Top mental-health officials for the VA San Diego Healthcare System are spending little time treating the burgeoning caseload of stressed-out war veterans because they are immersed in research, according to a new internal investigation by the Department of Veterans Affairs.
The medical director of the two main treatment programs for post-traumatic stress disorder “did not substantively participate in (their) operations” because of research work, said the report, which was issued last week by the VA's inspector general.
Other administrators are so tied down with research that they have been forced to work overtime and/or hand over certain patient-care duties to assistants.
“The people who do the PTSD clinical work are very, very good, but they are swamped,” said Bill Mahedy, a chaplain and former psychologist at the hospital whose complaint prompted the investigation. “Good leadership would have made sure the research tail isn't wagging the clinical dog.”
The imbalance may have contributed to delays in treatment for some veterans at peak times, the report said. Staff shortages also prevented follow-ups or caused poor follow-up with more than 80 percent of Iraq and Afghanistan war veterans who failed to make their appointments.
Young veterans frequently miss daytime appointments because of their work duties, said Bill Rider, a Vietnam War veteran who mentors local service members through the nonprofit group American Combat Veterans of War.
In the new report, investigators said they couldn't accurately track the nearly 1,200 PTSD cases diagnosed since 2003 among veterans of the Iraq and Afghanistan wars because of a chaotic record-keeping system.
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Major findings
A newly released investigation by the Veterans Affairs inspector general found that:
 Some mental-health leaders for the VA San Diego Healthcare System spend only a fraction of their time on patient-care programs for post-traumatic stress disorder because of heavy research obligations.
Case workers for Iraq and Afghanistan war veterans have been handling 120 patients each, about four times more than the VA standard.
Iraq and Afghanistan war veterans suffering from PTSD don't show up for up to 50 percent of their medical appointments. In 83 percent of those cases, VA staff did not follow up to find out why or had poor follow-up.
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They also said each of the local VA health system's three case workers for Iraq and Afghanistan veterans handled 120 patients, far above the VA standard of 25 to 30 cases.
“This is not the way to deal with these heroes coming home,” said Rep. Bob Filner, D-San Diego, chairman of the House Committee on Veterans' Affairs.
The heavy emphasis on studies and clinical trials is tied to the VA's partnership with the University of California San Diego, a research institution.
Gary Rossio, chief executive officer of the local VA health system, defended the collaboration. The main VA hospital is adjacent to UCSD's Thornton Hospital in La Jolla, and many VA doctors work for both institutions.
Such partnerships are common around the country and typically benefit the VA by attracting top-notch researchers and giving patients access to innovative technologies, Rossio said.
Overall, the inspector general's report points out problems that VA leaders have been struggling to fix for years – and are finally making progress because of a big funding boost in 2008, he said.
“They're really not telling us anything we don't already know,” Rossio said.
When the Iraq war began more than five years ago, he said, no one in the VA or other agencies expected such a long conflict involving hundreds of thousands of troops serving multiple combat tours.
Rossio said he has been asking for several years for more money to expand his staff. The local VA health system's patient load has grown from 36,000 in 1998 to 60,000 this year. Each week, Rossio said, the system enrolls 45 Iraq and Afghanistan war veterans.
Last year, Congress approved legislation that boosted the local VA health system's current budget by $50 million – to $374 million. Rossio said some of the money was used recently to hire more case workers and three psychiatrists whose full-time job is to treat PTSD in veterans of the Iraq and Afghanistan wars.
And last week, the system added an experienced combat psychiatrist to run its main PTSD programs.
“We will absolutely implement every suggestion in this report,” Rossio said. “This is a work in progress.”
Steve Liewer: (619) 498-6632; steve.liewer@uniontrib.com
