An Open Letter of Praise for the VA

Those of you who have been following my blog for a while should know a few things about me. I am a proud veteran, and I have Crohn’s Disease. And I have been an outspoken critic of the Veteran’s Administration, and the Veteran’s Health Care System in particular. But I try to be fair in my criticisms, and when someone does something right they deserve to be recognized. Such is the case with my recent hospitalization at the East Orange VA Hospital. Following is a letter I wrote to the Secretary of Veteran’s Affairs (Des.), David Shulkin and the Director of the New Jersey Veteran’s Health Care System, Vincent Immiti.

Gentlemen,

I am a Cold War era veteran who has dealt with the Veteran’s Health Administration since 1994. Over the intervening years, I have had my share of complaints. I have been either an inpatient and/or outpatient recipient of services at multiple hospitals: Ft. Lauderdale, Wilmington (DE), Philadelphia, New York Harbor and, of course, the Lyons and East Orange campuses of the NJVHCS. I am not writing to tell you that rainbows are blooming over the VHA – only a fool would believe that. But I feel that after years of heaping some well-deserved abuse on what has proven to be a dysfunctional system, my most recent experience is deserving of praise for a job well done.

On Saturday, January 21 of this year I was brought into the East Orange Veteran’s Hospital Emergency Room. I have suffered with Crohn’s Disease since 1994 and this was the beginning of yet another hospital stay for me. I was not looking forward to it, as my previous partaking’s of the VHA’s hospitality always left me feeling more as if I were a POW than a patient. Allow me to say, I was pleasantly (as pleasantly as a hospital stay can prompt) surprised by this admission.

It truly was a night and day experience, compared to all my previous hospitalizations. Whereas in the past, my concerns and questions were met with derision or (even worse) indifference, this time I found the medical staff earnestly answering my questions, explaining the anticipated course of therapy and being attentive to my concerns and those of my family. In past hospitalizations, medications would arrive haphazardly without any semblance of a schedule, nurses would be impossible to find, even when called, and doctors acted as if I, the patient, were a burden they would rather not deal with. The only thing they seemed interested in was prescribing high doses of pain killers and moving on to the next victim.

Hospital cleanliness was always a concern, as I could go days without seeing a mop or broom used. As you’re probably aware, Crohn’s patients in the middle of an extreme flare are prone to having accidental, violent bowel movements. In 2009, after once such episode, the nursing staff did eventually come in to change the bedsheets – but with a set of blood-stained ones. Such was the level of contempt that the overall staff seemed to have for the patients in their care.

As veterans, we do not ask for anything special. Every veteran I’ve ever met is proud of our service to our nation and would gladly reenlist should the nation need our services again. As patients, all we’ve ever asked for is to be treated with the basic respect anyone should give another human being. The anger and disgust many of us feel towards the VHA is rooted in the failure of the VHA to recognize and act upon that humanity.

But as I mentioned, this hospitalization was not only what one would expect at any medical facility, but in many ways surpassed even the highest expectations one could have of any hospital. The staff exhibited all the hallmarks of a professional medical organization: courtesy, attentiveness, compassion and competence. Nurse calls were answered promptly, and if an RN was needed but unavailable, the LPN’s explained the situation. My attending physician not only provided timely and pertinent explanations of my care – in terms a layman can understand! – but proved an exceptional coordinator with the specialists I needed (gastroenterology, pulmonology and cardio). Tests that were performed were explained beforehand, including not only descriptions of the procedures but the reasons for them. The residents, interns and medical students did not treat me as an object of fascination on par with a living cadaver, but as a suffering patient with information they needed to perform their duties. Even the orderlies, janitorial staff and other support staff approached their jobs with a general friendliness and professionalism that made the otherwise dread of a hospital stay comforting.

The change is remarkable. I was going to attempt to single out individuals for jobs well done, but then realized everyone associated with my care deserves special recognition.

I am not a medical professional. I suppose you could say I’m a professional patient, given my history, but that’s the extent of my medical training.  However, my post-military career has been in operations and program management. As such, I can recognize and appreciate when an outstanding manager has taken control of a bad situation and is effecting a complete turnaround.

As I began, I’m not going to gloss over the fact that there are still major problems and deficiencies throughout VHA. However, Mr. Shulkin, upon your confirmation I can think of no better place to start turning around the system than seeking out your best, listening to what they’ve done and implementing those practices throughout VHA. Based on my recent stay, you would do very well to begin with Mr. Immiti. The change he has effected is nothing short of amazing.

I thank you for your time and again, congratulations on a job well done.

Semper Fi and Regards,

Raymond Rothfeldt