Can government run a health care system?

The VA is the quintessential government bureaucracy--administratively officious, laden with red tape and meddlesome regulatory minutia destructive of both quality patient care and staff conduct. Three volumes of the U.S. Code (Title 38) and a full volume of the Code of Federal Regulations, plus scores of volumes of Federal personnel, medical, and administrative policy restrictions, govern each VA employee's every move. Thousands of pages are filled with fine print, detailed descriptions of medical conditions, degrees of disability and potential eligibility, even mathematical variations thereof (disabilities are rated from one to 100%)--a maze that is supposed to produce pension benefits and free health care.

Defending malpractice

Small wonder that it requires a phalanx of more than 400 VA attorneys to interpret and reinterpret the arcane substantive and procedural provisions. Along with lawyers from the Civil Division of the U.S. Department of Justice and the U.S. Attorneys' Offices across the nation, VA lawyers also must defend thousands of malpractice claims filed by injured patients or their bereaved survivors who blame the VA for the wrongful death of a veteran. For example, the following is a partial list of events that occurred at VA medical centers at Tampa and Bay Pines, Fla., from 1991 to 1993:

* For more than three months after abdominal surgery, a hospitalized veteran continued to complain of weakness and stomach pain. A VA radiologist misread the X-ray showing the infection-causing laproscopic sponge overlooked by a VA surgeon. The cost to taxpayers was $100,000 in damages.

* A VA orthopedic specialist misdiagnosed a veteran with severe back pain who was unable to stand up and ordered bed rest. The result was permanent paraplegia and a $1,000,000 settlement.

* An elderly, hard-of-hearing, overworked cardiologist ordered no tests for a veteran who insisted that he was suffering acute coronary pain. The doctor believed the vet was a malingerer and thus delayed lifesaving heart surgery for six months.

* For 20 years, physicians at one VA medical center freely provided Valium to a veteran who became addicted to benzodiazapines. While on vacation, he visited a Florida VA medical center, was abruptly removed from Valium, and went into seizures. He survived, but the incident cost taxpayers a $50,000 settlement.

* Two years of hearings and paperwork were required to remove permanently from duty a depressed VA nurse deemed to be a threat to patients.

VA doctors and other medical personnel have created a self-protective old-boy network. That incestuous relationship is illustrated best by the manner in which a Federal statute meant to protect patients from medical incompetents has been applied (or, rather, not applied) at the VA medical center at Bay Pines, Fla. The Medical Professional Review Act, which became effective in 1991, requires any health care provider to report to a national centralized data bank any doctor whose conduct leads to a payment as a result of a medical malpractice claim or legal action by a patient.