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Statement About the Veterans Medical Care Program

April 02, 1970

FOR a number of years, the Veterans Administration hospital system has been experiencing increasing difficulties in providing a full range of services for the care of sick and disabled veterans. As a result of past decisions, the ability of the VA hospital system to meet future needs has been seriously impaired.

Action must be taken now to insure that eligible veterans will receive the medical care they require.

When I appointed Donald E. Johnson to be Administrator of Veterans Affairs last June, I directed him to make a thorough review of the veterans medical care program: to identify the problems, analyze the causes, take such immediate corrective steps as appropriate, and recommend a total medical care program appropriate for future needs. He has completed that review, and today he reported his findings.

I am pleased that the Administrator and his new management team have taken a number of immediate administrative steps to improve the quality of the veterans medical care program. However, his review shows that additional funds are required immediately if the VA is to meet its obligations to veterans requiring medical attention. Therefore, I have approved an increase of $50 million in the VA's medical care budget request for fiscal year 1971--which makes it $210 million more than the approved appropriation for fiscal year 1970---and have authorized the VA to seek from Congress an additional appropriation of $15 million for the remainder of this fiscal year. These requests will enable the VA to improve medical care for all eligible veterans, particularly for those suffering from battle injuries.

This administration is committed to providing quality medical care for every eligible veteran.

BACKGROUND OF THE PROBLEM

A 1968 law required the Veterans Administration to reduce its staff to the mid-1966 level. This deprived the VA's medical care program of several thousand workers in all categories of the health services professions at a time when the VA requirements for such personnel were growing steadily.

Last September, to meet this problem, I raised VA's personnel ceiling by 1,500, even though employment authorizations for other Federal agencies were then being reduced by 51,000. I also approved the VA's fiscal 1971 appropriations request for an additional 2,100 medical care employees.

Even more health services personnel will be required in the immediate future to meet the special problems presented by an increasing number of Vietnam era dischargees and the increasing scope and complexity of health care delivery systems.

THE VIETNAM ERA VETERAN

Men and women with service in the Armed Forces since the onset of the Vietnam conflict are being discharged in steadily increasing numbers. The annual rate of separations grew gradually from 531,000 in calendar 1965 to 958,000 in 1969. In 1970 and 1971, the annual rate will climb well above one million.

Many of those now leaving the service suffer from wounds received in combat and are discharged directly into VA hospitals. Currently 7 percent of the patients in VA hospitals and 9 percent of VA outpatient treatment cases are Vietnam era veterans. These percentages are expected to rise during the next few years. Also, all Vietnam era veterans are entitled to VA dental care in the year following separation from service. Due to the increasing discharge rate, the demands for such treatment have led to an abnormally high backlog. Additional funds are required to correct this situation.

Better battlefield care and faster evacuation of the war wounded have resulted in a high incidence of patients with multiple amputations and spinal cord injuries in VA hospitals. Special hospital centers, with more staff than usual, are required for the care and rehabilitation of these patients.

These new developments combine to impose greater than normal demands upon the professional staffs of VA hospitals and clinics and require both more personnel and an increased range of specialized skills.

SPECIALIZED MEDICAL PROGRAMS

As medical knowledge expands, the techniques for saving lives become more complex, more specialized, and more expensive. For several years, the VA has identified for separate funding and control a group of 23 specialized medical programs, including: coronary/intensive care units, hemodialysis centers, organ replacement centers, and pulmonary emphysema units. These innovations in VA hospitals and clinics pioneer the latest advances in diagnosis and treatment.

The VA's efforts to make these programs available throughout its hospital system have been constrained by lack of funds. For example, there is presently an insufficient number of coronary/intensive care units in the VA hospital system. Such units reduce mortality in heart attack cases by 15 to 30 percent; every eligible veteran should have access to these fife-saving facilities.

Administrator Johnson also has found that the VA has not had the funds to open and operate a sufficient number of prosthetics treatment centers and spinal cord injury centers for severely wounded veterans from Vietnam.

These specialized medical programs are not only important to the veterans who benefit directly from them, they are also important to America because the veterans medical care program consistently has been a leader in the development of innovations of great importance to our total health delivery system.

Concern for the Nation's older veterans is an integral part of the VA's specialized medical care mission. These patients will require a greater number of chronic care and nursing care beds as the veteran population continues to age.

OTHER PROBLEMS

Administrator Johnson has identified a number of other problems affecting the veterans medical care program. Most of these have been brought on by a combination of inflationary pressures and budgetary restrictions. These include a reduction in supporting services available hi VA hospitals as compared to many nongovernmental hospitals, deferrals in the purchase of replacement equipment, stretch-outs of maintenance and rehabilitation projects, and curtailment of the construction program to modernize or replace outdated VA hospitals.

The VA's potential as a clinical training resource has been neglected. Fuller reliance on the VA's system of 166 hospitals for medical education purposes would not only improve the VA's position, as a consumer of health services personnel, but would also help the entire Nation meet its requirements in the health manpower area.

THE STEPS WE ARE TAKING

Solution of many problems related to the veterans medical care program will take time--even if we had all the necessary funds immediately.

We must, however, find early solutions to the more pressing problems which directly involve patient care. These include:

--the need for increased staffs to serve existing specialized medical programs, especially those concerned with care of wounded Vietnam veterans;

--the need to open and adequately staff and equip more centers under these programs;

--the need to bring the backlog of Vietnam veteran dental care cases within normal operating levels;

--the need to provide additional nursing care beds for older veterans.

The $15 million supplemental appropriation which I have authorized would be expended in April, May, and June to clear up the excessive backlog in Vietnam veterans dental claims; improve the staffing of existing specialized medical programs, especially the spinal cord injury centers and the coronary/intensive care units; carry out plans for taking hemodialysis units into the homes of veterans suffering from serious kidney ailments; and help meet increased costs of needed drugs and medicines.

The VA's budget request already submitted to Congress for the fiscal year to commence in July would provide extra staff to activate 121 additional bed units for specialized medical programs and to open an additional 1,155 nursing care beds, a 28-percent increase in this program.

The new request for $50 million would be used to increase the staffs of VA hospitals and clinics; to improve further the staffing of the spinal cord injury centers and other important specialized medical programs; to purchase seriously needed operating equipment; and to absorb rising drug and medical costs.

OTHER STEPS TO IMPROVE MEDICAL

CARE

Beyond these requirements for additional funds, a number of steps have been taken to improve the veterans medical care program.

New management team---An entirely new top management team for the VA's Department of Medicine and Surgery, headed by Dr. Marc J. Musser, has been appointed. This group has the talent, the initiative, and the outlook to develop and carry out needed improvements in veterans medical care.

Improved management controls Streamlined management controls over the widespread operations of the VA, including its system of 166 hospitals, have been established. By merging the fiscal audit, internal audit and investigation services, more frequent audits and faster investigations into complaints will be possible.

Improved management of hospitals--The management of each VA hospital is being evaluated, and a number of replacements in hospital directors, assistant directors, and chiefs of staff have already been made. Other personnel changes will be made as the need is demonstrated. A new program to upgrade the managerial skills of those in charge of the hospitals will make possible greater decentralization of appropriate authority to hospital directors. An executive recruitment and development program to provide for future hospital leaders will be undertaken, and work procedures and other hospital administrative practices is underway.

Study of future needs--a comprehensive study of the future needs of the veterans medical care is continuing to insure that the developing problems will be identified early and analyzed as to their significance to the program.

Closing health manpower gap--The VA, in coordination with other interested agencies, will explore new approaches to the problem of closing the gap in the Nation's critical health manpower situation. This will include studies to improve techniques of training health services personnel, improvements in health delivery systems, increased sharing of expensive and short-supply medical equipment by hospitals in the same community, and the potential for the establishment of new medical schools in conjunction with VA hospitals.

COMMITMENTS TO FULFILL

To those who have been injured in the service of the United States, we owe a special obligation. I am determined that no American serviceman returning with injuries from Vietnam will fail to receive the immediate and total medical care he requires. This commitment will require sound management of existing VA facilities, wise use of existing personnel and equipment, and, most importantly, a sensitivity to the needs of our veterans, personal as well as medical. Administrator Johnson and his staff have a keen appreciation of these requirements. We, as a people, have commitments to our veterans, and we shall fulfill them.

Note: On the same day, the White House released the transcript of a news briefing about the President's statement by Donald E. Johnson, Administrator of Veterans's Affairs, and Dr. Marc J. Musser, Chief Medical Director, Veterans Administration.

Richard Nixon, Statement About the Veterans Medical Care Program Online by Gerhard Peters and John T. Woolley, The American Presidency Project https://www.presidency.ucsb.edu/node/240913

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