Late January, a registered nurse within the Department of Veterans Affairs outlined and submitted several issues in regards to the transplant system for our military veterans. Jamie McBride is the program manager at the Solid Organ Transplant Program in the Audie L. Murphy Memorial VA Hospital in San Antonio, TX. He sent his findings to the U.S. Office of Special Counsel (OSC) in an attempt to shed more light on an ongoing problem.

A huge problem McBride spoke of was the sheer lack of VA Transplant Centers (VATC), and the distance one has to travel just to get to them. Upon investigation, the Office of the Medical Inspector (OMI) from the VA found that only 10% of the approximately 1,500 veterans who received a transplant actually lived within 100 miles of the VATC in which they were treated. For example, if you look at the image below, imagine that you live in Florida and you liver transplant — you would have to relocate to Richmond, VA. If you’re in New Mexico or in Arizona, you’re going to have to travel quite a ways to get a lung transplant. This can be a serious problem when there is a high risk involved in travel — people in need of organ transplants aren’t always in the traveling shape.

McBride claimed that these hardship costs were not adequately addressed by the VA, as the whole process could take months or even years. He states that the problem is so bad that some veterans decline the process and die, unwilling to put their families through all that.

Here is a map of the VA organ transplant centers:

There is a program that allows for veterans to use regular, closer hospitals with transplant facilities, and the VA will essentially cover it under the “Veterans Choice Program.” The VA pays for donor care and non-VA transplants just as they would cover the whole procedure in one of their own hospitals. However, there is a bit of a catch-22 here: the VA generally just covers for Medicare rates, and most regular hospitals don’t accept Medicare rates when it comes to the donor care side of things, making the two virtually incompatible.

McBride has provided documents to the OSC supplementing this assertion and proving multiple instances in which the VA declined to cover the costs of necessary transplants when it exceeded Medicare rates, calling it a “non-veteran expense item” or “non-veteran care.” McBride went on to say that the VA even declined some that were within Medicare rates.

In a letter to President Trump, the OSC’s Special Counsel Henry J. Kerner said that, “A review of [the Veterans Health Administration]’s payment records from October 1, 2015 to July 20, 2016 revealed that the VA covered one transplant at a non-VA hospital through the Choice Program…” There were some further discrepancies when the VA decided that their patients were getting additional, satisfactory care from other providers and so did not pursue the matter any further.

All of these bureaucratic and regulatory issues lead to a pretty simple, hard fact. Kerner writes, “OMI found that the rate of veterans receiving living donor kidney transplants at VATCs is lower than the national rate.” However, he continued to assert that the “barriers” preventing the transplants are not entirely apparent, insinuating that it is the unseen issues that require more research and deliberation that must be solved before we can begin to see treatment on par with VATC’s civilian counterparts.

Some of the potential barriers Kerner posits include the VATC’s criteria for kidney transplants, having a stricter BMI requirement than normal hospitals. He also reiterates the discrepancy between the Medicare rates the VA offers to pay for, and what the hospitals under the Choice Program will actually accept.

The VA system is continuously evolving, and unlike previous issues, the problem isn’t always in the mishaps and gross negligence. In this case, the problem seems to be inherent to the system itself, and that it’s the system that needs changing — not just the enforcement of existing rules. Kerner said that, “I have determined that the reports meet the statutory requirements (of the VA); however, the findings do not appear reasonable.”

Featured image courtesy of the Associated Press.