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Mr. Chairman, and members of these distinguished Committees,
on behalf of the Blinded Veterans Association (BVA), thank you
for this opportunity to present BVA's Legislative Priorities for
2001. Before I begin my formal remarks, I want to congratulate
you, Mr. Smith, on being selected as the new Chairman of the U.
S. House of Representatives Committee on Veterans Affairs and
welcome the new members to both Committees. Later this month,
BVA will celebrate our 56th year of continuous service to America's
blinded veterans and their families. BVA is especially proud of
the close working relationship and strong support we have enjoyed
from these Committees through the years. Together we make a substantial
difference in the quality of life for the men and women who have
sacrificed so much for our freedom.
BVA and its members are strong ambassadors
for VA’s blind rehabilitation programs. Throughout our 56
years of service, BVA has closely monitored VA's capacity to deliver
high-quality rehabilitative services in a timely manner. When
problems or concerns were identified, BVA has worked diligently
with VA and these Committees to resolve any service delivery deficiencies.
This morning I will be reporting on the status of blinded veterans,
as well as the programs and services designed by VA to address
their special needs.
Last year, I outlined a number of concerns
that affect the full continuum of care for blinded veterans. Regrettably,
Mr. Chairman, little has changed during the past year. This lack
of improvement magnifies our concerns for the future of these
essential programs. Unfortunately, the changes that have occurred
appear more cosmetic than substantive. Personnel and programmatic
decisions continue to be driven by cost rather than customer service
and quality of care. As vacancies for positions such as full-time
Visual Impairment Team (VIST) Coordinator, local manager, and
network director in critical Blind Rehabilitation Service (BRS)
programs open, they continue to make every effort to restructure
the position. They assign collateral duties rendering VIST responsibilities
as part-time, they fill these positions with unqualified individuals,
or they simply do not fill the positions at all. Nearly every
time these decisions have been brought to the attention of officials
at VA Headquarters, the local decisions are reversed. Unfortunately,
this process is time consuming and, in the interim, blinded veterans
go without essential services. Additionally, intervention by Headquarters
instills greater resistance in the field. Local managers and network
directors complain they are being micro-managed and denied the
opportunity to make decisions they believe are in the best interest
of their facilities.
This example is typical of the over-arching
issues that negatively affect VA BRS. Despite the national scope
of these unique and specialized programs, local managers in possession
of decentralized management authority are making devastating clinical
decisions without consulting or gaining approval of subject matter
experts. Furthermore, higher-level management charged with maintaining
VA capacity to provide specialized services to disabled veterans
are not approached regarding these decisions. The primary factor
driving these decisions is cost. Every aspect of the organizational
structure is vulnerable to reduction or elimination in order to
save money. In other words, the end justifies the means. We find
it hard to believe that one Full-Time Employee Equivalent (FTEE)
possessing essential professional knowledge, experience, and expertise
will make or break a medical center. This is especially hard to
comprehend when the FTEE is a VIST Coordinator who assures the
delivery of comprehensive service to a unique population of severely
disabled veterans. Furthermore, these positions are particularly
vulnerable because they are one-person services at a medical center
serving a low incidence disability population.
A specific example of a local decision affecting
a full-time VIST has occurred at one facility. Because of alleged
shortages in resources, the VIST Coordinator’s duties were
restructured, assigning 60 percent of his time assisting in establishing
Community Based Outpatient Clinics (CBOC). Only 40 percent of
his time was allocated for VIST duties. This one example is representative
of a fundamental problem directly associated with establishing
a health care delivery system vested with decentralized management
decision-making authority as opposed to accountability to National
Standards and Guidelines consistent with centralized management.
While BVA does not argue that the delivery of managed primary
care may be best managed by decentralized management decision
authority, we believe strongly that centralized management is
required for the special disabilities programs. During our 54th
National Convention, held August 1999 in San Juan Puerto Rico,
BVA adopted resolution 30-99 that addresses this issue in great
depth. Again last August during our 55th National Convention held
in Buena Park, California, this same resolution was adopted as
number 23-00 (see attached).
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