The “Deny and Defend” approach in healthcare refers to a traditional strategy where medical institutions deny responsibility for errors, adopt a defensive legal posture, and avoid transparency in communicating with patients and families. While increasingly criticized in modern healthcare for its detrimental effects, this approach continues to harm veterans in the VA healthcare system and its Community Care program.
The “Deny and Defend” Approach: A Legacy of Harm
Core Characteristics:
- Denial of Responsibility: Refusal to acknowledge errors or adverse events.
- Defensive Legal Posture: Prioritizing protection from legal claims over patient resolution.
- Lack of Transparency: Withholding information that could improve patient care and outcomes.
Negative Outcomes:
- Erosion of patient-provider trust.
- Increased litigation costs and adversarial interactions.
- Compromised patient safety and continuity of care.
In the VA system, the “Deny and Defend” model is particularly harmful due to veterans’ unique reliance on VA healthcare, their trust in the system, and the bureaucratic challenges they face in advocating for themselves.
Challenges in VA Community Care
The VA Community Care program, designed to outsource care to private providers, exacerbates the problems created by the “Deny and Defend” strategy. Veterans often face a fragmented healthcare experience, with gaps in oversight and coordination between the VA and private providers.
Systemic Failures:
- Inadequate Oversight:
- Community providers lack consistent monitoring, allowing errors to go unnoticed or unaddressed.
- “Fire-and-Forget” Referrals:
- VA referrals often end without proper follow-up, leaving veterans vulnerable when errors occur.
- Abrupt Termination of Care:
- Some community providers stop care after errors, failing to ensure continuity of treatment.
- Coordination Breakdowns:
- Limited communication between VA and private providers hampers effective care and resolution of issues.
Impact on Veterans
Veterans caught in this fragmented system bear the brunt of systemic failures:
- Care Coordination Burden: Veterans must navigate multiple healthcare systems, often without support.
- Managing Medical Records: Veterans are forced to document their own care, a role typically handled by healthcare providers.
- Advocacy Stress: Veterans must act as their own patient advocates, an overwhelming task for those already dealing with health challenges.
- Delayed or Incomplete Care: Errors and lack of follow-up lead to misdiagnoses, inappropriate treatments, and preventable harm.
Potential Negligence in the VA System
Systemic failures in VA and Community Care programs may constitute negligence under certain conditions:
- Failure to Meet Standard of Care: Inadequate oversight and coordination fail to uphold basic medical standards.
- Preventable Harm: Errors resulting in harm due to lack of communication or follow-up.
- Administrative Breakdowns: Delays in care caused by bureaucratic inefficiencies.
When veterans suffer due to misdiagnosis, treatment delays, or abandonment by providers, the responsibility often falls into a legal grey area, making it difficult to hold parties accountable.
What Can Veterans Do?
Proactive steps can help veterans protect themselves, though these measures unfairly place additional burdens on them:
- Keep Detailed Records:
- Track appointments, referrals, communications, and outcomes.
- Request Medical Records:
- Maintain copies of all test results and imaging studies.
- Follow Up Persistently:
- Ensure referrals and appointments are not left in limbo.
- Engage VA Support Services:
- Work with VA patient advocates and Veteran Service Officers (VSOs).
- Report Issues Early:
- File complaints and escalate concerns through proper VA channels.
These steps are critical but challenging, especially for veterans who are seriously ill or unfamiliar with navigating complex healthcare systems.
Moving Beyond “Deny and Defend”
The VA must address these systemic issues to fulfill its mission of comprehensive healthcare for veterans:
- Improved Oversight: Regular monitoring of community providers and follow-up on referrals.
- Transparent Communication: Acknowledge errors and work collaboratively with veterans to resolve issues.
- Enhanced Coordination: Streamline communication between VA and community providers to ensure seamless care.
- Patient-Centered Policies: Shift from a defensive posture to a model of transparency, apology, and resolution.
Veterans should not be forced to shoulder the burden of a broken system. Comprehensive reform is essential to rebuild trust, improve care quality, and ensure accountability in both VA and Community Care programs.
By moving away from the harmful “Deny and Defend” approach, the VA can honor its commitment to those who have served and sacrificed for their country.
Discover more about this issue at: https://enemyheldterritory.com/deny-defend/
Michael Stuart
Veteran USAF