WASHINGTON — A Green Beret’s terminal Stage IV cancer. An airmen’s routine appendectomy turns fatal. A judge advocate general suffers multiple miscarriages.
These are samples of medical cases gone awry under the care of military doctors.
But it doesn’t stop there: Patients and their families aren’t allowed to sue for medical malpractice. A special legal shield, known as the Feres Doctrine, blocks military servicemembers and their relatives from seeking recourse in court.
“The hardest thing I have to do is explain to my children when they ask me, ‘This doesn’t make sense, how is this happening?’ And I have no good answer,” Army Sgt. 1st Class Rich Stayskal, who is battling terminal Stage IV metastatic lung cancer, said Tuesday in congressional testimony. “I say ‘That’s why I am coming up here to help convince these folks in Congress to change this.’ This doctrine has effectively barred hundreds of servicemembers and their families any chance to be made whole for receiving negligent medical care.”
Stayskal was one of several witnesses called before a subpanel of the House Armed Services Committee to recount their stories of military medical care.
In Stayskal’s case, doctors missed signs of his cancer for months, until finally catching it in 2017. It’s since spread to his neck, lymph nodes, spleen, liver, spine, hip joint and other areas of his body.
Now, the Green Beret with 17 years of service is being separated from the military.
“The failure to detect my cancer … is a mistake that allowed an aggressive tumor to double in size and rob me, rob my life of my family, without any recourse,” Stayskal told members of the subpanel on military personnel issues. “My children are definitely the true victims, along with my wife.”
'Dean would still be alive'
Alexis Witt painfully recounted to lawmakers the 2003 death of her husband, Air Force Staff Sgt. Dean Patrick Witt, following a surgical procedure.
Following Witt’s appendectomy at Travis Air Force Base in California, a nurse administered a lethal dose of fentanyl and incorrectly inserted a breathing tube into his esophagus. Witt subsequently suffered from respiratory and cardiac arrest and died after being left in a vegetative state for three months.
Witt’s wife said the same nurse was linked to at least three other deaths, including one before her husband died.
“If the appropriate action had been taken on this nurse during her first lethal, negligent episode, Dean would still be alive today,” Witt told lawmakers.
Despite his terminal illness, Stayskal has lobbied Congress for months, between bouts of chemotherapy, to reverse the Feres rule, inspiring Rep. Jackie Speier, chairwoman of the House Armed Services subpanel, to call for Tuesday’s hearing.
Speier, D-Calif., said servicemembers deserve the same right to sue their medical providers as their spouses, other federal workers and even prisoners can.
“When our servicemembers suffer from medical malpractice — when doctors fail to perform or woefully misread tests, when nurses botch routine procedures, when clinicians ignore and disregard pain — servicemembers deserve their day in court,” Speier said. “When lives are disrupted, ruined, and cut short by negligence, servicemembers deserve a chance to receive just compensation.”
Rep. Trent Kelly of Mississippi, the panel’s ranking Republican member, urged the House Judiciary Committee to address the Feres Doctrine issue since it is under that panel’s jurisdiction. He also said ongoing revisions to the military health care system could address a series of new fixes.
“Our servicemembers, who sacrifice so much, deserve the best medical care that we can provide,” Kelly told the servicemembers and relatives. “And we as an institution let you down.”
The Feres Doctrine can be traced back to1950 when the Supreme Court issued a ruling in Feres vs. the United States. Four years earlier, Congress had enacted the Federal Tort Claims Act allowing for citizens to sue the government for damaging acts of negligence. However, the court in 1950 — combining three cases of harmed servicemembers — determined the act was not applicable for military members “in the course of activity incident to service.”
Since then, the court has interpreted the Feres Doctrine to mean that no active-duty servicemember can sue the federal government regardless of the circumstances.
“In our country, we rightfully revere servicemembers for their bravery and sacrifice,” Speier said. “It is disrespectful and shameful that for 69 years Congress has refused to give them the same rights as everyone else.”
'I was suicidal'
Rebecca Lipe, a former Air Force judge advocate general, was left with debilitating abdominal pain, 10 related surgeries and permanent damage to her reproductive organs after wearing ill-fitting body armor during a 2011 deployment in Iraq.
Initially, doctors accused her of having an extramarital affair and contracting sexually transmitted diseases, Lipe recalled. That was followed by a series of medical mistakes, unnecessary surgeries and an ordeal that would consume her health and family for years to come.
“I was suicidal,” she told lawmakers Tuesday.
Eventually, Lipe, who now works as a civilian, saw doctors in private practice who diagnosed her with injuries connected to her ballistic gear worn during deployment. The private doctors were able to correct eight areas of damage along her abdominal wall.
“The civilian doctors …attempted to reverse the unnecessary medical treatment I received at the hands of the military medical providers,” Lipe said. “But the damage was already done. I now deal with chronic abdominal pain and complications due to that medical treatment.”
Lipe and her husband could no longer conceive a child as a result of the damage, and underwent seven rounds of in vitro fertilization at a cost of $60,000. However, Lipe was still under military care when doctors at Andrews Air Force Base in Maryland missed her ectopic pregnancy, which resulted in an emergency surgery and loss of her fallopian tube.
Following a subsequent miscarriage, Lipe had to wait four days for Walter Reed National Military Medical Center in Bethesda to remove the remains rather than undergo an emergency procedure immediately. Then, the hospital lost the remains of the baby, Lipe said.
After she left the Air Force, the couple saw a civilian doctor for a sixth round of IVF. Lipe finally delivered a healthy baby girl in July 2017.
“I received a level of care I had never received while on active duty,” she said.
During a final round of IVF, Lipe suffered near-fatal complications and can no longer have children.
The Feres Doctrine could also come before the Supreme Court in the near future. The court could soon decide whether it will hear a petition tied to a military medical malpractice case that looks to overturn the rule that bars servicemembers from suing the government.
The petition is tied to the death of Navy Lt. Rebekah Daniel, who died after childbirth at Naval Hospital Bremerton in Washington state in 2014. Her husband, Walt Daniel, filed the petition targeting the Feres rule.
Rebekah Daniel, a labor and delivery nurse at the same hospital who was known as Moani, bled to death after giving birth to a baby girl, Victoria.
Daniel’s Supreme Court petition was filed in October after the 9th U.S. Circuit Court of Appeals upheld a district court dismissal of the case. In the Supreme Court petition, Daniel’s attorney argued she was not engaged in her military duties at the time of her death or while she was being treated at Bremerton.
As Daniel and others have learned, there are only two paths to changing the Feres Doctrine: the Supreme Court or Congress.
“This isn’t just a matter of justice,” Speier said. “It’s a question of accountability. Because behind the shield of Feres, DOD’s health providers act with impunity.”
Secretary of Veterans Affairs Robert Wilkie struck back at Rep. Alexandria Ocasio-Cortez, D-N.Y., on Wednesday, calling her accusations that the Trump administration wants to privatize the VA "nonsense."
"I won't be rude to the congresswoman and say that it is nonsense, but I will say it's nonsense," Wilkie said on "Fox News @ Night with Shannon Bream."
"If we are privatizing VA, we are going about it in a very strange way," Wilkie said. "I presented to the Congress a $220 billion budget, the largest budget in the history of the department. We are undergoing basic reforms to make the VA a modern, 21st-century health care administration. But what we are doing is opening the aperture on choice, so that our Veterans remain at the center their own health care, and if VA can provide what they need, we will give them the opportunity to go out into the private sector."
Ocasio-Cortez claimed during a New York town hall event last week that the VA “isn’t broken” despite the scandals that have plagued the agency over the last decade and claimed the Trump administration aimed to "privatize" health care for Veterans.
"That is the opening approach we have seen when it comes to privatization, it's the idea that this thing that isn’t broken, this thing that provides some of the highest quality care to our Veterans somehow needs to be fixed, optimized, tinkered with until we don’t even recognize it anymore," Ocasio-Cortez said, in comments first reported by the Washington Examiner.
"They are trying to fix the VA for pharmaceutical companies, they are trying to fix the VA for insurance corporations, and, ultimately they are trying to fix the VA for a for-profit health care industry that does not put people or Veterans first," Ocasio-Cortez said.
“And so we have a responsibility to protect it.”
The congresswoman's comments were aimed at Trump administration efforts to expand choice and private health care options in the VA health care system.
President Trump reacted to the congresswoman's comments by taking credit for turning around the VA.
"Rep. Alexandria Ocasio-Cortez is correct, the VA is not broken, it is doing great. But that is only because of the Trump Administration. We got Veterans Choice & Accountability passed," Trump tweeted.
Wilkie defended the Trump administration and supported the president's response on Twitter.
"The other part of our comments or they were answered by the president, who said that under this administration, the VA isn't broken. The scandals that she referred to happened in another administration," Wilkie said.
"I can say, as someone who's been accused of being a historian, no president in the post-World War II era has put the Veterans at the center of his campaign and administration until President Trump did it. We are seeing this in the way the VA's moving forward."
Calling the U.S. Department of Veterans Affairs a recognized leader in pain management and opioid safety, VA Secretary Robert Wilkie today underscored the department’s innovative approaches to chronic pain management.
Wilkie’s response followed President Trump’s speech April 24 at the annual Rx Drug Abuse & Heroin Summit in Atlanta, where stakeholders gathered to discuss prevention, treatment and actions to curtail the opioid crisis.
“More than 100 million Americans suffer from some form of chronic pain, and the overuse and misuse of opioids for pain management in our country is taking too many lives,” Wilkie said. “Veterans who have served our nation are particularly challenged by chronic pain. VA has demonstrated success in reducing opioid use, while addressing the challenge of living well with chronic pain.”
Over the past six years, VA’s Opioid Safety Initiative (OSI) has reduced opioid dispensing more than 50%. Most of this reduction is attributable to not starting new, long-term opioid therapy in Veterans with chronic pain.
Specifically, VA is not starting Veterans with chronic, noncancer pain on long-term opioid therapy, but is instead offering them complementary pain management strategies. These treatments include use of complementary therapies, such as acupuncture, yoga, chiropractic medicine, tai chi and bio-feedback, among other modalities, and have proven to be more effective for Veterans long term. Veterans are 40 percent more likely to have severe, chronic pain than non-Veterans.
VA has employed four broad strategies to address the opioid epidemic: education, pain management, risk mitigation and addiction treatment. VA addressed the problem of clinically inappropriate high-dose prescribing of opioids, while developing an effective system of interdisciplinary, patient-aligned pain management to provide safe and effective pain control. In the process, VA trained hundreds of clinicians on this approach to pain management.
VA’s approach is Veteran-centric and whole health. By understanding the Veteran’s goals and lifestyle and incorporating a variety of therapeutic treatments, Veterans are now achieving success in managing chronic pain.
VA continues to offer full transparency of its efforts to reduce opioid prescribing. To learn about the VA Opioid Safety Initiative or for more information on VA pain management, go to www.va.gov/painmanagement.
Available to Veterans, their families, caregivers, and survivors
The Code of Support Foundation provides essential and critical one-on-one assistance to struggling service members, Veterans and their families with the most complex needs. One of their goals is to integrate service members, Veterans and families into a searchable, Vetted, on-line platform called PATRIOTlink that makes direct connections to resources and services.
PATRIOTlink enables any user free access to Vetted, direct, cost-free, Veteran services. PATRIOTlink users can login, browse, and use hundreds of resources available to them. Veterans, caregivers, family members and providers can sign up for a Free Account and start searching today!
The Department of Veterans Affairs, Veterans Experience Office signed a Memorandum of Understanding with Code of Support in December 2018.
Together, VA and Code of Support hope to improve the access to and navigation of resources in local communities to best serve Veterans, families, caregivers, and survivors. Code of Support provides case coordination, education and engagement, and a navigation platform that allows service providers to reduce the amount of time it takes to find resources to meet their clients needs. VA cannot do it alone and partnerships like Code of Support help to augment and supplement VA services and benefits where needed.
VA is providing Code of Support the most up to date resource and contact information to access and navigate VA services and benefits that includes caregiver support services, suicide prevention and homeless coordinators, Vet Centers and domiciliary units. One of VA’s goals is to ensure that access to services and benefits is easy, efficient, and creates positive experiences in receiving care and support where they live.
Veterans and their families should not have to struggle with finding resources and services, so VA encourages Veterans and their families to use the free services from partners like the Code of Support Foundation for easier access and navigation support.
“When I called Code of Support my back was up against the wall. I was struggling with my VA Claim and just days earlier had lost a close friend to suicide. They did something that hadn’t happened in years: they listened.”— Zachary Bell, Marine Combat Veteran (from Code of Support website)
LUBBOCK, Texas - The new Lubbock VA clinic, which will be on the corner of 4th and Indiana, is planned to be modern with new developments.
As of now, the closest Veteran Affairs hospitals are in Amarillo and Big Spring. Both are more than 100 miles away from the Hub City. The new facility will provide more convenience to those who have fought for our country.
"Some of the Veterans are unable to go to Amarillo or Big Spring. Some of us can but it's better for us to have it here. It's a lot better and it's about time that we have something like this here," Veteran Jerry Lucero said.
Dalton Keel, the Clinical Service Chief, said the process of putting everything together was a group effort.
"There are four generals and then a fifth general who really are the group that got this started. Congressman Neugebauer was instrumental in putting the legislation forward and made this come to fruition," Keel said.
The hope is for the clinic to be finished by January of 2021.
President Trump seized on comments made by Rep. Alexandria Ocasio-Cortez, a frequent lightning rod for criticism by Republicans, that Veterans Affairs is not broken – but that’s not all she said about the federal agency.
“Rep. Alexandria Ocasio-Cortez is correct, the VA is not broken, it is doing great. But that is only because of the Trump Administration. We got Veterans Choice & Accountability passed,” the president wrote on Twitter Wednesday.
“‘President Trump deserves a lot of credit.’ Dan Caldwell, Concerned Veterans of America,” Trump continued.
In a speech last week, the freshman Democrat addressed a proposal to privatize parts of the VA.
“If it ain’t broke, don’t fix it,” Ocasio-Cortez said, adding that it provides the “highest quality healthcare.”
But she had more to say.
“They are trying to fix it. But who are they trying to fix it for? That’s that question we have to ask,” she said during a town hall in the Bronx last Tuesday.
“And this is who they’re trying to fix it for: They’re trying to fix the VA for pharmaceutical companies, they’re trying to fix the VA for insurance corporations and ultimately they’re trying to fix the VA for for-profit health care industry that does not put people or Veterans first,” she said. “We have a responsibility to protect it.”
In a Twitter post from last Thursday, Ocasio-Cortez urged Congress not to “starve it + then sell it off for parts.”
“We should fight to fully fund the VA + hire to fill its 49,000 vacancies,” she said.
Trump signed the VA Mission Act in June 2018 that would expand private health care options for Veterans.
But critics say it would lead to privatization of the VA, erode the quality of care and harm Veterans.
As the one-year anniversary of President Trump’s signing of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 approaches on June 6, the U.S. Department of Veterans Affairs (VA) is making significant strides in implementing major improvements to community care for Veterans.
“The Veteran is at the center of everything we do,” VA Secretary Robert Wilkie said. “Through the MISSION Act, Veterans will have more choices than ever in getting timely, high-quality care. Most important, Veterans will be able to decide what is important and best for them.”
The MISSION Act will strengthen VA’s health care system by improving both aspects of care delivery and empowering Veterans to find the balance in the system that is right for them,
A key aspect of the MISSION Act is the consolidation of VA’s community care programs, which will make community care work better for Veterans and their families, providers and VA employees. When this transition is complete, the following will occur:
- Veterans will have more options for community care.
- Eligibility criteria for community care will be expanded, including new access standards.
- Scheduling appointments will be easier, and care coordination between VA and community providers will be better.
- Eligible Veterans will have access to a network of walk-in and urgent care facilities for minor injuries and illnesses.
“Transitioning to the new eligibility criteria for community care should be seamless for Veterans,” Wilkie said. “Veterans will continue to talk to their care team or scheduler as they have been doing to get the care they need.”
VA also has been working closely with community providers to ensure Veterans have a positive experience when receiving community care. For example, VA has developed education and training materials to help community providers understand some of the unique challenges Veterans can face.
Going forward, community care will be easier to use, and Veterans will remain at the center of their VA health care decisions.
In addition to information VA has made available digitally, Veterans enrolled in VA health care can expect to receive a letter in the mail providing details on where to go for more information.
For more information about community care under the MISSION Act, visit here.
Recruiting for Red Coat Ambassadors
Every April, the nation recognizes health care and other volunteers and the services they provide. Across VA, volunteers donate thousands of hours at various sites of care. To ensure a consistent and positive Veteran experience, the Red Coat Ambassador volunteer program is now at every VA medical center.
What exactly is a VA Red Coat Ambassador volunteer?
The VA is fortunate to have talented volunteers, many of whom are Veterans, family members of Veterans, or just someone interested in giving back to Veterans. They donate their time to greet and assist patients and hospital visitors. But more Red Coat Ambassador are always needed, and the American Legion Auxiliary is helping to connect more volunteers to these vital positions at VA.
The VA is proud to have this continued partnership with the ALA to support the VA’s Red Coat Ambassador and volunteer programs.
The American Legion Auxiliary is the world’s largest women’s patriotic service organization with over 700,000 members and presence in more than 8,600 communities which provide volunteers in support of Veteran and families initiatives. Efforts like the ALA’s are improving the overall VA patient experience.
VA measures customer experience through ease, effectiveness, and emotion. Since 2017 more than 2.5 million Veterans have sent VA feedback via Veterans Signals, VA’s Customer Experience Feedback Survey. In April 2019, 93.2% of Veterans responded that it was easy to find their appointment, up from 91.1% in April 2018. VA volunteers like the Red Coat Ambassadors make a huge impact.
Veterans who were surveyed recently said:
- “In all my 64 years, I have never met a team more deserving of praise. From the volunteers at the door to greet you to the healthcare provider, the VA offers security good health treatment and advice. I’ve never dealt with a medical staff that shows so much concern for the Veteran. Thank you VA.”
- “My experiences at the CG VA have been nothing but good. Polite and cheerful greetings from staff. Appointments on time and very worthwhile.”
- “The service there is so great and everyone always greets us with a smile and a Thank You For Your Service. The audio tech really knew what she was doing and was eager to help us. As always, a good experience. We like going there.”
If you or someone you know is interested in becoming a volunteer with VA, you can start by talking with your local VA medical center or your local American Legion Auxiliary.
For more information online visit: https://www.volunteer.va.gov/apps/VolunteerNow/.
Rep. Alexandria Ocasio-Cortez, D-N.Y., defended the treatment of Veterans by the Department of Veterans Affairs during a town hall event in her district last week.
The freshman congresswoman said privatization of the VA will not help Veterans because of the "for-profit healthcare industry."
"If it ain't broke, don't fix it," Ocasio-Cortez, 29, said, insisting the VA provides "some of the highest quality" healthcare for Veterans. She said people who advocate for a privatized VA are only trying to fix it in favor of pharmaceutical companies.
"Here's the thing, they are trying to fix it. But who are they are trying to fix it for, is the question we gotta ask ...They are trying to fix the VA for pharmaceutical companies, they are trying to fix the VA for insurance corporations, and, ultimately, they are trying to fix the VA for a for-profit healthcare industry that does not put people or Veterans first," she said.
Because people are trying to privatize the VA, Ocasio-Cortez said, "We have a responsibility to protect it."
Calls to privatize the VA were heightened after news broke of secret waiting lists, which delayed many Veterans' care, in 2014. For instance, CNN reported at least 40 people died waiting for time-sensitive care because of the lists at the Phoenix Veterans Affairs Health Care system.
The Nation reported the socialist Democrat said the main problem with the department is that it is understaffed.
"If we really want to fix the VA so badly, let’s start hiring, and fill up some of those 49,000 [staff] vacancies,” she said, adding the VA would be a blueprint if "Medicare for all" were to pass: “If you ask me, I would like VA for all."
The new Cerner electronic health records replacement for VA’s VistA system will cost 60 percent more after less than one year of implementation, estimated at $16.1 billion.
The original cost estimate for the EHR solution was $10 billion. The agency went back and forth over the Cerner deal, which was inked by Secretary Wilkie before he was confirmed as the replacement for David Shulkin, MD.
Cerner received a no-bid contract for the deal after securing the same for the Department of Defense. Neither contract deal has proceeded as planned with the current cost increases coming out one year after the deal was inked.
The deal received much pushback one year ago when numerous authorities in the field projected the EHR transition has less than a 10 percent chance of succeeding.
One factor raised is the size of the Cerner system and its broadband requirements when communicating inside and outside each facility.
Another issue recently addressed is that the current Cerner EHR system is designed for insurance billing purposes. This means the new system may not adequately address the needs of federal agencies that do not bill insurance companies.
“VA is different. The focus of the VA’s electronic medical record is never about clinical documentation to support billing. It’s about giving the information to the provider at the right time to inform the best care. There are true risks to patients if they don’t do this right,” Heather Woodward-Hagg, PhD, former National Program Director (Acting), Veterans Engineering Resource Centers (VERC) and Founding Director, Veterans Affairs Center for Applied System Engineering (VA-CASE), told ProPublica.
Word is the transition, if it works, will cost tens of billions due to the size and complexity of not only the software but also the hardware required for such a behemoth to operate effectively.