How the VA creates barriers to organ transplantation
Monday, February 19, 2018
The Department of Veterans Affairs has been accused of making it difficult for veterans to access organ transplants. A recent report by the Office of the Special Counsel alleges that expecting veterans to travel to distant medical centers to access transplants "did not appear reasonable."
The allegations were first made in 2016 when whistleblower Jamie McBride accused the VA of requiring sick vets to travel long distances to receive care. McBride works as a manager of solid organ transplants at the VA hospital in San Antonio, Texas. McBride said that rather than allowing veterans to receive transplants at local hospitals, the VA required patients to travel long distances to hospitals across the country.
The requirement causes both financial and logistical challenges for vets which may have cost some their lives, McBride said. Before coming forward to the media, McBride had attempted to show records documenting the delays to officials in Washington, but the problem was not fixed.
A second report conducted by the Cleveland Clinic confirmed much of McBride's allegations. The report concluded that VA patients in need of kidney transplants were less likely to receive the surgery than other patients in need of the same procedure.
Specifically, VA patients were 28 percent less likely to have a kidney transplant than patients with private insurance. The report also found that VA patients were more likely to die while waiting on a kidney transplant, and VA patients lived an average of 282 miles from a VA transplant centers. Non-VA patients lived an average of 23 miles from a transplant center.
"The much greater distance from transplant centers may contribute to lower transplant rates in veterans, and other factors related to organ acceptance or center practices may also contribute to differences," said the study's lead author, Dr. Joshua Augustine of the Cleveland Clinic.
A third case study conducted at the University of Pennsylvania found that veterans in need of a liver transplants were more likely to die if required to travel more than 100 miles to a transplant center.
"They have less access to a lifesaving transplant, which directly correlates to a higher chance of dying from liver disease," said Dr. David Goldberg, the surgeon who led the study.
The subsequent investigation by the Office of the Special Counsel echoed McBride's claims and the research findings. In a letter to President Donald Trump dated Jan. 28, Special Counsel Henry J. Kerner wrote that the OSC found "several discrepancies and deficiencies in the evidence and findings presented" in initial and followup reports by the VA following the first allegations.
Specifically, Kerner wrote that the VA was not able to explain why it has a low rate of living kidney donors nor did the VA acknowledge the potential impact on patients who must travel great distances to access care or negotiate "overly restrictive criteria" in determining eligibility for a solid organ transplant.
Congressional leaders are discussing changes to the VA Choice program that allows veterans to access care at non-VA facilities. In his State of the Union address, Trump spotlighted the program as a method to ensure veterans receive healthcare.
"We are serving our brave veterans, including giving our veterans choice in their healthcare decisions," Trump said in his speech. "Last year, the Congress passed, and I signed, the landmark VA Accountability Act. Since its passage, my Administration has already removed more than 1,500 VA employees who failed to give our veterans the care they deserve — and we are hiring talented people who love our vets as much as we do.
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