And The Hits Just Keep On Coming...

by hilzoy

From the Washington Post:

"Department of Veterans Affairs doctors are furious over a recent decision by the Pentagon to block their access to medical information needed to treat severely injured troops arriving at VA hospitals from Iraq and Afghanistan.

The VA physicians handle troops with serious brain injuries and other major health problems. They, rely on digital medical records that track the care given wounded troops from the moment of their arrival at a field hospital through their evacuation to the United States.

About 30 VA doctors in four trauma centers around the country have treated about 200 severely wounded soldiers and Marines. The docs had been receiving the complete digital records from the Pentagon until the end of January, using the Pentagon's Joint Patient Tracking Application.

But on Jan. 25, when Shane McNamee, a physician in the Richmond VA Medical Center, tried to get the full records, he couldn't."

There follows a description of various emails back and forth, leading to this:

"Tommy Morris, director of Deployment Health Systems, responded the next morning to Parramore's inquiry, after contacting Ellen Embry, deputy assistant secretary of defense for force health protection. "I spoke with Embry and no agreements, no data sharing via access to JPTA."

The access cutoff came after Morris, in a Jan. 23 e-mail, instructed a colleague: "If the VA currently has access I need a list of persons and I need their accounts shut off ASAP. It is illegal for them to have access without data use agreements and access controls in place by federal regulations and public law.""

It's true that there are various laws -- e.g., HIPAA -- that require various hoops to be jumped through before medical data can be shared. But it defies belief that nearly four years into a war, we haven't got arrangements in place to allow VA doctors to get the full medical records of wounded veterans. I cannot think of a single good reason -- not one -- why this should still be an issue.

This sort of thing infuriates me. I mean: I am a mild-mannered person, but when I read things like this, I start entertaining thoughts like: why not announce to the department in charge of this that every single day we will take its highest-ranking surviving member, plus a few more people chosen at random, inflict serious injuries on them -- massive head traumas, the odd lost limb -- and treat them according to the provisions they have put in place for wounded soldiers. Every single day, until the doctors in VA trauma centers tell us it's not a problem anymore.

I don't actually want to do that. But nothing else seems to get results:

"Last week, Sens. Daniel K. Akaka (D-Hawaii) and Larry E. Craig (Idaho) -- the chairman and ranking Republican on the Veterans' Affairs Committee -- wrote David S.C. Chu, undersecretary of defense for personnel, of their "deep concern" about VA trauma center doctors not having access to complete records.

"For those servicemembers suffering from a traumatic brain injury," they wrote, "VA's access to in-theater imaging is an important and valuable tool for tracking their patient's progress since being wounded or injured." They suggested the VA doctor be given temporary access to JPTA while the data-sharing questions are worked out.

They're still awaiting an appropriate response. McNamee is still waiting for the records."

To quote Brad DeLong: Impeach George W. Bush. Impeach him now.

Comments

[Ugh]

AFAICT every doctor that's ever mentioned HIPAA to me think it's a giant waste of time and does nothing. But I'm not a doctor and am only related to 2, so perhaps I'm wrong.

[john miller]

As a person involved with HIPAA regulations every day, I can tell you that it is a case of well-intentioned, great in theory, but screwed up in practice.

And I think this is a little too strict interpretation of the rules. Since, in a way, th VA and military medical systems are under one roof, the UA Government, there probably would be no problem with shared information.

However, the remedy is really quite simple. Just have every member of the military, upon enlistment, sign a waiver allowing transfer of info from military health care to the VA. There, problem solved. Since brain trauma may cause those currently in treatment not to be competent to sign a current waiver (which creates its own exception category) there is probably a family member who can sign a release form.

There really is no excuse for this happening.

[john miller]

BTW, I don't think this should be fully placed at the feet of GBW. And it is hard for me to say that.

[H. Haller]

It's true that there are various laws -- e.g., HIPAA -- that require various hoops to be jumped through before medical data can be shared.

Hm. I thought HIPAA didn't apply where the PHI was being disclosed for treatment purposes. Perhaps the entities need to have a business-associate agreement, but those are boilerplate.

[hilzoy]

I have never really slogged through HIPAA's requirements, so I don't know whether it, in particular, is what's causing the problem. I just wanted to say: yeah, there are laws that could be the problem, but what's inexcusable is not having figured out how to deal with those laws long since.

As for GWB: being President is, among other things, being the head of a large and complex organization. By one's leadership, not to mention the appointments one makes, one can go a long way towards ensuring that screw-ups like this do not happen, because people know that they will not be tolerated. I would be a lot more tempted to say: well, but things can slide through the cracks, a leader can't be expected to be on top of everything -- which I believe -- if this were the first example of this sort of incompetence I had ever seen from this administration.

As it is, I'm reminded of what my Dad used to say, when I would come up with some (as I thought) ingenious explanation for why I had, yet again, not done my homework. He'd say: hilzoy, what you say may be true, but I ask myself: is it possible that each and every one of the improbable things you've told me, on every day this week are all true? Could any child's homework possibly be that disaster-prone? And I answer: it's awfully unlikely. So I'm going to have to punish you in some way, since even if you don't deserve it on this occasion, you surely do on one of the occasions on which you have not turned in your homework this week.

(Note: he was always right about when I was making stuff up. I found this maddening: all that work coming up with an absolutely unfalsifiable excuse down the drain!)

[LizardBreath]

Is 'Deployment Health Systems' a private contractor? Because the name sounds as if it is, rather than a governmental agency. I wonder if that's part of the legal/bureaucratic barriers. It still should be possible to overcome them, but I bet if the work was being done inhouse this problem wouldn't have come up at all.

[Slartibartfast]

Ok, I've thought about this a bit this morning, and I've just decided that I'm never going to say this to my own satisfaction. So I'm going to just say it, and hope that some of it communicates.

1) Putting an incitement to impeach at the bottom of this article seems to connect the contents of the article to crimes committed by the President, but there's no such connection formed in the article, that I noticed.

2) I don't support the impeach him now for a variety of reasons, but one reason I think you shouldn't support it is that now you have neither the case nor the political consensus to impeach. If you really want to impeach, and you're ok with litmus testing, I'd suggest that this is one of those situations that litmus-testing is best suited to: forming a clear, unified consensus so that an act requiring said consensus can be executed. I think if you try, and commit insufficiently prepared, you're going to have the D party damage itself badly.

I'm pretty sure I understand what you were thinking when you said this, but I'm not sure, and I doubt that everyone else will be.

[Slartibartfast]

By case, I meant something like fully prepared and researched case, but, as I said, it's never going to be right.

[hilzoy]

Slarti: true. It was probably a mistake. What I meant was something along the lines of: oh dear God, why on earth do we have this idiot in charge of things? (See above for why I blame him.) Can't we just, like, get a new one? It's more serious that my proposed decimation of the relevant department in the federal government, which obviously isn't serious at all, but just an expression of fury. But it's not a fully serious statement like: having reflected on the costs to the country, and the thrills of a Cheney Presidency, I have concluded that the Congress should bring articles of impeachment against Bush.

Or, shorter me: I meant it the way I assume Brad DeLong does.

LB: hard to tell. Google is mysterious on the subject. Best links I've found: here and here. I can't quite tell, from them.

[OCSteve]

So I'm going to have to punish you in some way, since even if you don't deserve it on this occasion, you surely do on one of the occasions on which you have not turned in your homework this week.

Reminds me of the time I got a whuppin’ for something I did not do. After my father found out that I did not in fact do it, he said, “Well I’m sure you’ve done something recently to deserve it that I just don’t know about.” He was right as well.

I take your point about the pattern of incompetence; still I think it’s a stretch to try to pin this kind of typical bureaucratic red tape on the President.

DR. David Chu would seem to be the man most directly able to resolve this. He appears to have been a life-long administrator though – the type more known for creating red tape rather than cutting through it.

[Decided FenceSitter]

The Sarbanes-Oxley Act (SOX) was put into place to prevent corporate malfeasance. Publically owned company CEOs and CFOs are now required to put their name on the dotted line that the various items required by SOX are correct and that they are responsible.

I'm sure that many of the lawyers here could get into the case law, and how it has changed. I just happen to be currently in a Business Legal Environment class (i.e., case law for MBA students).

I just want this sort of transperancy and accountability applied to our government, regardless of party, duty or function. I want segregation of duties, clear lines of responsibility.

It'll never happen because Congress will always exempt the gov't from following its own guidelines.

Damnit, I still want SOX for Gov't.

[Slartibartfast]

Thanks, hilzoy.

I figured that in order to have written that, you'd have to have been quit steamed.

If that's what Brad DeLong meant all those times, I may have to take back all those times when I wondered how a noted economist could be such a complete idiot.

[Slartibartfast]

"quite"

There's no sufficient amount of coffee, evidently.

[Bernard Yomtov]

It probably is a bit unfair to pin this on Bush. I think that what causes the anger at him in these situations is the suspicion that somewhere there is a Brownie in the middle of the problem. While all Administrations have patronage appointees, it's usually a good idea to keep them out of situations that seriously affect people's lives.

I sometimes wonder if it wouldn't be a good idea for government budgets at all levels to include a line item for "patronage positions." This would be money the President or Governor could draw on to hire supporters for explicitly useless jobs, with the proviso that all jobs with actual responsibilities be filled by qualified individuals. This would limit the damage these appointees do to just the cost of their salaries.

[hilzoy]

Slarti: steamed understates it. -- I mean, not having all the relevant medical data when you're treating a serious injury can make a big difference. And 'a big difference', in the case of (say) a serious brain trauma can mean: the difference between being able to regain a certain amount of function and not being able to.

The idea that the people we have asked to risk their lives might not recover as fully as possible because of a bureaucratic screwup that just should not be happening at this stage -- that we are not doing everything we can to minimize the number of soldiers who just don't have much in the way of short-term memory anymore, or haven't fully regained the ability to concentrate and focus, or just have some mystery malfunction that makes them just not able to function the way they used to -- just made me furious.

I would not be so quick to blame this on Bush if there hadn't already been the Iraq reconstruction, the staffing of the CPA, Katrina, etc., etc., etc.

[Ugh]

Speaking of bureaucratic screwups (though likely prompted by legislation), I heard on the radio today that grandparents who are raising children orphaned by the Iraq war do not get the same financial support from the gov't that a surviving spouse does.

[Slartibartfast]

Just for background:

Ellen Embry

Tommy Morris

Shane McNamee's name comes up in Google quite a bit; it's probable that he's the same guy who comes up in hits associated with Operation Helmet, which is an interesting, but not completely related, issue.

[Decided FenceSitter]

That's a long standing issue from what I recall Ugh, and not Iraq dependent. I know DC brought up increasing/extending (not sure which) the payments to grandparents who take in their children's children to the level as foster parents. The system just isn't naturally set up to deal with that scenario.

I may be wrong on the details, it was on the Television news a while ago.

[miscellanneous]

But the link to Bush becomes more explicit, at least in the future, with his recent amendment to Executive Order 12866, right? (Here's the OMB Watch response.) This makes explicit that final regulatory decisions are to be made by political appointees and not people within the appropriate agencies, as well that regulatory decisions can be made only because of "specific market failure."

This seems to me, at least, to be more of the "flowing from the top" pattern of how and why decisions -- such as the inhuman one being discussed here -- are made.

[Ugh]

More (though likely not a surprise) hits:

The Pentagon rejected qualified experts for reconstruction work in Iraq because they were not deemed loyal to the Republican party, according to the former chief of staff of the Washington Office of the Coalition Provisional Authority, Frederick Smith.

[Nell]

I was ready to join the chorus on pinning responsibility for this obscene bit of bureaucratic injustice well below the White House level, but then miscellaneous' comment stopped me cold.

After all, there was image-sharing all through the war and occupation right up until one week after the 'commisar for every department' order went out.

Or have I missed something in the Post story that makes clear where the new obstruction originated?

[Nell]

@LizardBreath: The link Slarti provided makes it sound as if Tommy Morris is a Defense Dept. employee, not a private contractor.

'Deployment Health Systems' appears to be some area/division/something-or-other within the Department, of which Morris is the Director. In the same way in which Ellen Embry is the Director of the 'Deployment Health Support Directorate'.

At any rate, this is FUBAR. And it's unclear why this has just come up now, after the hundreds (or thousands) of cases over the last four years in which VA doctors have been able to share the data.

[John Thullen]

Just a thought:

Since joining the military is one big waiver-signing anyway (we will send you to a place where you may be blown to smithereens), why can't it be assumed everything else has been waived as well?

In regard to the term "bureaucrat", I blame the collectively idiotic American people for this movement to take all power of decision away from the rank and file government employee and place it solely in the hands of unqualified political appointees. The American people swallowed the "good-for-nothing, faceless bureaucrat" crap fed out like chum since Ronald Reagan made an art-form of hating the government 37 years ago.

I think the whole thing, not just this instant of it, is frankly, funny.

[Ugh]

Hits.

[Nell]

Ugh, that is a dramatic story. But it's written as if it were impossible to sort out the nature of events there.

My understanding is that Baquba is [was] a city of Shiites surrounded by Sunni villages and countryside. The corrupt police chief appears to have been a Shia who sold out his own forces.

But the most upright and efficient police chief would have had one whale of a security job, because civilians and police were attacked systematically when traveling from Baquba to anywhere else over the last year.

As the sectarian fight intensified in Baghdad, so did the civil war in and around Baquba.

Last December, Odierno's Fourth Infantry Division did a series of sweeps through the Diyala countryside that produced nothing. Then they sealed off the area and bombed it heavily. As the bombing was wrapping up, a helicopter went down -- a harbinger of the most recent rash of downings. No mention of this context in the story.

Where are the former residents of Baquba living now? Not a question raised, much less answered, in the CNN story. One possibility: 'cleansed' former Sunni neighborhoods in east Baghdad. If that's so, how will the displaced Baqubans respond to implementation of the just-announced policy of removing those who can't prove they are owners or long-term residents?

More context and more relevant detail makes the Baquba story even more clearly evidence of the pointlessness or worse of the U.S. troop presence. But TV is TV; there's only so much you can fit into the framework of the three-minute story.

[Ugh]

Nell - thanks for providing more background info.

[rea]

"It probably is a bit unfair to pin this on Bush."

Harry Truman used to have a little sign on his desk, saying, "The buck stops here."

One of the defining characteriztics of this adminstration has been its compelte refusal to accept responsibility for anything that goes wrong. GWB's little sign, if he had one, would say something like, "The buck stops somewhere else."

Damn straight it's fair to blame Bush for this; he was President of the United States, last I looked, much though I may wish he were not.

[CaseyL]

"The buck stops somewhere else."

Consider all the bucks that have stopped somewhere else; all the disasters and threats and untruths Bush didn't know about.

The August 8 memo Bush didn't know about, the Summer of Threat leads Bush didn't know about, the Niger forgeries he didn't know were forgeries, the leak of a CIA agent's identity he doidn't know about, the unsecured weapons caches he didn't know about, the history of sectarian/ethnic hatred in Iraq he didn't know about, the lack of post-invasion planning he didn't know about, the insurgency he didn't know about, the need for more troops he didn't know about, the false figures his policy managers gave Congress he didn't know about, the need for emergency assistance on the Gulf Coast he didn't know about, the brand-new missed benchmarks he apparently didn't know about....

What does Bush know about?

What the devil does get discussed at all those meetings he goes to?

Does he even listen to anyone in those meetings? Or does he sit there like a lump, as he did during the Katrina briefings: incurious, uninterested, and forgetting whatever the topic was the minute the meeting is over?

What the hell is he anyway, nothing more than a speech-making, fund-raising doll?

[Hartmut]

Of course the sign would be: the bucks land in my cronies' pockets.

[BroD]

"It probably is a bit unfair to pin this on Bush."

No, it's not.

Impeach the mf. Impeach him now. (By which I mean to suggest that his culpability is so great and so comprehensive that--political calculations notwithstanding --the legal and moral case for impeachment is compelling.

[Josh Trevino]

I guess we're going to continue slogging through VA-related stories until we can find something to really, really pin on the President. In addition to bashing our hate-object, it allows us to show Support for Our Troops -- in lieu of doing meaningfully supportive things.

I hear there's a clerical error at the Fort Hamilton, NY, facility that may be plausibly blamed upon Bu$h.

And no, Hilary's otherwise charming tale of her father's punishment rationale is not sufficient grounds for this foolishness. There are folks asserting that the Utah mall shootings are evidence of the Global Jihad on the same grounds: X bad things are done by Y, therefore A must also be attributable to Y. This is sloppy and a non sequitur. Unless you can link Y to A with actual evidence, leave it be.

[Jesurgislac]

Trevino: I guess we're going to continue slogging through VA-related stories until we can find something to really, really pin on the President.

I asked you already in the other thread, who you think should be blamed ("held responsible" is a term some people use about the Commander in Chief of the armed forces, and the President of the United States). Do you intend to answer that?

[hilzoy]

Josh: I'd prefer it if you use my pseudonym. Thanks.

[liberal japonicus]

Related in today's WaPo Soldiers Face Neglect, Frustration At Army's Top Medical Facility There is also a slideshow.

[Hob]

HIPAA should not be a factor at all in this case: a hospital requesting data on the traumatic injury that brought the patient there is about the clearest case of "disclosure to facilitate treatment" that you can get. This is some other kind of intradepartmental pissing match.

Per the first two commenters, yes, a lot of people in health care do find HIPAA to be a pain in the ass. There's really not that much hoop-jumping required, though - except in the unfortunately frequent case of some office person who, due to severe cognitive deficits, is just unable to understand the fairly simple privacy law and ends up causing all kinds of havoc in order to avoid imaginary breaches. Similarly, the head nurse at my former job once tried to remove all the chairs from the desks because she had misread the fire code, and wouldn't listen to any of the other employees or managers on the other floors; the problem there was not really the fire code.

[Anarch]

in lieu of doing meaningfully supportive things.

Like writing blogposts declaring triumph over Occupied Byzantium.

[Fraser]

Hilzoy, I sometimes quote you in columns I write for my local paper. Would you prefer "hilzoy" or "Hilary Bok" which is what I usually use?

[Gary Farber]

I think that she doesn't use her real name here for a reason, and thus someone else blithely posting what they think it is might not be the most thoughtful comment ever.

Though I suspect that the comment this is in response to may disappear soon.

[spartikus]

See what happens when the Online Integrity website is taken down?

Oh the humanity.

[Mike Schilling]

My most vivd experience with HIPAA came when I went to visit my mother, who was elderly and lived alone, found that she was unexpectedly not home, and was told by her neighbors that she'd been taken away in an ambulance. I started calling all of the local hopsitals, none of which would "violate her privacy" by telling me whether she was there or not. I eventually found a human being at the ambulance service who broke the rules and told me where they had taken her.

[liberal japonicus]

Mine is not as good as that, but somewhat illustrative. When my daughter was hospitalized on a trip to the US, and I got an enormous bill when my wife and daughter returned (she was sick enough that she and my wife stayed in the US while I went back because classes were starting), they refused to send me an itemized bill because of privacy concerns. Of course, when they are charging 100 dollars or so for aspirin, you understand why privacy might be invoked.