Health care expert warns of VA privatization risks

Several years ago, as veteran health care journalist Suzanne Gordon was exploring patient safety, her research led her to a model medical provider: the Veterans Administration.

“The Veterans Administration is one of the only health care systems in the country that takes teaching teamwork really seriously,” Gordon said in a telephone interview. That’s important, she explained, because failures in teamwork and communication among health providers are responsible for “the vast majority” of the 250,000 or more deaths every year from preventable medical mistakes.

The more she learned about the agency, the more respect she gained for the VA health system, resulting in her 2018 book, Wounds of War: How the VA Delivers Health, Healing, and Hope to the Nation’s Veterans. A study conducted by the Dartmouth Institute for Health Policy and Clinical Practice echoes her assessment.

But what Gordon calls growing pressure to privatize the system has compounded her respect with alarm.  

“The VA health administration plays a huge, important role that most people don’t know anything about — not only in caring for veterans but in the health care of all Americans,” she told the Wisconsin Examiner. “If you dismantle the Veterans Health Administration, the primary victims are veterans, but we’re all hurt.” 

Privatization, she asserted, is “rolling full steam ahead” and poses a danger “to veterans, to families and to communities  — really, to all of us.”

On Monday, Nov. 11, Gordon will visit Wisconsin to speak about the issue in a program organized and sponsored by Veterans for Peace, the Milwaukee County Labor Council, the American Federation of Government Employees (AFGE), and the Wisconsin Federation of Nurses and Health Professionals (WFNHP), along with several other organizations. 

AFGE represents several groups of VA employees in Wisconsin. The WFNHP represents registered nurses at the Milwaukee VA Medical Center in Milwaukee and at four VA clinics around the state in Green Bay, Appleton, Cleveland, and Union Grove.

Reclaiming Armistice Day

Gordon’s talk is scheduled for 7 p.m. Monday at Central United Methodist Church, 639 N 25th St, Milwaukee. Her visit is part of the annual Veterans for Peace observance to reclaim Nov. 11 as it was originally designated in 1918: Armistice Day, held to promote world peace and celebrate the end of World War I.

Privatization of the VA medical system “has been a significant issue” for Veterans for Peace, said Bill Christofferson, an organization member and spokesman who spent 17 months in Vietnam as a combat correspondent in the Marine Corps.

Mark Foreman, a former president of the Milwaukee chapter of Veterans for Peace, served as a Navy medical corpsman in Vietnam, treating Marines on the battlefield. Wounded in action in 1968, he was permanently disabled and has used both the VA medical system and private sector health care providers in the 51 years since then.

“The VA was a hellhole back in the ‘70s and ‘80s,” Foreman told the Wisconsin Examiner. “But midway through the 1990s it was obvious to see that they were getting their act together.”

Disproportionate attention

Gordon said the extent of the VA’s reach is not well known, while bad press about the agency gets disproportionate attention. Reports of problems at VA facilities surged in 2014 and included the Tomah VA medical center. She said that such occurrences get disproportionate attention because as a government agency the VA is more transparent than private hospitals that may have similar problems.

In addition, she and Foreman said, a campaign by the Koch-funded Concerned Veterans for America has further ginned up bad news about the VA to undermine the agency and make a case for privatization. 

“People have this notion that the VA is broken because the press will not report on good things that happen at the VA,” Gordon said.

Those include the fact that the VA trains as many as 70 percent of American doctors, who may do rotations through VA facilities during their residency. “The system of health professional training would almost grind to a halt without the VA because there are not placements in the private sector for that many people.”

The VA also produces extensive medical research, including development of the shingles vaccine, the nicotine patch, and drugs to treat hepatitis C. “The VA is one of the biggest research powerhouses in the country,” Gordon said, “because it has a very large, long-term population whose health and data it can track over time.”

Additionally, it has led the country in integrating mental health treatment and primary care, routinely locating health practitioners in primary-care clinics, she said: “The VA delivers coordinated care that doesn’t exist in the private sector.”

Outside providers

Privatization fears have escalated since the passage in 2018 of the Mission Act, legislation expanding the use of providers outside the VA system. Besides Gordon, former VA Secretary David Shullkin has raised similar concerns in his new tell-all memoir of his time as Secretary of Veterans Affairs early in the Trump Administration. 

Gary Kunich, a spokesman for the Milwaukee VA Medical Center, said the Mission Act “gives veterans more options” to get care promptly. “If an appointment is not readily available here, they have options where they can get care in the community. We want the VA to be a medical center of choice for our veterans.”

Coupled with the issue of privatization, said Christofferson, is an increase in what employees have complained is “anti-union, anti-worker activity” in the agency, both in Milwaukee and nationally. 

At the Milwaukee VA, about 850 registered nurses are represented by the Wisconsin Federation of Nurses and Health Professionals. “Our members are stretched pretty thin,” said Jamie Lucas, executive director of the union. “Many of them feel as thought the VA is understaffed. They feel there are not enough nurses and support staff on the unit to support safe care.”

Nurses who have concerns about patient care questions “can’t speak up,” he said. 

‘Destabilizing and hogtying the unions’

Pam Fendt, president of the Milwaukee County Labor Council, has spoken with local AFGE leaders representing other staff groups in the VA and encountered union leaders inside the agency reluctant to speak out publicly for fear of retaliation on the job.

“The Trump Administration has really set its sights on destabilizing and hogtying the unions that represent federal workers,” Fendt said. 

President Donald Trump signed a series of executive orders in May 2018 curtailing federal union rights, including one that sharply limited the time federal workers could spend on union business like handling grievances. A federal judge blocked the orders but was subsequently overruled. Since then, the VA has made new contract demands of the AFGE that would write those limits into the labor agreement. 

Fendt said local VA workers have told her that management has accelerated its treatment of disciplinary cases. 

Instead of following past practices — in which disciplinary matters were first dealt with between an employee and a supervisor — “now any time there’s an issue, human resources is brought into the picture, and human resources seems to be willing to throw the book at people,” she said, increasing union-management tensions. “It’s been a very contentious relationship.”

Kunich, the VA spokesman, said the agency seeks to meet with employees and their unions. “They are our partners,” he said. 

Employment at the Milwaukee facility has risen by about 500 over the last three to four years, according to annual report numbers from the VA, but Kunich also acknowledged that at times recruiting has been difficult. “We face the same challenges at recruiting doctors and nurses that any medical center or hospital has,” he said.