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Author: TriSec    Date: 02/16/2016 11:06:09

Good Morning.

We're going to go back a few weeks and clear a couple of older stories from my cache.

At the end of January, veteran Barry Coates passed on with little fanfare, like so many before him who served without ever expecting recognition or reward.


Barry's death was a little different - he was just 46 when he passed, and he died not of wounds, or complications. Barry became the face of the VA's scandal when he waited almost a year for an appointment, and then was diagnosed with advanced cancer that was already past the point of treatment.


Less than two years after disabled Army veteran Barry Coates told a House committee, "I stand before you terminally ill," the South Carolina man is dead from the cancer that went undetected by VA doctors for nearly a year.

Coates, only 46 when he died on Jan. 23, became the face of the Veterans Affairs Department wait-time scandal -- in which patients whose appointments were put off by a system unable to handle the volume of men and women needing its services.

"It is likely too late for me," he told the House Veterans Affairs Committee during an April 9, 2014 hearing. "The gross negligence of my ongoing problems and crippling back log epidemic of the VA medical system has not only handed me a death sentence but ruined the quality of my life I have for the meantime."

Coates was among disabled veterans interviewed as part of a CNN investigative report on delays to veterans care. In his case, a cancer that could easily have been detected with a rectal exam grew and spread over 11 months of delays and inadequate care at VA facilities in South Carolina.

"Through no fault of his own, Barry Coates was dealt a tragic hand in life," Rep. Jeff Miller, a Republican from Florida and chairman of the House Veterans Affairs Committee, said Thursday morning.

"Time and again he was let down by the very agency established to serve him," he said. "Yet after all he endured, he kept a positive attitude and remained focused on ensuring that other veterans would not have to suffer the same mistreatment he did."

Sen. Johnny Isakson, a Republican from Georgia and chairman of the Senate Veterans Affairs Committee, in a statement said he mourns for the loss of any veteran, "but especially for someone like Barry Coates, who suffered from the systemic and cultural failings of the [VA]."

He added, "As a committee, we will continue working to right the wrongs at the VA that Barry Coates helped to uncover and restore the quality care at the VA that all veterans deserve and should receive."

The wait-times scandal broke with reports of delays and secret patient appointment waiting lists at the VA Medical Center in Phoenix, Arizona. CNN reported in April 2014 that up to 40 veterans died awaiting care.


Funny thing - I've been there. I called my doctor, got an appointment within 2 hours, and was operated on within 24 hours. Is that too much to ask for our veterans?

But remember, the bulk of our healthcare industry works on the "for-profit" model. Somebody has to make money at this. Sometimes you can 'upcode' or 'unbundle' procedures to get a few more pennies on that dollar, but then sometimes there's outright price-gouging. It's one thing when it's you and me, but gouging at the VA affects us all, whether we know and love patients in the system, or pay for it through our taxes.


The chairman of the House Veterans Affairs Committee is slamming an American pharmaceutical company for "price gouging" by charging upwards of $40,000 for a nine-week course of Hepatitis C medicine for veterans -- about 45 times what it charges for the same treatment in Egypt and elsewhere.

The medicine, called Sofosbuvir, has already prompted Congress to add an additional $2.7 billion to the Veterans Affairs Department's budget in order to "prevent the department from having to ration veterans' access to the drug," Rep. Jeff Miller, a Republican from Florida, said in an op-ed posted Wednesday on CNN.com.

The target of Miller's wrath is Gilead Sciences of Foster City, California, which Miller said earned about $10 billion in the first year its treatment for chronic liver disease hit the market in 2012.

"Gilead's tone-deaf pricing strategy also fails to take into account the fact that without the Department of Veterans Affairs, the drug at the center of this debate would not even exist," Miller wrote. "Sofosbuvir was invented by a team led by a VA doctor, who sold the company that developed the drug to Gilead in 2012."

Gilead Sciences did not respond to Military.com's request for comment.

He said more than 3.2 million Americans are affected by the disease, with at least 200,000 of them veterans. A CBS News report in December said most veterans in need of medicine treatment are Vietnam vets who contracted Hepatitis C while in country, where it was spread by battlefield blood transfusions and vaccinations.

Miller will be following up his CNN broadside next week with a hearing on Capitol Hill, where he will hear from a VA senior research scientist who helped invented the drug.

The hearing, "Lost Opportunities for Veterans: An Examination of VA's Technology Transfer Program," is scheduled for February 3rd.

The VA receives no revenues from the sale of Sofosbuvir even though the VA's Technology Transfer Program is reportedly supposed to ensure the department receives credit and revenue for medical advancements developed using its personnel and resources.

Among the witnesses invited to testify is Dr. Raymond F. Schinazi of the Atlanta, Georgia, VA Medical Center. In addition to his career at VA, he founded and operated several biotech companies over the years, including Pharmasset -- the one that developed Sofosbuvir -- which he sold in 2011 to Gilead for $11 billion.

But a source with knowledge of the upcoming hearing said VA informed the committee that Schinazi is retiring, effective Feb. 1.

Schinazi, who holds more than 90 U.S. patents, earned about $440 million from the sale of Pharmasset, according to a 2011 report in FierceBiotech, a trade publication for the biotech industry.


But it's not all bad on the VA front today. There's some niche treatments and specialties that are starting to see some increases, and indeed better treatment and outcomes within the VA than in the civilian market. Paradoxically, this actually improves treatment for all. Despite their being more patients in the system, this actually generates revenue, and in turn allows that revenue to be re-invested in better equipment and more personnel.


Military treatment facilities can do a better job of convincing military family members to use them instead of civilian providers by communicating their offerings while increasing the number of providers they have on hand for specialty care, officials said Tuesday at a hearing on Capitol Hill.

"We look at patient balance," said Air Force Col. Douglas Littlefield, who commands the 19th Medical Group at Little Rock Air Force Base in Arkansas. "Some of it is communication, talking to community partners … talking to the members that are out there and communicating the services we have and can provide that will allow them to come back in."

Over the last several years, military officials have sought to move more military family members, particularly those on Tricare Prime, away from off-base civilian providers to doctors within the Military Treatment Facility (MTF) system.

Some bases, such as Fort Campbell, Kentucky, launched publicity campaigns advertising what the MTF can offer and asking users to voluntarily move to an on-base doctor. But others, such as Marine Corps Base Camp Lejeune, came under fire last year after sending letters to Tricare Prime beneficiaries near the base informing them that they had simply been reassigned to on-base doctors.

"One of the things that we're wrestling with is: how do you incentivize the beneficiaries to come back into the MTF?" Rep. Joe Heck, a Republican from Nevada, who chairs the House Armed Services' Personnel Subcommittee, said at the hearing. "How do you address the issues of the relatively transient nature of military healthcare providers and the capability of the MTF to actually expand access to get more beneficiaries to come back in?"

Military medical facilities in the Washington, D.C., area have lowered their per-member, per-month cost over the last year by about $90 by increasing the number of specialty care providers in the MTFs, said Col. Mike Heimall, chief of staff at Walter Reed National Military Medical Center. The command recently hired 11 new physical therapists for the area, he said, and officials hope that that provider increase will bring even more users back on base.

Part of creating a system where military members want to use the MTF instead of being seen off base, said Army Col. Mike Place, who oversees Madigan Army Medical Center at Joint Base Lewis-McChord in Washington state, is creating a culture of familiarity among users and providers.

"We have to recognize that different people want different things for access," Pace said. "What's most important for us to do … is to change the culture to say we want them here and we embrace each other."


I suppose it's 'baby steps', but we've been at this for almost 15 years now - someday there will be a Great Leap Forward, one can hope.

15 comments (Latest Comment: 02/16/2016 18:14:22 by livingonli)
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