiring trauma (physical or mental/emotional), and the highest risk factor for developing PTSD among those entering the military is a previous trauma.
  • Caring for veterans requires looking at the big picture, including the consequences of different health conditions, such as housing problems, unemployment, financial difficulties and legal issues. The stigma of mental health issues prevents many vets from seeking care, as Susan Heavey has written, but then mental health programs are often underfunded as well.
  • Altose encouraged the media to look beyond the story on wait times to the VA’s many other programs providing holistic care. [Me: And yet, a journalist might see that as a diversion from the problems that need a light shined on them.]
  • The IEDs and similar blasts in Iraq and Afghanistan that would have killed soldiers in previous wars are no longer killing them due to better gear and medical care, but that means more catastrophically disabling injuries that require extensive lifetime care at home.
  • Note to journalists: Despite a recent news report showing that VA suicide hotline calls went to voicemail, Altose seemed to dodge questions about the time from phone calls to appointments for vets. However, via Twitter during the session, Cleveland VAMC provided the data they track.
  • AHCJ members: See the speakers’ presentations from this session.

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