The Veterans Health Administration and Homeland Security

By Sandra K. Foreman, J.D., LL.M. Candidate
Health Law & Policy Institute Graduate Research Assistant, Spring 2003

The Bioterrorism Preparedness Act of 2002 allotted $133 million in funding to the Veterans Administration (“VA”) to enhance the readiness of its medical centers to respond to a possible biological or chemical attack. On November 7, 2002, a bill pending in Congress that will establish those emergency preparedness responsibilities was signed into law: The Department of Veterans Affairs Emergency Preparedness Act of 2002, H.R. 3253, 107th; Public Law No. 107-287 (2002) (not yet reported in the Federal Register).  Additional legislation to provide for a partnership between the Department of Veterans Affairs and the Department of Defense (“DOD”) to develop and disseminate education and training programs on the medical responses to the consequences of terrorist activities remains pending in the U.S. House of Representatives: Medical Education for National Defense in the 21st Century Act. H.R. 3254, 107th (2002). This article provides a brief overview of the new law, the pending legislation, and a discussion of the challenges that would preclude the VA from treating non-veteran and non-military personnel.

Some of the areas addressed in the new law and pending legislation include establishing and maintaining four medical emergency preparedness centers; developing education and training programs for health-care professionals on medical responses to terrorist activities; and furnishing hospital care and medical services to individuals responding to, involved in, or otherwise affected by the disaster or emergency during and immediately following such disaster or emergency. Given the present demand posed on the VA to treat veterans in a timely and efficient manner, this author expresses concern over the discretion given to the VA to treat non-veteran and non-military individuals named in the legislation.

The key provisions of the Medical Education for National Defense in the 21st Century Act are as follows:

Establishment of a Joint Program With the DOD for an Emergency Medical Education Program:  This provision would require the Secretary of Veterans Affairs and the Secretary of Defense to jointly develop and disseminate model education and training programs on medical responses to terrorist activities. Sec. 7323.

Content of Education Programs: The Act requires that the education and training programs model existing programs established at the F. Edward Hebert School of Medicine in Bethesda, Maryland. At a minimum, the health care professionals would receive training in recognizing chemical, biological, and radiological agents that may be used in terrorist activities; identifying potential symptoms of those agents; understanding the possible long-term physical and psychological consequences resulting from exposure to those agents; emergency treatment for exposure to those agents; appropriate subsequent treatment, supportive care, and referral; actions that could occur while providing care for exposure to those agents to protect against contamination; and information on how to seek consultative support. Id.

Potential Trainees: Both Secretaries would develop different programs designed for a variety of health-care professionals, specifically including health professions students and graduate medical education trainees. Id.

The Department of Veterans Affairs Emergency Preparedness Act of 2002 includes some of the following provisions:

Medical Emergency Preparedness Centers: The Act would require the Secretary of Veterans Affairs to establish four emergency preparedness centers at Veterans Administration Medical Centers staffed by VA employees. A competitive proposal process would determine the locations for these centers. The centers would conduct research and develop methods of detection, diagnosis, prevention, and treatment of injuries, diseases, and illnesses arising from the use of chemical, biological, radiological, incendiary, or other explosive weapons or devices posing threats to the public health and safety; provide education, training, and advice to healthcare professionals, including those outside the Veterans Health Administration, through the National Disaster Medical System or through interagency agreements entered into by the Secretary; provide laboratory, epidemiological, medical, or other assistance to federal, state, and local health care agencies and personnel involved in or responding to a disaster or emergency. Sec. 7325(b), (c).

Content of Programs and Potential Trainees: These provisions are the same as those provided by the Medical Education for National Defense in the 21st Century Act. Sec. 7326.

Healthcare During Major Disasters and Medical Emergencies: The VA would have the discretion to provide hospital care and medical services to individuals responding to, involved in, or otherwise affected by that disaster or emergency; and veterans without regard to their enrollment in the VA healthcare system. A disaster or emergency is defined as any disaster or emergency declared by the President, or a disaster or emergency in which the National Disaster Medical System is activated by the Secretary of Health and Human Services. The VA could seek reimbursement for the cost of any care or services provided to an officer or employee of a different department or agency of the United States, or to a member of the Armed Forces.  The Act would further authorize the VA to furnish hospital care and medical services to members of the Armed Forces on active duty responding to or involved in that disaster or emergency. Sec. 1785.

In terms of conducting research and training and educating medical students, residents, and other health professionals in diagnosing and treating victims of terrorist activities, the VA is undoubtedly the agency to undertake that particular role in homeland security. First, veterans have historically sought treatment at the VA for combat-related conditions not usually presented to other healthcare providers, i.e., post traumatic stress syndrome based on experiences in combat; Gulf War Syndrome, and Agent-Orange related conditions.   And, second, the VA annually trains more health professionals than any other institution in the United States. About 85,000 health professionals affiliated with approximately 1400 medical schools and other programs rotate through its health system. General Accounting Office, Homeland Security: Need To Consider VA’s Role in Strengthening Federal Preparedness, GAO-02-145T (2001).  Therefore, it is quite appropriate for the VA to conduct research and train and educate students and health professionals in the medical responses to emergency and disaster situations.

There are concerns, however, with the discretion given to the VA to treat non-veteran and non-military individuals. Significant challenges preclude the VA from effectively serving the present veterans enrolled in its healthcare system. The VA experiences financial strains and increased veteran enrollment. These persistent problems recently prompted a directive not to actively engage in marketing and outreach activities to enroll additional veterans into its system. VA Health Facilities Told to End Outreach, Houston Chron., Aug. 1, 2002, at A13. (Please note that the VA has not stated that it will not enroll new applicants into its system, only that it will not actively engage in marketing and outreach activities). Also, like most healthcare systems, the VA experiences difficulties with nurse recruitment, retention, and retirement. See, Department of Veterans Affairs Veterans Health Administration, Call to Action: VA’s Response to the National Nursing Shortage (November 2001). And, finally, veterans not only experience delays in receiving healthcare appointments, but, they also experience significant wait times to visit with a provider on the day of an appointment. See, General Accounting Office, Major Management Challenges and Program Risks, GAO-01-255 (January 2001).

The primary mission of the VA healthcare system is to treat the military veterans of this country. Yet, another healthcare mission is to serve as the principal medical care backup for the military health system, and to provide support to communities following domestic disasters and emergencies. Within the past few years, the VA and the DOD have engaged in agreements to better utilize each agency’s healthcare resources. For this reason, the VA and DOD are probably apt to coordinate treatment for military personnel during a period of war or national emergency. However, until the noted problems are remedied, the VA health system could not adequately extend its services to non-veterans and non-military individuals during a state of emergency or disaster.