Sheila Elliott works at the Hampton VA Medical Center in Hampton, Virginia, where she is a pharmacist and the president of her local union, the American Federation of Government Employees (AFGE) Local 2328.
The Veterans Administration “actually had an incentive to keep people well.” This is in contrast to the rest of U.S. health care, which is dominated by short-termism. But that short-termism has crept, too, into the VA system in recent years, and the workers are paying the price.
That makes it her job to keep an eye on the workers at the center during a crisis like the COVID-19 pandemic, in addition to her day job. And currently, three of Elliott’s co-workers have tested positive for the virus. One of them is on a ventilator, she told me. “The other two, they are just sick as dogs.”
Elliot was waiting on her own COVID-19 test results when we spoke by phone on April 1. It would take, she says, around five days—the tests, as far as she knew, were being sent out to an external lab for processing.
“I know that a lot of privileged people are getting tests without symptoms, and they get them in short order and get the results in short order,” Elliot says. “That is not right.”
Her co-workers were concerned that, in coming to work, they were being exposed to the virus. And that, even if they contracted it, they might not show any symptoms. In those cases, there are no provisions for paid sick leave other than to use the days they’ve already saved up.
Nationwide, with more than 1,200 facilities, the story at VA health care centers—“America’s largest integrated health care system” according to the VA’s own website, and its only truly government-run health care provider—mirrors the stories I’ve heard from nurses elsewhere.
The Veterans Administration is an institution unique in U.S. health care, says Phillip Longman, author of Best Care Anywhere: Why VA Health Care Would Work Better For Everyone, because it has “a very long-term—practically lifetime—relationship with its patients.” Now it is struggling to meet its care needs.
As an institution, Longman says, the Veterans Administration “actually had an incentive to keep people well.” This is in contrast to the rest of U.S. health care, which is dominated by short-termism. But that short-termism has crept, too, into the VA system in recent years, and the workers are paying the price.
In Arkansas, Barbara Whitson-Cassanova, a nurse at the VA medical center in Little Rock and president of AFGE Local 2054, told me that masks were locked away—not only the N95 masks used to protect health care providers working directly with COVID-19 patients, but regular surgical masks as well. Tests were hard to come by; she got her own from an outside provider when she came down with a fever.
“It is hard to social distance when you are a nurse,” Whitson-Cassanova says. “That is just not a part of our world.” Yet protections were not forthcoming; she had heard from another provider that nurses were using garbage bags as gowns.
“Theoretically, a garbage bag might give you more protection than a gown,”,” she says. “But the thought of it is just a horrible image that shouldn’t happen in a country like the United States.”
Tisha Thomas, who works at the Bay Pines VA medical center in Florida, says it’s important that staff have enough PPE [personal protective equipment] for patient contact. They should also minimize other appointments and switch to virtual appointments, to protect both patients and staff from the virus.
At Thomas’s center, staff also must fit-test new N95 masks from a new provider. If the masks don’t fit properly, she says, they won’t protect properly. All employees, she explains, had to go through a screening process each day before starting a shift. “It is terrifying to have to wait in line before coming into work.”
As of March 27, the Bay Pines VA had only one COVID-19 patient and one employee with a positive test, but its staff was gearing up for more.
“We are getting ready to roll into mandatory twelve-hour shifts for all nursing staff,” Thomas says. “We are just trying to make sure we stay vigilant, stay safe, and make sure we are able to actually take care of any veterans that come in with COVID-19.”
According to Elliott at the Virginia VA, the directives on teleworking, protective equipment, and testing were confusing or sometimes straight-up insulting. Even regular masks were rationed; N95 were, she was told, in short supply.
“We have pharmacists on one side of the counter, and the veterans are less than three feet away,” she says. “We have some masks in the pharmacy and so some of the staff put the masks on and they were told that they could not wear the VA masks, but if they wanted to go buy their own masks, they could wear those. And where are they going to find them?”
The pharmacists moved to an office, formerly a cashier’s office, that had glass between them and the patients, shortly after the experience with the masks, but, Elliott notes, “that could have been done in the very beginning.”
Elliott’s VA issued a directive allowing older staffers or those with compromised immune systems to work remotely or get additional PPE. But Elliott, who has worked at the Virginia VA for more than thirty years, says she was told she had to save the mask and wear it the next day as well. And then came the final insult: “We got an email that implied that the staff were stealing them.”
“This is a bit of a perfect storm because the VA, and obviously our union, has been dealing with the VA Accountability Act that passed in 2017,” says Ibidun Roberts, a supervisory attorney at AFGE’s National VA Council.
Passed with bipartisan support but later criticized for overreach, the act allows for faster removal of VA employees. “The VA is not willing to meet with the union to talk about safety issues and how to best address them with our employees,” Roberts says. “Then, if employees are—like now—afraid to come into work without equipment, they will use the Accountability Act to remove them.”
The Accountability Act and other changes in the VA over the years have resulted in vacancies—produced, according to Longman, by a leadership in disarray. Loopholes in the act, Longman noted, have meant that outsourcing is rampant.
Elliott says the changes have happened gradually, over the last twenty years or so, and have gotten worse under Trump. Yet Longman says the VA should have been “particularly good at the kind of thing that we are facing right now,” because of its long-term focus.
Veterans Health
VA Medical Center in Des Moines, Iowa.
Elliott thinks there’s plenty more that could be done, and she’s been reaching out to elected officials with suggestions. She has spoken with staff from the offices of Virginia Senators Tim Kaine and Mark Warner, suggesting things like providing scrubs for everyone to change into on-site for their shifts and having them laundered professionally by the center; more testing; and perhaps having medical staff stay at the now-vacant student housing at a nearby college, to avoid spreading the virus to families.
But the big worry for the VA workers was that as the pandemic spread, they would not have enough capacity to uphold the VA’s “Fourth Mission.”
“The Fourth Mission is that we are to support the community,” Whitson-Cassanova says. All health care workers, she adds, are happy to do so, but they need the right equipment to properly care for the veterans who are their primary mission.
“A nurse shouldn’t have to bargain for protective gear,” she says. “It should be a right. Not just a nurse, but anyone. We’ve got housekeepers. Dietetics, because they deliver trays to every room. And to physically lock them up and you have to go get permission to get a mask? Our independent clinical judgement should tell us. That is what we get paid for.”