The most morbid stories I have ever heard about patient care have been told by physicians recalling their patient experiences at the VA hospitals.  This is no secret and is nothing new.  Whenever a government take over of health care has been proposed, one of the reflexive responses has been:  ”if you want to know what government health care is like, go to the VA.”

Please understand what I mean by “morbid.”  I mean patient neglect, unnecessary suffering and death.  Reading Samuel Shem’s “House of God” will give you an idea of what the delivery of medical care has been like in a VA.  I remember as a medical student how shocked I was at the differences in workload between the nursing staff at the VA’s at which I worked and non-VA hospitals.  The medical students and residents assumed many of the duties of nurses at non-VA hospitals.  While this was certainly a learning opportunity, I remember being called at all hours of the night to start IV’s or to obtain a blood specimen, for instance, routine duties for nurses working elsewhere.  If the medical student or resident wasn’t available (in surgery, for instance), these routine patient care tasks simply didn’t get done.

I remember being taught to ask for X-rays from the VA radiology department at least two hours before you needed them.  It was best to make the request then return.  If the clerk saw that you were in a hurry, you would wait even longer.  I remember the clerk at the laboratory at one VA, when told the potassium level on a blood specimen he had just been handed (turns out it was extremely difficult to obtain from the patient with poor vein access) was needed “stat,” opening the vial and pouring the specimen in the trash for all to see.  Nothing was going to happen in a hurry on his shift.

In one VA where I worked, I remember being called to a patient’s room at 5 am because as the nurse said “His IV no work.  Alarm go off all night.”  Upon arriving at the patient’s bedside I discovered why the machine delivering his IV fluids was alarming.  He was dead.  It was difficult to determine the time of death as this nurse had charted normal vital signs for this patient for 4 hours after I arrived finding him in this condition.

These are just some of my memories.  I have heard much worse from others who have spent more time in these “hospitals” than I did.  That veterans have been treated poorly in these facilities is nothing new.   That this is what government health care looks like everywhere is no mystery. That those who are in favor of legislation like Obamacare are shocked that VA hospital care is substandard and implements “death panels” is not stupid.  It is evil and duplicitous and I for one am not buying the feigned reaction to the VA revelations from those who support government healthcare.  I suggested to a friend the other day that he should stop calling evil people “stupid,” as ignorance is too easily forgiven and deliberate aggressors shouldn’t get off the hook so easily.  ”I didn’t know things were bad at the VA.”  Really?

G. Keith Smith, M.D.

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