Not that anyone reading this blog really expected any different. After all, the VA been in failure mode since before I was born.
But, via many sources, we have new information about the VA. Namely that nearly 1/3 of the 850,000 people waiting to get on the waiting list died before their applications were processed. So they never got to wait for care, they were waiting to be told to wait for care.
As an ethicist, I could write pages telling you what you already know about how despicable this is. But I’m going to take a different tack here.
What may surprise many people is how much of your government dollars go to funding ethics specifically for the VA. Indeed the VA has an entire division for it: the “National Center for Ethics in Healthcare.” I don’t have an exact figure handy, but let’s do some back of the napkin math.
Their staff page lists over 20 people in that center. Even assuming $50k salaries, that’s over $1million/year in just salaries.
To do what one wonders. Especially considering this:
No. NCEHC does not deal with matters of fraud, abuse, negligence, medical malpractice, or other questions about compliance with specific regulations.
Wait, what? OK, OK, I get it. You’re more of a case based group that handles tough ethical choices like what to do with the patient who refuses an amputation that would save his life. Fair enough, most hospitals push “risk management” off on the lawyers anyway.
Let’s look at this sidebar some more. What’s this? A trademarked program called “IntegratedEthics”(R). You bothered to trademark it so it must be important! Ok then, what’s that all about:
IntegratedEthics is more than an organizational change initiative, a quality improvement intervention, or the sum of new policies, standards, training programs, measures, tools and structures. IntegratedEthics is a transformational idea that redefines ethics as it is both practiced and led in the health care arena.
But wait, 30 seconds ago you just told me you can’t actually do any Quality Improvement?
Also, your program is pretty clearly a failure. I mean just look at my first link. I can’t speak to the quality of case based ethics at the VA, but as far as “integrated ethics” goes…well…QED.
My field is always trying to combat the notion of the “roving ethicist” who wanders the hospital halls looking for bad things to jump in on. But frankly that’s what the VA needs. Instead what it gets is a giant group of people sucking up resources to make pamphlets (Just look at this little one sheet and laugh).
Ideally, the VA needs to be “fundamentally transformed” (read: burned to the ground and replaced with something else). But that’s unlikely to happen any time soon.
I’m going to engage in a bit of career suicide here by saying: start by shutting this program down. Clearly it’s not equipped to handle the mess that is the VA. An ethics consulting group may still need to be maintained to handle individual cases as they crop up, but not a gigantic team of 20+ people who…do what exactly? (Seriously I still can’t tell what they do besides oversell their abilities.)
And while we’re shutting down programs that don’t do much, got a minute to listen to me about the NIH’s center for “alternative medicine”….
(Full disclosure, I once considered applying for a VA ethics fellowship, but their offices are east/west coast only, despite hospitals all over the US. I emailed to inquire about working closer to home and…never heard back. So I guess it’s about as efficient as the rest of the VA.)