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Overview:

The Veterans Health Administration (VHA), located within the Department of Veterans' Affairs (VA), is responsible for providing a wide range of medical services to 5.5 million veterans across the US. Operating one of the largest networks of health care facilities in the nation, VHA has undergone considerable restructuring of its medical delivery system after years of complaints of inadequately treating veterans’ health care concerns. Although the VHA has been credited with significant improvements in helping veterans receive quality care, controversies have continued to occur, including poor treatment leading to deaths.

 
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History:

The first effort by the federal government to provide medical care to disabled veterans was the Naval Home, established in Philadelphia in 1812. This was followed by two more facilities in Washington, D.C. -- the Soldiers’ Home in 1853 and St. Elizabeth’s Hospital in 1855. In his second inaugural address in 1865, President Lincoln called upon Congress “to care for him who shall have borne the battle and for his widow, and his orphan.” This was later adopted as the VA’s motto.
 
Following the end of the Civil War, the number of disabled veterans was so great that Congress created the National Home for Disabled Volunteer Soldiers in 1873. This government organization established individual residences, called branches, that provided mostly room and board to former soldiers. These homes also gave incidental medical care to disabled and indigent veterans, regardless of whether their disabilities were service related. In the years that followed, national homes cared for veterans of the Mexican, Civil, Indian and Spanish-American wars, and for noncombat veterans as well. By the late 1920s, the homes provided hospital-level medical care.
 
World War I brought about the next great expansion of the medical care system for veterans. Almost five million Americans fought in the war, resulting in 116,000 deaths and 204,000 wounded. Most medical care was provided by military hospitals, though the sheer number of veterans in need of care made this task difficult. Congress helped by adopting several pieces of legislation, the first coming in 1917 that established funding and programs for rehabilitation and vocational training for veterans with dismemberment, sight, hearing, and other permanent disabilities. The Vocational Rehabilitation Act of 1918 authorized the establishment of an independent agency, the Federal Board for Vocational Education. Under the new law, any honorably discharged disabled veteran of World War I was eligible for vocational rehabilitation training. A 1919 law authorized the building of new hospitals, though the additional facilities still weren’t enough to keep up with the growing demand of wounded veterans, resulting in the government contracting with private hospitals to help handle the overflow.
 
In 1921 Congress created the Veterans’ Bureau in order to consolidate veterans programs managed by three agencies - the Bureau of War Risk Insurance, Public Health Service and the Federal Board of Vocational Education. The consolidation still left two other agencies administering veterans benefits - the Bureau of Pensions of the Interior Department and the National Homes for Disabled Volunteer Soldiers. The newly created Veterans’ Bureau was led by Col. Charles R. Forbes, a veteran of World War I. Forbes served for two years before being forced to resign because of charges (that eventually led to jail time) of conspiracy to defraud the government on hospital contracts.
 
The Veterans Bureau didn’t last long. In 1929, President Herbert Hoover proposed consolidating the bureau along with the Bureau of Pensions and the National Homes for Disabled Volunteer Soldiers into one entity: the Veterans Administration (VA). The new agency was responsible for medical services for war veterans plus other benefits. From 1931 to 1941 the VA expanded the number of veterans’ hospitals from 64 to 91, which doubled the number of available hospital beds. It did so because demand for hospital care grew dramatically during the Depression, thanks in part to a rise in tuberculosis among veterans. Another contributing factor was an increase in neuro-psychiatric conditions among World War I veterans who complained of “shell shock,” the precursor to Post-Traumatic Stress Disorder of the Vietnam era and subsequent wars.
 
After the end of World War II, the federal government implemented the GI Bill, a landmark piece of legislation that helped assist the return of millions of veterans back into society. For the VA’s medical care system, the end of the war brought a new leader to the agency: General Omar Bradley, a decorated commander in the European Theater.
Bradley brought along Major General Paul Hawley, chief surgeon for the European Theater, to direct VA medicine.
 
Hawley led the formation of a separate department of medicine, outpatient treatment for veterans with disabilities not related to military service and the creation of resident and teaching fellowships in VA hospitals. He also established a policy of affiliating new VA hospitals with medical schools. In 1946, Hines Hospital in Chicago was the first VA facility to affiliate with medical schools, signing up with Northwestern and the University of Illinois. The appointment of VA medical staffs was removed from civil service rules in an effort to attract higher caliber doctors and other professionals in larger numbers. Hawley also started the VA’s hospital-based research program.
 
In 1946, the VA was operating 97 hospitals with a total bed capacity of 82,241 patients. Another 13,000 beds were planned through new hospital construction. But because of the demobilization of World War II servicemen, totaling more than 15 million, the existing VA hospitals were soon filled to capacity, and there were waiting lists at practically all hospitals. Until more VA hospitals were opened, the Navy and Army both made beds available. By the time Bradley left the VA in 1947, the agency had opened 29 new hospitals, along with establishing 13 branch offices, 14 regional offices and 721 contact offices to handle the increase in veterans’ claims.
 
Then came the Korean War, creating new veterans on top of the millions who came home from World War II. The number of VA hospitals between 1942 and 1950 increased from 97 to 151. Two years later the total escalated to 541 hospitals.
 
With the coming of the Vietnam War, the challenges confronting the VA had less to do with the usual increase in veteran totals and more with their medical conditions. Difficult-to-diagnose conditions stemming from exposure to chemicals used by US armed forces, such as Agent Orange, were questioned by the federal government, leaving veterans without treatment at first. Veterans complaining of psychological problems, later termed Post Traumatic Stress Disorder (PTSD), were initially ignored by VA officials. Not until the late 1970s and early 1980s did the VA begin to take steps to address Agent Orange-related illnesses.
 
In 1981, the VA established a special eligibility program that provided free follow-on hospital care to Vietnam veterans with any health problems whose cause was unclear. At first, the only allowable claims related to Agent Orange were for chloracne, a form of skin rash. Then during the 1990s the VA gradually recognized claims involving soft-tissue sarcoma, non-Hodgkin’s lymphoma, Hodgkin’s disease, porphyria cutanea tarda (liver disease), respiratory cancers (lung, bronchus, larynx and trachea), multiple myeloma (a cancer involving bone marrow), acute and subacute peripheral neuropathy and prostate cancer. These decisions followed the release of a National Academy of Sciences study that concluded sufficient evidence existed establishing a connection between herbicide exposure and certain medical conditions.
 
For veterans of the Gulf War and Iraq, a similar fight has been waged to convince VA officials that, like their Vietnam brethren, they are suffering from ailments with no readily identifiable cause. Gulf War Syndrome includes symptoms of fatigue, skin rash, headache, muscle and joint pain, memory loss and difficulty concentrating, shortness of breath, sleep problems, gastrointestinal problems and chest pain. Post-traumatic stress also continues to be a serious problem. From 1999 to 2007, the number of veterans receiving disability compensation for PTSD increased from 120,000 to more than 280,500.
 
After a generation of complaints about medical care in the VA hospital system, Congress passed legislation during the Clinton years to improve the VA’s delivery of health care to veterans. In 1996, the Veterans Health Care Eligibility Reform Act reorganized the system using the HMO model, focusing it from a “hospital system to a health care system.” The bill also opened up VA health care to all veterans, not just those with service-related illnesses or injuries. Twenty-two Veterans Integrated Service Networks (VISNs) were established geographically around the country to meet all of the health care needs of veterans. While VA hospitals continued to serve an important role in the new system, community-based outpatient clinics grew considerably in size, from fewer than 200 in 1996 to 850 in 2004.
 
Several studies produced this decade have lauded improvements in veteran’s health care. From the New England Journal of Medicine to the Annals of Internal Medicine, the VHA system was congratulated for improvements in several key areas of patient care. These successes were attributed not only to the 1996 congressional mandate, but also to Kenneth Kizer, who served as Under Secretary for Health at VHA during the 1990s and was responsible for spearheading changes in VA’s medical bureaucracy.
 
In spite of these positive developments, VA’s hospitals and medical delivery system continue to receive serious complaints, including incidents of poor treatment that led to the death of veterans at a VA center in Illinois (see Controversies).
 

History of the Department of Veterans Affairs

 

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What it Does:

The Veterans Health Administration, located within the Department of Veterans' Affairs, is responsible for providing a wide range of medical services to 5.5 million veterans across the US. The VHA operates one of the largest networks of health care facilities in the nation that includes 171 medical centers, 340 outpatient clinics, 127 nursing home care units and 196 Vietnam Veterans Outreach Centers. In addition, the VHA helps support veterans' health care in non-VA hospitals and is the country’s largest provider of graduate medical education.

 
Medical and health programs run by the VHA include Agent Orange research, rehabilitation services for blind veterans, care for women veterans, assistance to homeless vets, care for veterans suffering from multiple traumas and research into war-related injuries. Visit Clinical Programs and Initiatives for a complete listing of all VHA programs.
 
Approximately 20 million gallons of herbicides were used in Vietnam between 1962 and 1971 to defoliate the Vietnam countryside in order to locate enemy forces. Following their military service, some veterans reported a variety of health problems and concerns which were attributed to exposure to Agent Orange or other herbicides. This program is a comprehensive effort to address medical problems and concerns stemming from this chemical exposure.  The principal elements of the program include health care services, disability compensation for veterans with service-related illnesses, scientific research, outreach and education. 
 
This program coordinates a healthcare service delivery system that provides care for blinded veterans which extends from their home environment to the local VA facility and to rehabilitation centers. Services include adjustment to blindness counseling, patient and family education, benefits analysis, comprehensive residential inpatient training, outpatient rehabilitation services, the provision of assistive technology and research.
 
In November 1994, legislation was passed into law creating the Center for Women Veterans within the Department of Veterans Affairs. The primary mission of the center is to review VA programs and services for women veterans, and assure that women veterans receive benefits and services on a par with male veterans and encounter no discrimination in the process.
 
First authorized in 1987, programs designed to help homeless veterans have offered outreach to those living on streets and in shelters, clinical assessment and referral to needed medical treatment for physical and psychiatric disorders, including substance abuse. Other services offered include long-term sheltered transitional assistance, case management and rehabilitation plus employment assistance, income supports and help to acquire permanent housing.
 
Polytrauma care is for veterans and returning service members with injuries to more than one physical region or organ system, one of which may be life threatening, and that results in physical, cognitive, psychological or psychosocial impairments and functional disability. Some examples of Polytrauma include traumatic brain injury, fractures, hearing loss, burns, amputations and visual impairment.
 
In February 2009, the VA established a web site to help service members returning from Iraq and Afghanistan. The site explains benefit programs for veterans and their families and hosts social networks for veterans of both wars.
These centers evolved from the Gulf War Referral Centers that were developed by the VA in the 1990s to address the health concerns, including difficult-to-diagnose problems, of Gulf War veterans. Following inquiries and recommendations from the Executive branch, Congress and other governmental and non-governmental agencies, legislation was enacted in 1998 that directed the VA to develop centers that specialized in all combat-related illnesses and injuries regardless of conflict. In 2001, the VA approved two centers whose sole mission was to specialize in the study and treatment of war-related illnesses and injuries among combat veterans. The Washington DC VA and the East Orange VA were selected as the two sites for these centers. They provide second opinions for veterans with difficult-to-diagnose war-related illnesses and injuries that remain unexplained after medical examinations by the local VA medical center. Combat veterans with medically unexplained illnesses may request a referral from their VA physician to these centers.
 
The Veterans Health Administration: Quality, Value, Accountability, and Information as Transforming Strategies for Patient-Centered Care (by Jonathan B. Perlin, Robert M. Kolodner and Robert H. Roswell, American Journal of Managed Care)

Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care (by Ashish K. Jha, Jonathan B. Perlin, Kenneth W. Kizer and R. Adams Dudley, New England Journal of Medicine)

 

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Where Does the Money Go:

The VHA’s most important stakeholders are military veterans, active-duty and reserve military personnel. Currently, almost 6 million veterans use the VHA system consisting for hundreds of VA-run hospitals, medical centers and outpatient clinics. A key non-veteran stakeholder is the Institute for Healthcare Improvement (IHI), a national health care consulting firm. Following the 1996 legislation ordering the VA to restructure its health care delivery system, VHA contracted with IHI to help revamp its operations and develop a new structure for getting veterans the care they need.
 
There are other non-veteran entities under contract with VHA that provide services to support the VA health care deliver system. EDS, a leading information technology company founded by Texas entrepreneur and former president candidate Ross Perot, has signed several contracts with VHA to help run its computer systems.
 
Another IT giant, Unisys Corp., has held VA contracts to improve patient management, billing and collections capabilities for the VHA. Unisys’s work, however, has been criticized by the VA’s Inspector General (see Controversies).
 
VHA also contracts with architecture and engineering firms when it comes time to build new medical facilities. In September 2007, VHA announced that a three-party venture will design the replacement VA hospital for New Orleans. The three companies are NBBJ of Columbus, Ohio, Eskew+Dumez+Ripple of New Orleans and Rozas-Ward Architects, also of New Orleans.
 
Numerous veterans advocacy organizations also pay close attention to the work of the VHA. Vietnam Veterans of America is the only national Vietnam veterans organization Congressionally chartered. VVA's goals are to promote and support issues important to Vietnam veterans, to create a new identity for this generation of veterans and to change public perception of Vietnam veterans.
 
Veterans of Foreign Wars (VFW) is the country’s oldest nonprofit veterans service organization that has long served as a voice for veterans and a catalyst for change in improving veterans' benefits through community service programs and special projects.
 
The National Coalition for Homeless Veterans is a group of community-based organizations seeking to eliminate homelessness among veterans. It serves as a liaison between branches of the federal government and local homeless veteran service providers.
 
Disabled American Veterans has more than 1.2 million members and is committed to aiding veterans with disabilities. Through its National Service Program, DAV operates 88 offices plus a corps of 260 National Service Officers (NSOs) and 26 Transition Service Officers (TSOs) who directly represent veterans with claims for benefits from the Department of Veterans Affairs. The free service is available to all veterans.
 
New Directions is a long-term drug and alcohol treatment program that provides food, shelter and rehabilitation to homeless veterans at four locations throughout Los Angeles. An estimated 27,000 homeless veterans live in Los Angeles, which is also home to the country’s largest VA hospital.
 
Swords to Plowshares is a community-based veterans' self-help group that advocates for veterans' rights and provides services to veterans. Its goal is to help homeless and low-income veterans through direct services and advocacy of effective public policy. Their web site provides information about programs and services, such as a drop-in center and legal services.
 
Unisys wins VHA patient management, accounting solutions (by Gail Repsher Emery, Washington Technology)
 
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Controversies:

Although the VHA has made considerable progress since the mid-1990s in improving its delivery of health care services to veterans, problems continue to plague the department and its facilities.
 
In January, the Chicago Tribune reported that poor medical care at the Marion VA Medical Center left nine patients dead and 34 others seriously injured during a two-year period, according to an investigation by the VA’s Inspector General. Ten of the 34 injured patients later died, but investigators were unable to link the deaths to the care provided at the medical facility. The report also detailed a long list of serious problems at the hospital, including a surgical program "in disarray" and "fragmented and inconsistent" administrative oversight. The failures at Marion prompted VHA to review not only the medical credentials of doctors at the Illinois facility but also those of 17,000 other health care providers across the country.
 
In a report (PDF) released in September 2006, the Inspector General’s office also cited problems at numerous VA facilities, ranging from poor sanitation procedures to failures in maintaining pharmacy drug controls. Additional investigations by the IG have uncovered mistakes made with VHA’s effort to modernize its blood bank operations and its decision to contract with IT-giant Unisys for computer systems support, resulting in performance failures.
 
An investigation by McClatchy Newspapers found shortcomings with VHA’s delivery of mental health services to veterans. Using VA reports, as well as information obtained through the Freedom of Information Act, McClatchy analyzed 200 million records, including every medical appointment in the system in 2005, and spoke with mental-health experts, veterans and their families.
 
The investigation found that nearly 100 local VA clinics provided virtually no mental-health care in 2005 and inconsistent care among those facilities that did. In some places, veterans received individual psychotherapy sessions, while others met mostly for group therapy. Some veterans were cared for by psychiatrists while others saw only social workers. The same investigation also discovered that VHA was not providing enough resources to help veterans coping with Post-Traumatic Stress Disorder.
Substandard care leaves 9 dead at VA Hospital (by Deborah L. Shelton, Chicago Tribune)
Veterans Attest to PTSD Neglect by VA (by Maya Schenwar and Matt Renner, Truthout)
VA comes up short for Iraq vets (by Chris Adams, Seattle Times)

VA straining to treat post-traumatic stress

(by Hal Bernton, Seattle Times)

 

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Congressional Oversight:

Senate Committee on Veteran Affairs

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Comments

Debby 7 months ago
Hey everyone, I am a paralegal and I believe I can get you to the right person to help you. Please feel free to e-mail me at sgtdebby@yahoo.com. Let's talk and get you some help. Debby
tom 10 months ago
VA is saying my Means test was not submitted on time. and now i am being charged for the hospital stay at a VA Hospital, I am Disabled and only receive $974 a month for myself and my wife and now they are taking $150 a month out of my Check Leaving me $824 a month i ask to have it removed because of being Indigent and was told no. Someone Please Help Me, I am at my Breaking Point Stress is to Much and I Just had my Second Stroke 2 weeks ago.
IVAN PRUNTY 2 years ago
i am a vietnam vet and have contacted parkinsons --i have a rating of 100 percent-my records indicate agent orange-having problems moving around, is there any benifits in the way of home care
M. Douglas 3 years ago
am i sorry i volunteered, like my brother miguel is? partly. i am sorry for volunteering because no one really gives a crap that i served. yeah, i get the lip service, but when it comes time for a real problem, i am treated like a malingerer. it is not my fault that i am so ill. i have complex problems, many of them painful. my "peers" in the civillian sector do not have the types of problems that i have, and most veterans have. although the va knows i am too sick to work, and only ...
byron willis 3 years ago
I've had 4 va Drs tell me that I need pain meds.My primary care Dr said "I'm scared to put my name on the paper". Where does that leave me?What am I to do? I served well.Help me please?
Keith Vourazeris 3 years ago
I am trying to find any information that pretains to men that worked for the Gov during the 1948 thru 1952 time period that worked in either the Enewetak of Los Alamos facilities. I have heard there are funds for surviors (wives, children) because of unusual cancer deaths amoung these men that worked at these places. Any help or information would be appricated. Keith Vourazeris
miguel soto 4 years ago
my benefits has being denied for over 35 years.i was volunteer in 1969.i thrust the army telling me about benefits i was going to have,but is not true .they betrayed you . you are going to be sorry of joining the army.is better to live a life healthy and working ,than living a life sick with no hope,because your worst nightmare is going to be veterans affair. i was 17 years old when i volunteer .i being a 100% disabled on social security for 35 years.i thank social security for help...
miguel soto 4 years ago
volunteer in 1969.100% disabled on social security for 35 years.diagnosed by va doctors with schizophrenia,ptsd,major depression,sirrosis of my liver etc.being denied my benefits for 35 years.i am spanish from puerto rico .i live in nj for 20 years and this is the worst place for a spanish veterans to open a claim. the nj va affairs would do anything to denied your claim.they would ignore evidence,they denied your claim making any excuse.every time they denied your claim you have to...
Laurance 4 years ago
I live in Chicago and use the J. Brown Medical center. The wait times to see a doctor are very bad. When I feel sick and have to call for a appointment to see my primary it takes from 4 to 6 weeks to get one. When i see him and have to be refered to another clinic it take 1 1/2 to 2 months to see a doctor there. All the special clinics work 6 hours once a week and during that amount of short they have to see hundreds of patients in the day of time they are there. The Pulmonary, GI, ...
Kenneth Okamuro 4 years ago
I am very disapointed with the VA policy on charges for prescription drugs..most of which are understandably generic. At a cost of $8/month, this is twice the price that Walmart or Walgreens charges. Further, since the VA doctors cannot write a prescription for other than dispensing by the VA pharmacy, a Vet cannot get health care at the VA without paying a high price for any prescriptions needed. Some of my prescriptions are half the dose needed per pill. I am required to split the...

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Founded: 1988
Annual Budget: $35 billion
Employees: 198,000
Veterans Health Administration
Walcoff, Michael
Acting Under Secretary

A career employee of the Department of Veterans Affairs (VA), Michael Walcoff has served as Acting Under Secretary for Benefits since January 4, 2010, and, according to some VA observers, could become the permanent head of the Veterans Benefits Administration (VBA), a position that has been vacant since February 2008, The last Under Secretary, George W. Bush appointee Daniel Cooper, infuriated many veterans when, at a time that the backlog of disability claims was mushrooming to 400,000, appeared in a religious fundraising video stating that Bible study was “more important than doing the job—the job's going to be there, whether I'm there or not."

 
Walcoff attended college at American University in Washington, D.C., where he received his Bachelor of Arts in political science. He later went to law school at Temple University in Philadelphia, receiving a Juris Doctor degree, and eventually became a member of the Pennsylvania Bar.
 
In 1974, he began his career as a VA claims examiner at the Philadelphia Regional Office and Insurance Center. He gradually moved up through the bureaucratic ranks, serving as director of the VBA regional offices in Seattle, Washington, and Huntington, West Virginia., as well as deputy area director of VBA’s Western Area.
 
Walcoff was then promoted to Associate Deputy Under Secretary for Field Operations, putting him in charge of VBA’s 57 regional offices and more than 13,000 employees.
 
In January 2008, he was appointed Deputy Under Secretary for Benefits, a post he held until becoming Acting Under Secretary for Benefits. In his current capacity, he directs the administration of VA’s disability compensation, pension, education, home loan guaranty, vocational rehabilitation and employment, and life insurance programs.
 
VA Watchdog.org believes Walcoff’s elevation to Acting Under Secretary for Benefits is just a prelude to his becoming the permanent leader of the VBA at some point. He will be tasked with revamping a dysfunctional bureaucracy that has been routinely criticized for failing to assist veterans with their disability claims and other needs.
 
At a congressional hearing in March 2009, held in the wake of revelations that VBA officials had hidden away tens of thousands of unopened claims letters, Walcoff admitted that veterans have lost trust in his department. “That loss of trust is understandable, and winning back that trust will not be easy,” he told lawmakers.
 
At a House Veterans’ Affairs Committee hearing on June 15, Walcoff noted that, “In 2009, for the first time, we received over one million claims during the course of a single year. The volume of claims received has increased from 578,773 in 2000 to 1,013,712 in 2009 (a 75 percent increase).”
 
Unopened Claims Letters Hidden at VA Offices (by Rick Maze, Military Times)
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Petzel, Robert
Under Secretary

On November 17, 2009, President Barack Obama nominated Dr. Robert A. (Randy) Petzel to be Under Secretary for Health in the Department of Veterans Affairs. Petzel was officially sworn in by Veterans Secretary Eric Shinseki on April 23, 2010, taking over the leadership of the Veterans Health Administration, which provides medical care to all veterans and runs VA hospitals throughout the country.

 
Petzel, who has spent almost his entire career with the VA as a doctor or administrator, graduated from St. Olaf College in Northfield, Minnesota, in 1965 and from Northwestern University Medical School in 1969. He did his residency in internal medicine at the University of Minnesota. 
 
Petzel began his medical career at the VA, with the majority of his residency spent at the Minneapolis VA Medical Center.  He rose up to become chief of staff at the Minneapolis Center in 1980, at the age of 35. For the next 15 years, he supervised the medical center’s clinical, research, and education activities. During this time he also became a member of the faculty at the University of Minnesota Medical School
 
In 1995, Petzel took on regional responsibilities, becoming network director for the VA Upper Midwest Health Care Network (VISN 13). He held this position until September 2002. When two regional networks merged, Petzel took over first and interim director and then, in October 2002, as network director for VISN 23. In this capacity, Petzel was responsible for for eight medical centers and 42 community based outpatient clinics serving veterans in Iowa, Minnesota, Nebraska, North Dakota, South Dakota, Western Illinois and Western Wisconsin.
 
Prior to his nomination by President Obama to take over the leadership of the Veterans Health Administration, Petzel was appointed Acting Principal Deputy Under Secretary for Health in May 2009. 
 
His professional interests have focused on evidence-based management, evidence-based medicine and the relationship between work place stress and patient outcomes. 
 
Petzel has co-chaired the National VHA Strategic Planning Committee and the VHA System Redesign Steering Committee.
 
Petzel and his wife, Sue, who is also a doctor, have two sons and a daughter.
 
 
Network Director Biography (Department of Veterans Affairs)
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Bookmark and Share
Overview:

The Veterans Health Administration (VHA), located within the Department of Veterans' Affairs (VA), is responsible for providing a wide range of medical services to 5.5 million veterans across the US. Operating one of the largest networks of health care facilities in the nation, VHA has undergone considerable restructuring of its medical delivery system after years of complaints of inadequately treating veterans’ health care concerns. Although the VHA has been credited with significant improvements in helping veterans receive quality care, controversies have continued to occur, including poor treatment leading to deaths.

 
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History:

The first effort by the federal government to provide medical care to disabled veterans was the Naval Home, established in Philadelphia in 1812. This was followed by two more facilities in Washington, D.C. -- the Soldiers’ Home in 1853 and St. Elizabeth’s Hospital in 1855. In his second inaugural address in 1865, President Lincoln called upon Congress “to care for him who shall have borne the battle and for his widow, and his orphan.” This was later adopted as the VA’s motto.
 
Following the end of the Civil War, the number of disabled veterans was so great that Congress created the National Home for Disabled Volunteer Soldiers in 1873. This government organization established individual residences, called branches, that provided mostly room and board to former soldiers. These homes also gave incidental medical care to disabled and indigent veterans, regardless of whether their disabilities were service related. In the years that followed, national homes cared for veterans of the Mexican, Civil, Indian and Spanish-American wars, and for noncombat veterans as well. By the late 1920s, the homes provided hospital-level medical care.
 
World War I brought about the next great expansion of the medical care system for veterans. Almost five million Americans fought in the war, resulting in 116,000 deaths and 204,000 wounded. Most medical care was provided by military hospitals, though the sheer number of veterans in need of care made this task difficult. Congress helped by adopting several pieces of legislation, the first coming in 1917 that established funding and programs for rehabilitation and vocational training for veterans with dismemberment, sight, hearing, and other permanent disabilities. The Vocational Rehabilitation Act of 1918 authorized the establishment of an independent agency, the Federal Board for Vocational Education. Under the new law, any honorably discharged disabled veteran of World War I was eligible for vocational rehabilitation training. A 1919 law authorized the building of new hospitals, though the additional facilities still weren’t enough to keep up with the growing demand of wounded veterans, resulting in the government contracting with private hospitals to help handle the overflow.
 
In 1921 Congress created the Veterans’ Bureau in order to consolidate veterans programs managed by three agencies - the Bureau of War Risk Insurance, Public Health Service and the Federal Board of Vocational Education. The consolidation still left two other agencies administering veterans benefits - the Bureau of Pensions of the Interior Department and the National Homes for Disabled Volunteer Soldiers. The newly created Veterans’ Bureau was led by Col. Charles R. Forbes, a veteran of World War I. Forbes served for two years before being forced to resign because of charges (that eventually led to jail time) of conspiracy to defraud the government on hospital contracts.
 
The Veterans Bureau didn’t last long. In 1929, President Herbert Hoover proposed consolidating the bureau along with the Bureau of Pensions and the National Homes for Disabled Volunteer Soldiers into one entity: the Veterans Administration (VA). The new agency was responsible for medical services for war veterans plus other benefits. From 1931 to 1941 the VA expanded the number of veterans’ hospitals from 64 to 91, which doubled the number of available hospital beds. It did so because demand for hospital care grew dramatically during the Depression, thanks in part to a rise in tuberculosis among veterans. Another contributing factor was an increase in neuro-psychiatric conditions among World War I veterans who complained of “shell shock,” the precursor to Post-Traumatic Stress Disorder of the Vietnam era and subsequent wars.
 
After the end of World War II, the federal government implemented the GI Bill, a landmark piece of legislation that helped assist the return of millions of veterans back into society. For the VA’s medical care system, the end of the war brought a new leader to the agency: General Omar Bradley, a decorated commander in the European Theater.
Bradley brought along Major General Paul Hawley, chief surgeon for the European Theater, to direct VA medicine.
 
Hawley led the formation of a separate department of medicine, outpatient treatment for veterans with disabilities not related to military service and the creation of resident and teaching fellowships in VA hospitals. He also established a policy of affiliating new VA hospitals with medical schools. In 1946, Hines Hospital in Chicago was the first VA facility to affiliate with medical schools, signing up with Northwestern and the University of Illinois. The appointment of VA medical staffs was removed from civil service rules in an effort to attract higher caliber doctors and other professionals in larger numbers. Hawley also started the VA’s hospital-based research program.
 
In 1946, the VA was operating 97 hospitals with a total bed capacity of 82,241 patients. Another 13,000 beds were planned through new hospital construction. But because of the demobilization of World War II servicemen, totaling more than 15 million, the existing VA hospitals were soon filled to capacity, and there were waiting lists at practically all hospitals. Until more VA hospitals were opened, the Navy and Army both made beds available. By the time Bradley left the VA in 1947, the agency had opened 29 new hospitals, along with establishing 13 branch offices, 14 regional offices and 721 contact offices to handle the increase in veterans’ claims.
 
Then came the Korean War, creating new veterans on top of the millions who came home from World War II. The number of VA hospitals between 1942 and 1950 increased from 97 to 151. Two years later the total escalated to 541 hospitals.
 
With the coming of the Vietnam War, the challenges confronting the VA had less to do with the usual increase in veteran totals and more with their medical conditions. Difficult-to-diagnose conditions stemming from exposure to chemicals used by US armed forces, such as Agent Orange, were questioned by the federal government, leaving veterans without treatment at first. Veterans complaining of psychological problems, later termed Post Traumatic Stress Disorder (PTSD), were initially ignored by VA officials. Not until the late 1970s and early 1980s did the VA begin to take steps to address Agent Orange-related illnesses.
 
In 1981, the VA established a special eligibility program that provided free follow-on hospital care to Vietnam veterans with any health problems whose cause was unclear. At first, the only allowable claims related to Agent Orange were for chloracne, a form of skin rash. Then during the 1990s the VA gradually recognized claims involving soft-tissue sarcoma, non-Hodgkin’s lymphoma, Hodgkin’s disease, porphyria cutanea tarda (liver disease), respiratory cancers (lung, bronchus, larynx and trachea), multiple myeloma (a cancer involving bone marrow), acute and subacute peripheral neuropathy and prostate cancer. These decisions followed the release of a National Academy of Sciences study that concluded sufficient evidence existed establishing a connection between herbicide exposure and certain medical conditions.
 
For veterans of the Gulf War and Iraq, a similar fight has been waged to convince VA officials that, like their Vietnam brethren, they are suffering from ailments with no readily identifiable cause. Gulf War Syndrome includes symptoms of fatigue, skin rash, headache, muscle and joint pain, memory loss and difficulty concentrating, shortness of breath, sleep problems, gastrointestinal problems and chest pain. Post-traumatic stress also continues to be a serious problem. From 1999 to 2007, the number of veterans receiving disability compensation for PTSD increased from 120,000 to more than 280,500.
 
After a generation of complaints about medical care in the VA hospital system, Congress passed legislation during the Clinton years to improve the VA’s delivery of health care to veterans. In 1996, the Veterans Health Care Eligibility Reform Act reorganized the system using the HMO model, focusing it from a “hospital system to a health care system.” The bill also opened up VA health care to all veterans, not just those with service-related illnesses or injuries. Twenty-two Veterans Integrated Service Networks (VISNs) were established geographically around the country to meet all of the health care needs of veterans. While VA hospitals continued to serve an important role in the new system, community-based outpatient clinics grew considerably in size, from fewer than 200 in 1996 to 850 in 2004.
 
Several studies produced this decade have lauded improvements in veteran’s health care. From the New England Journal of Medicine to the Annals of Internal Medicine, the VHA system was congratulated for improvements in several key areas of patient care. These successes were attributed not only to the 1996 congressional mandate, but also to Kenneth Kizer, who served as Under Secretary for Health at VHA during the 1990s and was responsible for spearheading changes in VA’s medical bureaucracy.
 
In spite of these positive developments, VA’s hospitals and medical delivery system continue to receive serious complaints, including incidents of poor treatment that led to the death of veterans at a VA center in Illinois (see Controversies).
 

History of the Department of Veterans Affairs

 

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What it Does:

The Veterans Health Administration, located within the Department of Veterans' Affairs, is responsible for providing a wide range of medical services to 5.5 million veterans across the US. The VHA operates one of the largest networks of health care facilities in the nation that includes 171 medical centers, 340 outpatient clinics, 127 nursing home care units and 196 Vietnam Veterans Outreach Centers. In addition, the VHA helps support veterans' health care in non-VA hospitals and is the country’s largest provider of graduate medical education.

 
Medical and health programs run by the VHA include Agent Orange research, rehabilitation services for blind veterans, care for women veterans, assistance to homeless vets, care for veterans suffering from multiple traumas and research into war-related injuries. Visit Clinical Programs and Initiatives for a complete listing of all VHA programs.
 
Approximately 20 million gallons of herbicides were used in Vietnam between 1962 and 1971 to defoliate the Vietnam countryside in order to locate enemy forces. Following their military service, some veterans reported a variety of health problems and concerns which were attributed to exposure to Agent Orange or other herbicides. This program is a comprehensive effort to address medical problems and concerns stemming from this chemical exposure.  The principal elements of the program include health care services, disability compensation for veterans with service-related illnesses, scientific research, outreach and education. 
 
This program coordinates a healthcare service delivery system that provides care for blinded veterans which extends from their home environment to the local VA facility and to rehabilitation centers. Services include adjustment to blindness counseling, patient and family education, benefits analysis, comprehensive residential inpatient training, outpatient rehabilitation services, the provision of assistive technology and research.
 
In November 1994, legislation was passed into law creating the Center for Women Veterans within the Department of Veterans Affairs. The primary mission of the center is to review VA programs and services for women veterans, and assure that women veterans receive benefits and services on a par with male veterans and encounter no discrimination in the process.
 
First authorized in 1987, programs designed to help homeless veterans have offered outreach to those living on streets and in shelters, clinical assessment and referral to needed medical treatment for physical and psychiatric disorders, including substance abuse. Other services offered include long-term sheltered transitional assistance, case management and rehabilitation plus employment assistance, income supports and help to acquire permanent housing.
 
Polytrauma care is for veterans and returning service members with injuries to more than one physical region or organ system, one of which may be life threatening, and that results in physical, cognitive, psychological or psychosocial impairments and functional disability. Some examples of Polytrauma include traumatic brain injury, fractures, hearing loss, burns, amputations and visual impairment.
 
In February 2009, the VA established a web site to help service members returning from Iraq and Afghanistan. The site explains benefit programs for veterans and their families and hosts social networks for veterans of both wars.
These centers evolved from the Gulf War Referral Centers that were developed by the VA in the 1990s to address the health concerns, including difficult-to-diagnose problems, of Gulf War veterans. Following inquiries and recommendations from the Executive branch, Congress and other governmental and non-governmental agencies, legislation was enacted in 1998 that directed the VA to develop centers that specialized in all combat-related illnesses and injuries regardless of conflict. In 2001, the VA approved two centers whose sole mission was to specialize in the study and treatment of war-related illnesses and injuries among combat veterans. The Washington DC VA and the East Orange VA were selected as the two sites for these centers. They provide second opinions for veterans with difficult-to-diagnose war-related illnesses and injuries that remain unexplained after medical examinations by the local VA medical center. Combat veterans with medically unexplained illnesses may request a referral from their VA physician to these centers.
 
The Veterans Health Administration: Quality, Value, Accountability, and Information as Transforming Strategies for Patient-Centered Care (by Jonathan B. Perlin, Robert M. Kolodner and Robert H. Roswell, American Journal of Managed Care)

Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care (by Ashish K. Jha, Jonathan B. Perlin, Kenneth W. Kizer and R. Adams Dudley, New England Journal of Medicine)

 

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Where Does the Money Go:

The VHA’s most important stakeholders are military veterans, active-duty and reserve military personnel. Currently, almost 6 million veterans use the VHA system consisting for hundreds of VA-run hospitals, medical centers and outpatient clinics. A key non-veteran stakeholder is the Institute for Healthcare Improvement (IHI), a national health care consulting firm. Following the 1996 legislation ordering the VA to restructure its health care delivery system, VHA contracted with IHI to help revamp its operations and develop a new structure for getting veterans the care they need.
 
There are other non-veteran entities under contract with VHA that provide services to support the VA health care deliver system. EDS, a leading information technology company founded by Texas entrepreneur and former president candidate Ross Perot, has signed several contracts with VHA to help run its computer systems.
 
Another IT giant, Unisys Corp., has held VA contracts to improve patient management, billing and collections capabilities for the VHA. Unisys’s work, however, has been criticized by the VA’s Inspector General (see Controversies).
 
VHA also contracts with architecture and engineering firms when it comes time to build new medical facilities. In September 2007, VHA announced that a three-party venture will design the replacement VA hospital for New Orleans. The three companies are NBBJ of Columbus, Ohio, Eskew+Dumez+Ripple of New Orleans and Rozas-Ward Architects, also of New Orleans.
 
Numerous veterans advocacy organizations also pay close attention to the work of the VHA. Vietnam Veterans of America is the only national Vietnam veterans organization Congressionally chartered. VVA's goals are to promote and support issues important to Vietnam veterans, to create a new identity for this generation of veterans and to change public perception of Vietnam veterans.
 
Veterans of Foreign Wars (VFW) is the country’s oldest nonprofit veterans service organization that has long served as a voice for veterans and a catalyst for change in improving veterans' benefits through community service programs and special projects.
 
The National Coalition for Homeless Veterans is a group of community-based organizations seeking to eliminate homelessness among veterans. It serves as a liaison between branches of the federal government and local homeless veteran service providers.
 
Disabled American Veterans has more than 1.2 million members and is committed to aiding veterans with disabilities. Through its National Service Program, DAV operates 88 offices plus a corps of 260 National Service Officers (NSOs) and 26 Transition Service Officers (TSOs) who directly represent veterans with claims for benefits from the Department of Veterans Affairs. The free service is available to all veterans.
 
New Directions is a long-term drug and alcohol treatment program that provides food, shelter and rehabilitation to homeless veterans at four locations throughout Los Angeles. An estimated 27,000 homeless veterans live in Los Angeles, which is also home to the country’s largest VA hospital.
 
Swords to Plowshares is a community-based veterans' self-help group that advocates for veterans' rights and provides services to veterans. Its goal is to help homeless and low-income veterans through direct services and advocacy of effective public policy. Their web site provides information about programs and services, such as a drop-in center and legal services.
 
Unisys wins VHA patient management, accounting solutions (by Gail Repsher Emery, Washington Technology)
 
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Controversies:

Although the VHA has made considerable progress since the mid-1990s in improving its delivery of health care services to veterans, problems continue to plague the department and its facilities.
 
In January, the Chicago Tribune reported that poor medical care at the Marion VA Medical Center left nine patients dead and 34 others seriously injured during a two-year period, according to an investigation by the VA’s Inspector General. Ten of the 34 injured patients later died, but investigators were unable to link the deaths to the care provided at the medical facility. The report also detailed a long list of serious problems at the hospital, including a surgical program "in disarray" and "fragmented and inconsistent" administrative oversight. The failures at Marion prompted VHA to review not only the medical credentials of doctors at the Illinois facility but also those of 17,000 other health care providers across the country.
 
In a report (PDF) released in September 2006, the Inspector General’s office also cited problems at numerous VA facilities, ranging from poor sanitation procedures to failures in maintaining pharmacy drug controls. Additional investigations by the IG have uncovered mistakes made with VHA’s effort to modernize its blood bank operations and its decision to contract with IT-giant Unisys for computer systems support, resulting in performance failures.
 
An investigation by McClatchy Newspapers found shortcomings with VHA’s delivery of mental health services to veterans. Using VA reports, as well as information obtained through the Freedom of Information Act, McClatchy analyzed 200 million records, including every medical appointment in the system in 2005, and spoke with mental-health experts, veterans and their families.
 
The investigation found that nearly 100 local VA clinics provided virtually no mental-health care in 2005 and inconsistent care among those facilities that did. In some places, veterans received individual psychotherapy sessions, while others met mostly for group therapy. Some veterans were cared for by psychiatrists while others saw only social workers. The same investigation also discovered that VHA was not providing enough resources to help veterans coping with Post-Traumatic Stress Disorder.
Substandard care leaves 9 dead at VA Hospital (by Deborah L. Shelton, Chicago Tribune)
Veterans Attest to PTSD Neglect by VA (by Maya Schenwar and Matt Renner, Truthout)
VA comes up short for Iraq vets (by Chris Adams, Seattle Times)

VA straining to treat post-traumatic stress

(by Hal Bernton, Seattle Times)

 

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Congressional Oversight:

Senate Committee on Veteran Affairs

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Comments

Debby 7 months ago
Hey everyone, I am a paralegal and I believe I can get you to the right person to help you. Please feel free to e-mail me at sgtdebby@yahoo.com. Let's talk and get you some help. Debby
tom 10 months ago
VA is saying my Means test was not submitted on time. and now i am being charged for the hospital stay at a VA Hospital, I am Disabled and only receive $974 a month for myself and my wife and now they are taking $150 a month out of my Check Leaving me $824 a month i ask to have it removed because of being Indigent and was told no. Someone Please Help Me, I am at my Breaking Point Stress is to Much and I Just had my Second Stroke 2 weeks ago.
IVAN PRUNTY 2 years ago
i am a vietnam vet and have contacted parkinsons --i have a rating of 100 percent-my records indicate agent orange-having problems moving around, is there any benifits in the way of home care
M. Douglas 3 years ago
am i sorry i volunteered, like my brother miguel is? partly. i am sorry for volunteering because no one really gives a crap that i served. yeah, i get the lip service, but when it comes time for a real problem, i am treated like a malingerer. it is not my fault that i am so ill. i have complex problems, many of them painful. my "peers" in the civillian sector do not have the types of problems that i have, and most veterans have. although the va knows i am too sick to work, and only ...
byron willis 3 years ago
I've had 4 va Drs tell me that I need pain meds.My primary care Dr said "I'm scared to put my name on the paper". Where does that leave me?What am I to do? I served well.Help me please?
Keith Vourazeris 3 years ago
I am trying to find any information that pretains to men that worked for the Gov during the 1948 thru 1952 time period that worked in either the Enewetak of Los Alamos facilities. I have heard there are funds for surviors (wives, children) because of unusual cancer deaths amoung these men that worked at these places. Any help or information would be appricated. Keith Vourazeris
miguel soto 4 years ago
my benefits has being denied for over 35 years.i was volunteer in 1969.i thrust the army telling me about benefits i was going to have,but is not true .they betrayed you . you are going to be sorry of joining the army.is better to live a life healthy and working ,than living a life sick with no hope,because your worst nightmare is going to be veterans affair. i was 17 years old when i volunteer .i being a 100% disabled on social security for 35 years.i thank social security for help...
miguel soto 4 years ago
volunteer in 1969.100% disabled on social security for 35 years.diagnosed by va doctors with schizophrenia,ptsd,major depression,sirrosis of my liver etc.being denied my benefits for 35 years.i am spanish from puerto rico .i live in nj for 20 years and this is the worst place for a spanish veterans to open a claim. the nj va affairs would do anything to denied your claim.they would ignore evidence,they denied your claim making any excuse.every time they denied your claim you have to...
Laurance 4 years ago
I live in Chicago and use the J. Brown Medical center. The wait times to see a doctor are very bad. When I feel sick and have to call for a appointment to see my primary it takes from 4 to 6 weeks to get one. When i see him and have to be refered to another clinic it take 1 1/2 to 2 months to see a doctor there. All the special clinics work 6 hours once a week and during that amount of short they have to see hundreds of patients in the day of time they are there. The Pulmonary, GI, ...
Kenneth Okamuro 4 years ago
I am very disapointed with the VA policy on charges for prescription drugs..most of which are understandably generic. At a cost of $8/month, this is twice the price that Walmart or Walgreens charges. Further, since the VA doctors cannot write a prescription for other than dispensing by the VA pharmacy, a Vet cannot get health care at the VA without paying a high price for any prescriptions needed. Some of my prescriptions are half the dose needed per pill. I am required to split the...

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Founded: 1988
Annual Budget: $35 billion
Employees: 198,000
Veterans Health Administration
Walcoff, Michael
Acting Under Secretary

A career employee of the Department of Veterans Affairs (VA), Michael Walcoff has served as Acting Under Secretary for Benefits since January 4, 2010, and, according to some VA observers, could become the permanent head of the Veterans Benefits Administration (VBA), a position that has been vacant since February 2008, The last Under Secretary, George W. Bush appointee Daniel Cooper, infuriated many veterans when, at a time that the backlog of disability claims was mushrooming to 400,000, appeared in a religious fundraising video stating that Bible study was “more important than doing the job—the job's going to be there, whether I'm there or not."

 
Walcoff attended college at American University in Washington, D.C., where he received his Bachelor of Arts in political science. He later went to law school at Temple University in Philadelphia, receiving a Juris Doctor degree, and eventually became a member of the Pennsylvania Bar.
 
In 1974, he began his career as a VA claims examiner at the Philadelphia Regional Office and Insurance Center. He gradually moved up through the bureaucratic ranks, serving as director of the VBA regional offices in Seattle, Washington, and Huntington, West Virginia., as well as deputy area director of VBA’s Western Area.
 
Walcoff was then promoted to Associate Deputy Under Secretary for Field Operations, putting him in charge of VBA’s 57 regional offices and more than 13,000 employees.
 
In January 2008, he was appointed Deputy Under Secretary for Benefits, a post he held until becoming Acting Under Secretary for Benefits. In his current capacity, he directs the administration of VA’s disability compensation, pension, education, home loan guaranty, vocational rehabilitation and employment, and life insurance programs.
 
VA Watchdog.org believes Walcoff’s elevation to Acting Under Secretary for Benefits is just a prelude to his becoming the permanent leader of the VBA at some point. He will be tasked with revamping a dysfunctional bureaucracy that has been routinely criticized for failing to assist veterans with their disability claims and other needs.
 
At a congressional hearing in March 2009, held in the wake of revelations that VBA officials had hidden away tens of thousands of unopened claims letters, Walcoff admitted that veterans have lost trust in his department. “That loss of trust is understandable, and winning back that trust will not be easy,” he told lawmakers.
 
At a House Veterans’ Affairs Committee hearing on June 15, Walcoff noted that, “In 2009, for the first time, we received over one million claims during the course of a single year. The volume of claims received has increased from 578,773 in 2000 to 1,013,712 in 2009 (a 75 percent increase).”
 
Unopened Claims Letters Hidden at VA Offices (by Rick Maze, Military Times)
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Petzel, Robert
Under Secretary

On November 17, 2009, President Barack Obama nominated Dr. Robert A. (Randy) Petzel to be Under Secretary for Health in the Department of Veterans Affairs. Petzel was officially sworn in by Veterans Secretary Eric Shinseki on April 23, 2010, taking over the leadership of the Veterans Health Administration, which provides medical care to all veterans and runs VA hospitals throughout the country.

 
Petzel, who has spent almost his entire career with the VA as a doctor or administrator, graduated from St. Olaf College in Northfield, Minnesota, in 1965 and from Northwestern University Medical School in 1969. He did his residency in internal medicine at the University of Minnesota. 
 
Petzel began his medical career at the VA, with the majority of his residency spent at the Minneapolis VA Medical Center.  He rose up to become chief of staff at the Minneapolis Center in 1980, at the age of 35. For the next 15 years, he supervised the medical center’s clinical, research, and education activities. During this time he also became a member of the faculty at the University of Minnesota Medical School
 
In 1995, Petzel took on regional responsibilities, becoming network director for the VA Upper Midwest Health Care Network (VISN 13). He held this position until September 2002. When two regional networks merged, Petzel took over first and interim director and then, in October 2002, as network director for VISN 23. In this capacity, Petzel was responsible for for eight medical centers and 42 community based outpatient clinics serving veterans in Iowa, Minnesota, Nebraska, North Dakota, South Dakota, Western Illinois and Western Wisconsin.
 
Prior to his nomination by President Obama to take over the leadership of the Veterans Health Administration, Petzel was appointed Acting Principal Deputy Under Secretary for Health in May 2009. 
 
His professional interests have focused on evidence-based management, evidence-based medicine and the relationship between work place stress and patient outcomes. 
 
Petzel has co-chaired the National VHA Strategic Planning Committee and the VHA System Redesign Steering Committee.
 
Petzel and his wife, Sue, who is also a doctor, have two sons and a daughter.
 
 
Network Director Biography (Department of Veterans Affairs)
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