Veterans make up one fourth of individuals with spinal cord injuries in the U.S. Most prefer to receive care provided by the Department of Veterans Affairs, which runs the nation’s largest and most comprehensive network dedicated to treatment and clinical research on spinal cord injuries and disorders (SCI/D).
But the VA’s SCI/D program was the subject of a recent congressional hearing due to concerns about the VA’s ability to meet the needs of veterans with SCI/D.
AFGE member Dr. Jenny Kiratli, director of SCI clinical research at the VA Palo Alto Health Care System in California, testified on behalf of AFGE from the perspective of a researcher with more than 30 years of experience conducting research on clinical issues affecting people with SCI. Dr. Kiratli is also director of the VA Advanced Fellowship Program in SCI Research and associate research director for the SCI Medicine Clinical Fellowship Program. She has been an AFGE member since 2009.
Testifying before the House Committee on Veterans’ Affairs, Dr. Kiratli said the VA’s SCI/D program is aimed at supporting the veteran as a whole person with services that reintegrate veterans into the community and provide family education and assist caregivers.
Here are the highlights of Dr. Kiratli’s testimony about what’s happening inside the VA’s SCI/D care delivery system.
- The VA SCI/D network provides lifelong integrated care that doesn’t exist anywhere. The VA’s 25 SCI/D hubs and 120 designated medical “spoke” facilities provide lifelong, comprehensive, coordinated care that includes primary care, rehabilitation, emergency care, acute medical and surgical care, mental health care, and home care. The 25 SCI/D centers are the hub facilities staffed with clinicians including therapists and psychologists trained to provide specialized care to people with a spinal cord injury or disorders.
- Most physicians in the SCI/D centers pursue an additional year of focused training in SCI Medicine as they need special training to serve SCI/D patients’ specific needs. For example, primary care physicians treating the SCI/D population must be able to diagnose and treat an array of problems that may present differently in patients with spinal cord injuries, such as bone breaks and infections. They must also be trained to recommend appropriate preventive care screenings and manage comorbidities common to SCI/D patients such as metabolic disease, endocrine disease, and musculoskeletal disorders.
- More facilities are needed. The 25 hubs and 120 designated spoke facilities serve about 18,000 veterans across the country. While those with service-connected injuries are eligible for enhanced services, VA SCI/D centers serve veterans and active-duty military personnel with nonservice related spinal cord injuries and disorders. The spoke facilities have increased veterans’ access to SCI/D care, but more are needed especially in the rural areas to reach more veterans.
- There’s a need for staffing increases. Individuals with SCI need significant support as they live with secondary complications and are two to five times more likely to die prematurely. SCI is also associated with higher rates of mental illness, with one in five suffering from depression. Because of the complexity of SCI/D care, it requires specialized certification and training, and the VA needs to hire more people to meet veterans’ unique needs. Staffing shortages create burnout, and staff often leave just when they have gained enough skills to perform their duties. SCI nurses can be moved elsewhere to help with staffing shortages, but non-SCI nurses cannot easily fill in on SCI unit as specialized training is required.
- VA’s research benefits both veterans and the general population living with spinal cord injuries and disorders. VA Palo Alto’s Spinal Cord Center, for example, conducts significant clinical research aimed at developing best practices for care for veterans with SCI/D. A modification to standing wheelchairs pioneered by a team from the Minneapolis VA Health Care System allows people to move while in standing positions. All VA research is ultimately shared with non-VA SCI facilities through published research and conferences, contributing to the overall benefit of the larger, non-VA SCI/D population.
- The VA works with employers to help return veterans with SCI/D to the workforce. The VA participated in a multi-site VA study to establish and test a model for vocational rehabilitation that increase opportunities for veterans with SCI/D to return to work in meaningful ways by partnering with potential employers to understand the needs of each individual and develop jobs that meet their needs.
- Privatization could harm veterans and the VA’s ability to care for them. The Mission Act has sent more veterans to non-VA facilities, which could potentially harm veterans because the VA’s SCI/D program provides uniquely comprehensive and integrated services delivered by highly knowledgeable teams of specialists that do not exist in the private sector. Non-VA providers also don’t have access to VA resources such as medical equipment and a wide array of adaptive products, often created for each individual veteran to meet his or her specific needs. In addition, non-specialists often do not recognize serious disorders such as a bone fracture because the patient may not have the symptoms. Non-VA providers are also more expensive, which cuts into funding that should be used by the VA to hire and train specialists and increase the number of SCI/D facilities.
