It took 15 months and a phone call to U.S. Rep. Harry Mitchell before Iraq war veteran Ruben Gallego could get treatment for his injured knee. Gallego left the Marines in September 2005 and didn’t seek help right away. Once he did, delays and roadblocks he encountered with the Veterans Health Administration left him feeling frustrated and abandoned by the country he risked his life to serve.
“I was willing to give the ultimate sacrifice to my country,” he said. “All we ask of the government in return is some adequate response, some assistance.”
Though not as shocking as crippled soldiers left to fend for themselves in cockroach-infested outpatient housing at Walter Reed Army Medical Center, problems within the VA health care system – including long waits, backlogged claims and computer snafus – have drawn scrutiny in the wake of the Walter Reed scandal.
That’s despite the fact that it’s run by a separate civilian agency, the U.S. Department of Veterans Affairs, whose leaders have won raves for turning crumbling urban hospitals into national models.
The government-run, single payer health care system cares for some 5.8 million veterans, including 2,000 Phoenix-area soldiers who served in Iraq and Afghanistan. Roughly 64,000 local veterans were treated last year at the Carl T. Hayden VA Medical Center or one of its four area clinics, including the Southeast Health Care Clinic in Mesa.
The VA has earned accolades in recent years for patient care and satisfaction, lower prescription drug prices and its electronic medical records system.
But, symbolic of its bureaucratic challenges, VA computers still can’t get medical data from the Defense Department on newly discharged soldiers.
Staffing shortages and bales of paperwork have health care workers putting in nights and weekends to keep up. The Phoenix hospital, for example, is down five psychiatrists. It has opened a Saturday clinic, which has seen up to 150 patients, to keep up with the needs of new veterans.
And the kinds of injuries suffered in the Middle East conflicts have put tremendous strains on mental health and neurology programs. A new support group for posttraumatic stress disorder was launched last month at the Mesa clinic.
“Anytime that demand exceeds supply, it’s a problem,” said Dr. Keith Piatt, associate chief of staff for ambulatory care at the Phoenix VA Medical Center. “There have been some that have fallen through the cracks. We want the patients to call. We want to fix the problems.”
At the same time, the Veterans Benefits Administration, which deems veterans eligible for health care, has 400,000 men and women – including nearly 7,400 Arizonans of which 703 served in Iraq or Afghanistan – caught in a claims processing backlog. It takes an average of nearly six months for an Arizona veteran’s claim to be processed.
Mitchell, D-Ariz., and other congressional Democrats have vowed to take care of the country’s veterans. In the wake of news reports last month about conditions at Walter Reed, they have toured VA and military hospitals, passed legislation to beef-up funding and staffing, and called for quicker turnarounds for disability claims.
“Too many soldiers are finding an endless stream of red tape as they try and secure the benefits they have earned in the VA system,” Mitchell, a former Tempe mayor and civics teacher, said in a floor speech last month.
Mitchell held a hearing as chairman of an oversight subcommittee of the Veterans’ Affairs Committee, taking testimony from Arizona veterans about their difficulty getting care from military and VA hospitals.
Like testimony during the congressional hearings, complaints in the Phoenix VA hospital system deal mostly with out-patient access to care, rather than quality of care. Veterans are frustrated about long waits to see specialists, delays in scheduling and phone calls that go unanswered.
“Our biggest concerns are in our outpatient,” said Sue Colvin, the VA’s patient advocate coordinator. “Our veterans were having problems with just not being able to get ahold of anybody.”
Colvin said a new phone system for appointment scheduling has corrected most of that problem, but concerns remain, particularly among older veterans, that they’re not getting treatment in a timely manner.
Mesa veteran John Pancrazio was repulsed by the VA after he returned to his native Iowa from three tours in Vietnam.
“I went to the VA hospital and didn’t go back for 30 years,” he said. “They were uncaring and rotten and I wanted nothing to do with them.”
Still, he spent the past 15 years helping veterans become eligible for VA benefits as a service officer for the Vietnam Veterans of America. In 2000, he gave the health care system another chance, found “they had completely reversed it” and filed his own disability claim.
Pancrazio said Vietnam vets are instrumental in helping returning combat soldiers get the care they need.
“We were basically abandoned by the other veterans organizations when we returned,” Pancrazio said. “Our founding principle is: Never again will one generation abandon another.
But claims get lost and workers get behind, he said. Veterans shouldn’t try to complete the paperwork alone, he said. Service organizations and the Phoenix office of the Veterans Benefits Administration have counselors who can help.
“A lot of times, people will file a claim on their own and it’ll be denied and they can’t figure out why,” he said. “They’ll just give up.”
Ruben Gallego refused to give up. He first noticed the pain in his left knee during his stint as a Marine infantryman in Iraq in 2005. Each step caused a jabbing sensation in his leg.
He saw other U.S. service men and women suffer far worse combat injuries nearly every day, however, and he wanted to remain with his unit. So Gallego continued to strap on his armor and equipment and go on patrol.
“Sometimes it hurt, sometimes it didn’t,” said Gallego, a 27-year-old corporal. “So I could always push off the pain a little while longer.”
Over time, the knee became deformed, as if a tennis ball had been lodged under his skin.
When his tour ended, he took a few months to clear his head and then called the VA to get treatment for his knee, which prevents him from jogging or walking long distances. Iraq and Afghanistan combat veterans are entitled to two years of free health care upon release from active duty.
The first VA doctor referred Gallego to a specialist, who referred him to another specialist for a second opinion. After two months without hearing from any of the physicians and still without even a diagnosis, Gallego said, he started calling the first specialist.
“He hadn’t even read the report or even talked to the other doctor,” he said. “This happens all the time with the VA, it seems. It’s like I just keep falling through the cracks.
In frustration, he called Mitchell and soon afterward, he said, he was contacted by the VA. The physicians had agreed on a treatment plan.
“There are veterans out there that are in a lot worse shape than I am,” he said. “I just hope that they’re getting much better treatment than I am.”
Social worker Pat Tuli has met many of those veterans through her work as the point of contact at the Phoenix VA hospital for Iraq and Afghanistan veterans.
She helps them fill out forms, coordinates their care and generally holds their hands. She’s created three new support groups and reaches out to community organizations and state and local agencies for extra help.
“They have a lot of issues just based on where they were and what they were exposed to over there,” she said. “As we find problems, we start putting things into place to help solve them.”
Tuli and other VA staff have adjusted schedules and taken on extra duties to accommodate the influx of new patients. But Tuli remains a one-woman show, pedaling as fast as she can.
“We’re working at full capacity and we’re working overtime and we’re working late,” she said. “We’re getting to the point where it’s difficult to manage.”