a comment on the VA medical service


"Dear Colonel Lang,

My architectural firm had a series of contracts to develop facility plans for 15 or so VA hospitals in the mid to late 90s. I was the Principal on them.  Along with my team, I visited them, studied them and developed plans for solving their facility needs in a way that added to the whole and prepared them as best we could for the unknown needs of the future. I made many trips to DC to present our findings and recommendations to the VA brass. The facilities I worked with ran the gamut from urban, to suburban and rural, and to ones affiliated with academic medical centers or not. From that experience, I offer the following

I worked in most every type of hospital in the USA and I enjoyed working  most at VA, children’s and cancer hospitals. In general, all three attract a kind of physician who is not in it for the money, but for something nobler, and that attitude can carry though the place.

Many of the problems at VA hospitals are a direct result of being resource constrained – lack of adequate staff, and/or specific treatment spaces, or beds. Staff are not trying to withhold care, there simply aren’t enough physicians to see every patient, or beds to  put them in. Most established patient though do get in for they are known by the staff and the regularity of their  care is important. It’s the new patients that have trouble getting in and getting established.

A significant percentage of VA eligible patients never use the VA, virtually all because they also have insurance through their employer or Medicare. Similarly, many patients with outside insurance do use the VA because of familiarity, camaraderie, or specialized treatment. The VA doesn’t lose though this, as they bill the outside carrier.

The camaraderie at VA hospitals comes from not only seeing other veterans, but having a large percentage of the staff having been veterans, and the offering by the VA to virtually every Veterans Service Organization to have an office at the facility to serve as advocates.

Many VA patients have both physical injuries/illnesses and behavioral/drug/alcohol problems. The VA is relatively alone in being able to treat them as a whole person. Were the VA hospitals to be abolished, these patients would suffer greatly in the outside world for private hospitals are not equipped for them.

If you’ve seen one VA hospital, you’ve seen one VA hospital. Some VA hospitals also have long term care. Some have specialized programs – the VA Palo Alto had in the mid-90s the only spinal cord injury treatment center. Some have top notch administrators, some less so. Some have affiliations with academic medical centers, and so the medical care is delivered by residents supervised by faculty. Some have outpatient outreach into the community to deal with homeless veterans.

There is an issue of declining volumes. The population of veterans from WWII is declining and later wars simply did not put as many soldiers, sailors and airmen in harms way. That decline could give the Congress an excuse to cut funds, or give the VA a better ability to meet the needs of eligible veterans. I’m not a veteran, but I’d hope we keep these facilities going and properly fund them.


Paul Justison"


I am glad to have received this.  All the tales I have heard of actual VA medical treatment have been tales of good care.  A friend is a lady doctor in a VA hospital.  I cannot imagine a more conscientious, caring person.  My complaints about VA concern the ponderous nature of the bureaucracy OUTSIDE the VA Health service.  pl

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