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Doris writes a weekly column for LaGaceta, the nation's only trilingual newspaper, which has pages in English, Spanish, and Italian.  Begun in 1922 for Tampa's immigrant community, it continues to thrive more than a century later.  Her column is titled "In Context," as it aims to put contemporary issues in the context of the past.

Fixing the VA

Last week I said that Hubby had pneumonia and was in intensive care in Tampa’s VA hospital, adding that this week I would write about that experience. Let me say at the beginning that the actual health care professionals – doctors, nurses, pulmonary specialists, etc. were great, but the administrators who create the policies and procedures under which they work could use a few clues.

First off, please realize that there are 24 hours in a day, and for more than a century, we’ve had electricity that allows us to use those 24 hours. Sickness does not take time off, but at the James A. Haley Hospital one would be led to believe that everything begins at 8:00 in the morning and ends at 4:00 in the afternoon. We had an inkling of this before, as appointment setters for outpatient care consistently tell Hubby that he should be there at 8:00. I spoke with a woman from Brooksville who is a night worker; she got permission from her employer to leave earlier than her 7:00 quitting time so that she could get her man to Tampa by 8:00. We talked at 3:00 in the afternoon, and he still hadn’t seen his doctor.

I don’t know if this is a holdover for veterans of the active duty military mentality of early-to-bed, early-to-rise, but even in the military, it’s never been smart. Nothing prevents crises, in or out of the military, from occurring at night, and not everyone has to do everything at the same time. Just even it out, planners, and that would do a great deal to overcome the image of overcrowded hospitals and clinics.

Hubby is entitled to VA services because he got tuberculosis while in the Army Security Agency. He worked in rooms that were triple-locked and unventilated, with men who were going back and forth to Third World nations – and smoking cigarettes all the while. He quit when a doctor at Washington’s Walter Reed Hospital suggested -- but did not order him – to do so. They sent him on to six months of hospitalization at Valley Forge, Pennsylvania, where a majority of the tuberculosis patients continued to smoke. Some even deliberately contaminated their tests so that they could stay in the hospital and not go to Vietnam.

Hubby’s TB has been in remission since 1968, and he faithfully checks in with the VA to make sure it stays that way. When he had trouble breathing recently, he went in and they gave him some inhalers. That didn’t help, so he went again on a Tuesday and they did a chest x-ray. The rest of the week and his weekend were miserable, so he called again on Monday morning. Someone looked at the x-ray and said, essentially, “you’ve got pneumonia. You’d better call 911.” So might we have more weekend workers? Not only are there 24 hours in a day, there are seven days in a week.

I spent thirteen hours at the hospital that Monday, and it was nearly midnight when I left. In another example of poor planning, the parking garage is about a third of a mile from the hospital. It is the only parking available to caretakers and to able-bodied patients – and some not so able-bodied. I knew from previous visits there that volunteers (always older men) drive oversized golf carts for those who can’t walk that far. I’ll repeat another of the maxims I’ve learned in life: administrators everywhere prefer spending on capital equipment than on people, and several carts sat in the garage unused. Meanwhile patients with walkers and canes had to wait for another shuttle to come around. Volunteers are driving those carts, so there’s no cost to using the ones in the garage. It’s just another case of poor planning and administration. And one of the shuttle drivers advised me that it will only get worse as winter comes on, and veterans from elsewhere need care in Tampa.

But back to leaving that night. I went from ICU to the main lobby, where I found no one on duty or anywhere in sight. I did spot a phone and dialed the operator, who was amazed at my naivety when I asked if a shuttle to the garage still was available. That, of course, had ended soon after everything else closes at 4:00. She gave me directions to the security department, and when I found that obscure office, three uniformed guards were chatting with each other. One found time to take me to the garage in his well-equipped cop car, another sign of questionable capital expenditure. Again, administrators: why not assign at least one of these guys to the front door? It is electric and was open. Anyone could walk in, go down the corridor to the open elevators, and wrack all kinds of havoc.

* * *

I also was appalled to discover that the construction going on just south of the hospital is not going to rid us of the VA’s many aluminum structures that could blow away in a strong wind. I had assumed that the building there was hospital expansion, but instead this valuable land has been sold to a private corporation that will rent apartments to USF students. (And whatever happened to on-campus dorms?) Were sensible people in charge, this land should have been kept for the VA. In addition to the portables – which doubtless contain millions of dollars worth of equipment, to say nothing of endangering lives in a hurricane -- the VA now has outpatient clinics in at least eight other North Tampa locations. They range from physical therapy on 42nd Street to the eye clinic on 46th to the Women’s Center on Lake Terrace Lane, which I can tell from the zip code is in Tampa Palms. Even at the main hospital, you have to enter busy 30th Street and go past this new student housing and some other private enterprises to get to the VA’s buildings for dermatology and pharmacy. This means that patients leaving the hospital have another stressful situation, as they must wait in a long line to pick up the prescriptions they need to take home. Planners? Anyone at all at the wheel?

I went home that first night having eaten almost nothing all day because I had yet to discover the “we close everything early” rule. I’d been busy helping Hubby move from ER to a floor and then to ICU, so when I inquired about the cafeteria, I discovered that it had closed at 2:00 and I’d better hurry if I wanted to make it to the “convenience” store, which closed at 4:00 -- as does the small snack bar off of the main lobby, which no one mentioned at all. When I rushed into the convenience store, I saw a guy restocking shelves and noticed rows of appliances such as mixers and toasters. “Who,” I asked him, “buys a mixer in a hospital?” He replied that about 75% of the sales were to employees. His comment reinforced my increasing perception that the VA may care more about its staff than about patients or (especially) their caretakers.

I’m quite sure, though, that the folks who run the “Patriot Café” and the others sharing that logo are private contractors. I don’t know why they wouldn’t stay open to serve the hundreds, maybe thousands, of people who remain in the big hospital at dinnertime. Someone is missing a market there. They also are missing a market in failing to serve appetizing and healthy food. The cafeteria offers just one entrée at lunchtime, and its non-lunch menu is heavy on pizza, cheeseburgers, and hot dogs. A hospital should do better: the one I worked in back in Arkansas during my student days offered infinitely better food. To the VA’s credit, a dietitian came round and introduced herself to Hubby on the first day – but left no calling card telling us how to contact her when he got mashed potatoes, which he hates, for four of five days.

On about the third day, we got a slick card with photos of the people who were ostensibly Hubby’s team, but also sans contact info. We remembered meeting only one of the five who were pictured. Upwards of a dozen doctors and nurses had introduced themselves by then, none of whom was his regular physician as an outpatient. We understand that the VA is affiliated with USF’s Medical School (in fact I go to USF’s Morsani Clinic because I appreciate the cutting-edge folks in med school), but something should be done to keep these baby doctors from asking the same questions. While gasping for breath during the first days, Hubby must have repeated his medical history a half-dozen times. Again, there’s room for systematic improvement. Those records are on the computer, and if the questions are repeated for verification of authenticity, please use some common sense.

I finally got assertive and interjected myself into these conferences. The doctors seemed to appreciate that, but most nurses did not. I got the definite impression that they don’t want caretakers around, as they insist that we use a restroom outside of ICU and then telephone for permission to re-enter each time. I had nothing but a hard-back chair, and when I tried to exercise by walking, I was chastised because – from fifteen or twenty feet away – I was a threat to the privacy of other patients. I mention this only because when Hubby was transferred out of ICU, he went to a four-bed room with nothing but curtains separating the small space. All of the beds were occupied, and there was no privacy, medical or otherwise. We could hear every word -- including those of a woman who kept asking her unresponsive father if he knew where he was, while her young daughter repeatedly shouted, “You’re in the VA hospital, Grandpa!” Because of the proximity of these other men, Hubby got almost no sleep.

Let me say again, though, that I realize VA health care professionals do not have an easy job, especially with a nearly all-male population that was once trained to kill. From the moment one drives into the hospital grounds, signs advise that no guns, knives, or weapons of any sort are allowed. More detailed posters in the hospital spell out the unacceptability of profanity, yelling, or ethnic attacks. (There is, in fact, great staff diversity, with many Asians, Latinos, and others.) Especially in the handicapped parking lot, though, I saw lots of indications of disaffected veterans, with Confederate flags and gang symbols on pick-up trucks and motorcycles. Many of the young patients must have looked much different when they were in the military, as they now seem to wear ponytails and tattoos as a badge of alienation.

That’s a problem bigger than I can tackle, but I do want to point out one final problem that I trust the courts are currently addressing. It’s accountability – a favorite word of Republicans who also cut up congressional districts so that no one knows who is accountable. The James A. Haley Hospital should have been named for Tampa’s Sam Gibbons, a real veteran who parachuted into France on D-Day. Instead, it was named for a congressman from Polk County, and that geographical confusion got it off to a bad start. Even I – someone who keeps up with these things – can’t say for sure if it currently is part of the district of Polk County’s Dennis Ross or if it’s represented by Pasco’s Gus Bilirakis or if it belongs (as it should) to Tampa’s Kathy Castor. A first step to correcting its problems is to figure out who’s in charge.

And if I declared myself to be a consultant and fancied up this analysis, someone probably would have paid $100,000 for it. That’s a problem, too.


Doris Weatherford writes a weekly column for La Gaceta, the nation's only trilingual newspaper. With pages in Spanish, Italian, and English, it has been published in Tampa since 1922.
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