Fourteen years ago, an ABCNEWS hidden-camera investigation ignited a firestorm about conditions and competence inside Veterans Administration hospitals.
Recently, there have been new stories of misdiagnosis, disastrous management and deficient care at some of the nation's 162 facilities.
At a hospital near Cleveland, an ABCNEWS hidden-camera investigation found bathrooms filthy with what appeared to be human excrement. Supply cabinets were in disarray, with dirty linens from some patients mixed in with clean supplies, or left in hallways on gurneys.
At a neighboring facility, examining tables had dried blood and medications still on them. In several areas, open bio-hazardous waste cans were spilling over. Primetime obtained internal memos documenting that the equipment used to sterilize surgical instruments had broken down — causing surgical delays and possible infection risks.
With 130,000 young American men and women putting their lives at risk in Iraq today, these conditions are particularly relevant. While current soldiers are treated in military hospitals, when they leave the service and need treatment, many will seek care at Veterans Affairs (as the Veterans Administration is now known) hospitals.
"Once you come back to be a veteran, it's like a black hole, you know — nothing," former Army Sgt. Vannessa Turner told ABCNEWS.
Turner was stricken with a mysterious illness while on duty in Iraq this past year. She retired from the military on medical grounds, and when she reported to a VA hospital for treatment, doctors scheduled her for an appointment six months later.
Not a Point of Pride
Veterans who responded to a survey by the American Legion in 2003 said it took an average of seven months to get a first appointment at a VA hospital. In some hospitals, patients have waited as long as two years.
In 1999, Jack Christensen, a former army sergeant who served in the Korean War, was admitted to the VA hospital in Temple, Texas, with pneumonia, and ended up staying three years.
Christensen's wife, Pat, says the attitude of some of the practical nurses was shocking. Some of the patients were forced to beg for food and water, she says. Instead of helping her husband go to the bathroom, she said, "they would put a towel under his hips and tell him to use the towel."
Pat Christensen said her husband's condition worsened over several months — so badly that at one point he developed horrific bedsores and dangerous infections, and she says his doctors said they would have to amputate his legs.
Pat moved her husband to a private facility, where his infection healed and he underwent extensive physical therapy. She sued the VA, and then used the money to pay for private care for her husband. The VA denied liability but paid a settlement.
Dr. Jonathan Perlin, the deputy undersecretary for health, said the VA system has sophisticated quality control. But when he was shown ABCNEWS' hidden-camera video of hallways and supply closets in disarray, he said, "This is something we're not proud of."
Critics have long charged that the VA system puts patients on a kind of assembly line, passing them from doctor to doctor.
There's also criticism of how the VA uses residents — doctors still training and not certified in their specialties.
Terry Soles served in the Navy during the Vietnam War. His wife, Denise, says he was one casualty of this practice. In 1998, he went to the VA hospital in Cleveland complaining of pain and diarrhea, and doctors removed small cancerous growths from his stomach and esophagus.
But as his symptoms persisted over the next two years, his wife says the VA gave him painful tests and repeatedly lost the results. His wife says Soles was seen by a parade of constantly rotating resident doctors, and there was little consistency in his care.
Once, Soles was prepped for surgery but before the operation the doctors who were present couldn't agree on what they were going to do, she said.
Before he got sick, the 6-foot Soles weighed more than 200 pounds. By the time his family finally decided to take him to a private hospital, he weighed 80 pounds. Some VA doctors thought his problem was psychosomatic.
When he could no longer recognize his own son, Soles was rushed to a private hospital. There, Soles learned he was "a total mass of cancer from his trachea to his renal bowel. And that there was nothing that could be done," his wife says. Terry Soles died three days later.
The VA's Perlin said the Soles story was tragic, but added: "However, that is not the experience of most of the veterans who come to us for care. … We take care of 7 million veterans. While the majority of care is good, in a big system, bad things happen."
Critics charge that one of the big problems facing the VA is that too much money goes toward administration, at the cost of nursing and patient care.
Dean Billik, the former director of the VA in Charleston, S.C., is brought up as an example.
In 1996, he was denounced for allegedly spending about $200,000 in taxpayer money to redecorate his office; $1.5 million to renovate a nursing home unit that stayed empty for two years; and tens of thousands of dollars for a fish tank in the lobby — while there were budget shortfalls and staff cutbacks were contemplated.
Congress heard testimony claiming Billik was "blatant in his mismanagement," and an inspector general's report confirmed several of the numerous allegations against him.
But after everything was brought to light, Billik still got a bigger job: He was put in charge of the third-largest hospital system in the VA, encompassing eight cities, 295 acres of land and 83 buildings. And his salary immediately jumped about $15,000.
Primetime obtained budget information on the central Texas VA system for Billik's six-year tenure at the top. It confirms that Billik cut spending $2 million for the people in direct patient care — nurses aides and practical nurses.
Other documents obtained by Primetime show that $129 million was spent on construction at three of six facilities in Temple, Texas.
One source says Billik spent $1.8 million renovating a building at Temple for his own offices — after it had been renovated for patient care.
Furthermore, Nancy Kelsey, who was a nurse at one of the Temple facilities under Billik's supervision, says the way some of the staff treated patients was alarming. She says IVs ran out, patients were neglected and dressings weren't changed.
Melba Bell, whose husband, Ed, served in Korea, said the staff was often idle and it would often take hours to get help. Other families said that if patients or their families persisted in asking for help, some of the staff retaliated.
At one point, Bell's infection got so bad that the hospital used maggots to try to eat away the decay. That's not unusual treatment, but what happened afterward was.
"The dressing that they had on there was real poorly done," said Bell's granddaughter, Chesney Shirmer. "Some of the maggots got out and they were in the bed with him, you know? He could feel them in the bed."
Ed Bell died of gangrene in the VA hospital in 2002.
One More Problem
When confronted with these details, Perlin said he shared the outrage and promised to look into fixing these things.
But there is one more problem. Many whistle-blowers and critics say if you try to expose the truth, VA managers don't want to hear it.
Charles Steinert, who worked for Billik in Charleston, says he felt pressure to leave after he complained about some of the building projects and how he was being treated by supervisors.
Nurse Melissa Craven, who also worked at the Charleston VA, says she suffered retribution for two years after she spoke out about some of her supervisors.
Perlin said it is easy for patients and their loved ones to lodge complaints about VA care. "That's important to us, because if there are concerns, we want to address them," he said.
But many patients and their loved ones told ABCNEWS that wasn't their experience — and even worse, many of the families are afraid to speak out.
"They're afraid to say what really goes on, because they're afraid any little benefits that they have are going to be taken away from them," said Denise Soles.
The day after Primetime presented its findings to the VA's Perlin, he ordered inspections of the facilities Primetime investigated.
They found a number of problems at the Temple, Texas, VA, including poor hygiene, insufficient staffing and low satisfaction among patients and their families.
The VA announced it would bring in new supervisors, reassign some personnel, train others, and begin recruiting additional staff.
Inspectors who went to the VA in Cleveland said it was in good condition. However, after their visit, Primetime received phone calls from several sources saying that the hospital had advance warning of the so-called surprise inspection.
And to those patients who accuse the VA of assembly-line care — that patients go through a succession of doctors — a public relations officer for the VA said it tries to ensure continuity of care, but that may not always be possible.
As for Dean Billik, he has now retired. In a phone conversation on Wednesday, he said he disagreed with the VA inspectors, saying their report was "an opinion."
Billik said he relied on his staff to supervise nursing and recommend budgets, and if he had renovated some buildings that then were closed it was because he didn't possess 20/20 hindsight and made the best decisions at the time.
Rep. Ted Strickland, a member of the House Veterans Affairs Committee, called for the White House and Congress to approve enough money to ensure that veterans get the care they deserve.
It's a "situation that's crying out for change," the Ohio Democrat said after viewing Primetime's tapes.
Veterans and their families agree they deserve better. "They were good enough to go fight for their country," said Melba Bell. "They deserve to have the best treatment that they could get."
Denise Soles says that before her husband died he asked just one thing of her: to speak out.
She said Terry Soles told her, "If we can help one other veteran from going through the hell … That's what we have to do."
Some Internet resources for veterans: GIreports, http://www.gireports.com; Iraq War Veterans Organization, http://www.iraqwarveterans.org; American Legion, http://www.legion.org; National Gulf War Resource Center, http://www.ngwrc.org