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VA care of brain injuries 'troubling'

WASHINGTON — Many Iraq war veterans with traumatic brain injury are not getting adequate health care and job assistance for their long-term recovery despite years of government pledges to do so, Veterans Affairs Department investigators say.

The busiest of the four specialized hospitals that treat these veterans is Tampa's James A. Haley VA Medical Center, where reports of poor patient care have surfaced for years.

"This is very troubling," said Michael O'Rourke, assistant director for veterans health policy at Veterans of Foreign Wars, who blamed the troubles on inadequate resources in a conflict that has lasted longer than expected. "I've seen a lot of effort to correct problems that exist. But constant vigilance is required."

The report, released Thursday by the VA's inspector general, is the first to examine the Bush administration's long-term efforts in supporting veterans with traumatic brain injury, which often are caused by explosions from roadside bombs, and are considered the signature wound of troops serving in Iraq and Afghanistan. Up to 20 percent of returning troops suffer brain injuries, which can cause lasting emotional and behavioral problems.

Haley, which recently entered into a partnership with USF to research the injuries, has been the target of congressional and VA scrutiny over reports of inadequate care.

In 2006, surgeons implanted an unsterilized cranial plate in a patient, causing medical complications. Later that year, an outbreak of flies attracted to spoiled food in an employee's locker forced the hospital to close operating rooms and cancel some surgeries.

The study tracked a group of 52 patients who received VA treatment after sustaining brain injury in 2004. An initial review two years later found gaps in follow-up care and family counseling and urged the VA to improve long-term care.

The VA pledged to coordinate with the Pentagon and improve, but the latest audit concludes that efforts are still falling short for roughly one in four patients.

Of the 41 veterans who agreed to interviews, 10 said they weren't getting help for health care, vocational rehabilitation, family support or housing. At least four patients specifically cited trouble getting eye care, while others reported family counseling gaps for problems such as depression and anger.

Mental health care at the Tampa facility came into question in December, when the Times reported that a complaint filed with the state said 12 of 34 psychologists on staff at Haley were unlicensed and received little, if any, supervision.

Haley, which serves about 450,000 veterans in a seven-county area, was investigated by the VA's inspector general in 2006. The VA also reviewed the director of the facility, Forest Farley, who was reassigned in early 2007.

The inspector's report on Haley said hospital managers were swamped by a growing caseload and routinely delayed operations because surgeons were unavailable. Consultants brought in by the VA reported that "the demand for services exceeded the medical center's capacity, signaling a rapidly approaching crisis." And the investigation found that a Haley patient died because of medical error in 2002.

The VA responded in Thursday's report by acknowledging problems with case management. But it also stated that recent improvements have developed systems to meet the needs of veterans with brain injuries.

For example, the VA announced last week it would start calling 570,000 recent combat veterans to make sure they know what services are available to them.

In the audit, investigators praised the new measures as "positive steps" but questioned whether the VA's latest promise to keep watch over veterans would become reality. Investigators stated they will continue monitoring the VA to ensure Iraq war veterans are receiving the care they need.

The report comes amid renewed scrutiny of the Bush administration's efforts in treating veterans with traumatic brain injury, which in its mild form is known as a concussion, as well as post-traumatic stress disorder in light of a prolonged Iraq war. About 19 percent — or an estimated 320,000 — of U.S. combat troops who fought in Iraq or Afghanistan may have suffered head injuries, according to a recent RAND Corp. study.

VA care of brain injuries 'troubling' 05/01/08 [Last modified: Sunday, May 4, 2008 11:40am]
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