The un-rest cure

If the federal Veterans Health Administration was a sick patient, its suffering through five years of shock therapy is about to come to an end. Not that the patient is entirely cured, but its exhaustive overhaul demands a temporary respite.

The doctor in charge of the VHA since 1994, Kenneth W. Kizer, learned last week that his chances of being reconfirmed by the Senate were not good. Putting his family through a political battle, he said, was not worth it, and so he announced his departure. He leaves behind a VHA much changed with still many more changes to go. Primarily, his plan called Prescription for Change tried to hold down the rapidly rising cost of treatment to what is now mostly older veterans by offering health care services outside the traditional large VA hospitals.

Not surprisingly, tighter budgets demanded more scrupulous attention to the needs of patients. Sometimes this was accomplished and sometimes it was not, as the experience many Maine veterans have had at Togus demonstrates. Even Dr. Kizer acknowledged to the White House that the changes had been radical. “Indeed, without reservation,” he wrote to President Clinton, “I can tell you that no other health care system in the United States has changed as rapidly or as dramatically as the veterans health care system.”

Even if the VHA requires a breather after Dr. Kizer, more changes are inevitable, as the VHA, part of the Department of Veterans Affairs, responds to the same pressures being experienced by other health care plans. In fact, Maine’s congressional delegation was warned last week to expect the overhaul to continue. Writing two days after Dr. Kizer’s announced departure, acting VHA chief, Dr. Thomas Garthwaite, first made clear that their were no plans to close Togus and that he was committed to funding any budget deficits at Togus in fiscal year 1999.

He made equally clear, however, that Togus currently does not measure up and that further changes there are essential. Writing to Sens. Olympia Snowe and Susan Collins, Dr. Garthwaite said, “Togus must take steps to improve both access to care and its resource management. … Please also know that local management will be asked to be much more innovative and creative in its efforts to improve VA’s service to Maine’s veterans.”

That means more changes, which are upsetting in themselves but could eventually provide better services to Maine veterans. One encouraging note was Dr. Garthwaite’ emphasis on improving communication between hospital officials and the people who depend on the system. Still, with or without the doctor who began these changes, Togus is a long way from full recovery.