A History of Neglect

Since as far back as the American Revolution, politicians and the public have welcomed soldiers home from war with promises of cutting edge medical knowledge, comprehensive rehabilitation, and ongoing care as compensation for their service. Just as often, though, these promises have gone unfulfilled in the face of their enormous expense. The history of the veteran’s health system thus has been one of best intentions and poor funding.

Generations of US veterans have encountered this history of neglect, starting dramatically with Shays’ Rebellion in 1786-87.[1] This neglect resulted sometimes from corruption, and sometimes from excessive bureaucracy and red tape, but almost always from a lack of funding adequate to properly care for the men and women sent to fight the nation’s wars.

The most recent example came to national attention on April 23, 2014, when CNN reported in A Fatal Wait that at least 40 veterans had died while waiting for treatment from Phoenix Veterans Affairs Health Care clinics. Further investigations and an internal audit soon followed and confirmed allegations of secret waiting lists to hide exorbitantly long wait times (over 57,000 people had to wait at least 90 days for appointments rather than the promised 15), attempts to cover up the delays, and a culture of coercion to prevent employees from resisting the practice. Former VA Secretary Eric Shinseki resigned on May 30 due to the growing scandal. Additional investigation by the US Office of Special Counsel revealed, in a June 23 letter to the White House, not only more widespread scheduling cover-ups, but also cases of two VA psychiatric patients left for seven and eight years after admission with no comprehensive evaluation. Subsequently, a June 27 White House report, prepared by Deputy Chief of Staff Rob Nabors, cited a “corrosive culture” that hurt patient care at the VA.

Despite the current scandal, the VA does provide excellent medical care to about 6.5 million veterans, making it the largest health care provider in the United States. This, however, has not always been the case.

Congress created the Veterans Administration in 1930 to consolidate multiple agencies and to replace the largely corrupt Veteran’s Bureau. In 1988, President Reagan signed legislation to convert the Veterans Administration, no stranger to corruption and scandal itself, into the cabinet-level Department of Veterans Affairs. But no matter its name or home in government, the veteran’s health system, the government, and the nation as a whole have a long history of neglecting, distrusting, and mistreating veterans.

We’ve historically been much better at sending soldiers off to battle than at serving those who return from it. Veterans’ services, especially after war has faded from the front pages of the nation’s news, tended to be some of the first cuts in times of budget tightening. The political will and national demand for maintenance of these services often evaporated at war’s end to such a degree that instances of tragic and utterly avoidable maltreatment echo through the history of the United States.

We could begin with the Bonus March after WWI, or with the many who died of typhoid in Camp Wikoff after the Spanish American war in Cuba, even though the army’s official stance was that the fever was “mild.”[2] Or we could go all the way back to Daniel Shays, as Richard Severo and Lewis Milford did in their expansive 1989 history, The Wages of War. CNN also provides a telling timeline of The VA’s Troubled History.

For the sake of time, we’ll look at two particularly telling examples: World War II and Vietnam. During and immediately after both conflicts the VA health system drew significant media, public, and (eventually) political condemnation for its services, or lack thereof. In World War II, however, the context of national mobilization, the “Greatest Generation” mentality, and some additional factors meant important, if short-lived, changes in the VA health system. The scandals during Vietnam generated less widespread condemnation and a Spanish-American-War-level of denial from the Veteran’s Administration around the issue of Agent Orange.

WORLD WAR II

Between 1943 and 1945, the total number of veterans returning to the United States from the war in Europe and the Pacific in need of medical care ballooned from 71,823 to 385,972. This growing tide of patients slammed into a VA that had neither the logistical nor medical services to handle them and resulted in a national scandal in 1945 and beyond.

In 1945, publications like the New Republic, Reader’s Digest, and the Journal of the American Medical Association reported unclean, dangerous facilities and medical care that was “often perfunctory and incompetent.”[3] John Rankin, chair of the House Committee on World War Veterans’ Legislation, responded to complaints by launching an investigation not of the VA, but of one of the lead reporters. That same year, President Truman accepted the resignation of VA Administrator Frank Hines and appointed General Omar Bradley in his place.

The biggest problems after 1945 came from personnel shortages and inadequate facilities. After the war, the VA estimated an immediate need for 3,600 doctors and expected to require twice that in the coming years. But they had only about 2,300 doctors, most of them on loan from the armed forces and scheduled for demobilization. Worse, Bradley complained that most of the VA’s lead doctors lacked modern medical training and held their jobs due to political connections rather than professional ability.

Under Omar Bradley’s leadership — and largely thanks to immense public support and savvy political maneuvering — the VA succeeded in taking over control of medical staffing from the Civil Service, increased nurses’ pay, made stronger connections with the medical community to attract new doctors, and secured a dramatic budget increase. In 1947, the VA budget surpassed $500 million, up from $177.6 million just two years before. Over the same time, funding for medical facilities increased from $17.9 million to $242.8 million. These changes had a profoundly positive effect on millions of lives, but unfortunately they would not last.

The end of the 1940s also marked the end of the fiscal generosity directed towards the Veteran’s Administration. Bradley, a charismatic (and rather bullish) leader, left the VA at the end of 1947. Even before his departure, though, the VA experienced less and less support from the legislature. In early 1947, budget cuts forced the VA to order a hiring freeze and limit travel. With Bradley’s departure, power began to centralize back in Washington, reversing Bradley’s preference for more local decision-making and adding an additional level of review to all medical decisions — an action that angered many VA doctors. These doctors, faced with shrinking budgets, began to resign. By 1950, more than 4,000 beds — equaling about 16 average-sized hospitals — lay empty due to lack of staffing.

VIETNAM

During Vietnam, VA health care again sparked near-1945 levels of national outrage. In 1970, LIFE ran an exposé of VA hospital conditions revealing criminal levels of neglect and mistreatment. The article quoted Marine Marke Dumpert, paralyzed from the neck down by a bomb blast, describing the “sickening” conditions he endured in the Bronx VA Hospital:

“Nobody should have to live in these conditions …. We’re all hooked up to urine bags, and without enough attendants to empty them, they spill over the floor. It smells and cakes something awful. The aides don’t commit themselves wholeheartedly, but with what they earn a year why should they? I’ve laid in bed on one side from 6 a.m. to 4 p.m., without getting moved or washed. … It’s like you’ve been put in jail, or you’ve been punished for something.”[5]

Veterans endured rats, overflowing garbage, inattention, poor and perfunctory medical care; the list goes on. LIFE reported doctors in Los Angeles calling VA hospital conditions “medieval” and “filthy.” The VA hospital system — then, as now, one of the largest in the world — was so woefully understaffed that even at the VA’s showcase Washington, DC, hospital a single nurse struggled to take care of as many as 80 patients at once.

The LIFE story and accompanying photo essay by Co Rentmeester — with pictures both heartrending and infuriating — helped bring the case to widespread attention. A Senate inquiry lasted five months and confirmed widespread neglect and inadequate care and facilities. The investigation pointed to a series of cutbacks in the VA health system’s budget as the direct cause for the tragic circumstances in VA hospitals. Donald E. Johnson, head of the VA at the time, would eventually resign under pressure from veterans’ groups and Congress, but not until 1974.

Even as conditions for many veterans in the VA system deteriorated during the Vietnam era, the situation for women veterans was especially acute. By the 1980s, the VA system served at least 1.2 million women veterans from a variety of conflicts. But the VA only employed seven full-time gynecologists. The VA worked with private physicians to make up for the shortcoming, but veterans reported waits of up to four months with these providers. National Women’s Director of the Vietnam Veterans of America, Lynda M. Van Devanter, testified before the Senate Committee on Veteran’s Affairs about the appallingly unacceptable care women received in VA hospitals, noting also a general lack of privacy, leading to some women being examined “in full view of men passing through the exam area.”[6]

A recent Boston Globe article by Garance Burke of the Associated Press suggests that, while the VA now employs more gynecologists, its care for women veterans still falls short. The article, “5 Things to Know About Women’s Medical Care at VA,” reports that the head of the VA’s office of women’s health acknowledges continued shortcomings despite a $1.3 billion training effort in place since 2008. According to the report, nearly 25% of VA hospitals still lack a full-time gynecologist, and mammogram results are still very slow to arrive.

Looking back on this troubled history of neglect and mistreatment, it’s clear that the VA health system today is in much better shape, and provides drastically better care, than it did even 40 years ago. Some recent statistics show that it actually compares very well to private health care. According to the Washington Post, the VA health system scored four points higher than private hospitals for inpatient care in a 2013 survey. And recent comments from the VA’s acting director, Sloan Gibson, regarding support for whistleblowers and further investigation into wait times is reassuring. But the weight of the VA’s long history of neglect and underfunding leaves little room for optimism.

The exact nature of the scandals have changed over time, but the history of veterans’ health services in the United States shows a troubling continuity of neglect. This neglect manifested itself at the individual level as veterans failed to receive needed medical care, but also on a national scale in the unwillingness to adequately fund the VA system itself. At the root of every VA health scandal has been a failure to follow through on commitments made to those sent to fight the nation’s wars. It remains to be seen what increased pressure from veterans groups, Congress, and the White House — including President Obama’s June 29 announcement that he would nominate West Point graduate and former CEO of Procter & Gamble Bob McDonald to head the VA — will contribute to this history.

NOTES AND SOURCES

1. Richard Severo and Lewis Milford, in The Wages of War: When America’s Soldiers Came Home–From Valley Forge to Vietnam (New York: Simon and Schuster, 1989), traced this long history of neglect, suspicion, and sometimes outright mistreatment of US veterans all the way back to Daniel Shays and Shays’ Rebellion. Severo and Milford conclude that “the VA’s mission–not its stated mission but its real one, nevertheless–is to limit the liability of Government for the wages of war.” (422)

2. Richard Severo and Lewis Milford, The Wages of War: When Americas Soldiers Came Home—From Valley Forge to Vietnam (New York: Simon and Schuster, 1989): 189-227.

3. “Trouble in the VA,” New Republic 112 (April 23, 1945): 545, quoted in Michael D. Gambone, The Greatest Generation Comes Home: The Veteran in American Society, 1st ed, Texas A&M University Military History Series (College Station: Texas A&M University Press, 2005), 42.

4. This history comes from Michael D. Gambone’s The Greatest Generation Comes Home, which is also a great source for much more on the experiences of veterans and the VA after World War II.

5. Charles Childs, “From Vietnam to a VA Hospital: Assignment to Neglect,” LIFE, May 22, 1970, 24D-33.

6. Severo and Milford, The Wages of War, 303.