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The Need for Cultural Reform at the VA
Date:12/4/2008

s also begs the question of leadership and quality. Also in Texas, misguided priorities in a culture are reflected when a psychologist team leader at Central Texas Veterans Health Care System (CTVHCS) sent e-mails to other mental-health specialists in May, arguing that "Given that we are having more and more compensation seeking veterans, I'd like to suggest that you refrain from giving a diagnosis of PTSD straight out." Post-traumatic stress disorder (PTSD), a serious mental health condition, is estimated by the Rand Corp. to affect nearly 1 out of 5 soldiers returning from the war in Iraq and Afghanistan. CTVHCS also serves as a poster-child of bad behavior in another case study, when leadership suppressed and failed to act to disclosures of suspected fraud, waste, mismanagement and funding of scientifically invalid work in humans and $2.5 million dollars later, not a single veteran with traumatic brain injury (or otherwise) benefited (http://www.va.gov/oig/54/reports/VAOIG-08-01105-171.pdf).

A cultural problem? An insulated bureaucracy that overly relies on internal monitoring sets the stage for stagnancy and resistance to reform of systemic problems. Alas, when disclosures of wrongdoing are made internally to the VA, suppression and inaction can occur. Beware to the potential whistle-blower as the internal policing of the VA may "have ears to hear, and hear not."

How can we tackle veterans' doubts of integrity and transparency of the system? A new system of regional, independent oversight to provide early, proactive opportunities for the Central Oversight of Congress could replace the reactive options left after the media unearths problems. These advisory bodies could also serve as better, truly independent safe-havens of refuge, above and beyond those offered by the VAs own Inspector General, for those fearing reprisals
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SOURCE Robert W. Van Boven, M.D., D.D.S.
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