WASHINGTON — The suppliers of grave-site headstones are on alert. Directors of the national cemeteries have been told to go out of their way to accommodate the wishes of next of kin, even if that means providing for rare weekend burials. "Casualty assistance counselors" are on standby to process life insurance and disability claims. Eighty hospitals are preparing to receive the wounded, perhaps directly from the killing fields.
With little notice, the Department of Veterans Affairs is grimly preparing for the decidedly unglamorous, heart-rending side of the Persian Gulf War.
"This probably is the biggest challenge for the VA since World War II," said Edward J. Derwinski, secretary of veterans affairs. "Quite frankly, in the first month or two (after the U.S. deployment of troops to the Middle East) there was a lot of dust and sloppiness in the system. But now we're ready."
Once widely regarded as a bloated, mismanaged agency second in size only to the Pentagon, the VA is now a full-fledged Cabinet department bent on acquiring a new image. And it suddenly finds itself under enormous pressures.
"The challenge before us is enormous," Derwinski said in an interview. "But we are prepared to meet head-on the awesome challenge presented by Desert Storm."
However, others are not so sanguine. There are those who fear that the 250,000-employee department will not live up to the task should the casualties begin coming home in vast numbers after a bloody ground war against Iraq begins.
The Veterans of Foreign Wars, for instance, this week sent its own inspectors around the country to verify the VA's claim that its hospitals and medical personnel are ready to receive more than 9,000 wounded American fighting men and women within 24-hours notice and up to 25,000 GIs with three-days notice. Rep. Les Aspin (D-Wis.), chairman of the House Armed Services Committee, has put the estimated number of U.S. casualties at 10,000 to 20,000 if a ground war breaks out.
"I hope the VA is ready, but I've got some serious concerns," said Larry W. Rivers, a Vietnam veteran who now heads the 2.2 million-member VFW.
Whether the department, which acquired Cabinet status in March, 1989, can meet the challenge may well shape the department's public image for years to come--and perhaps affect its ability to serve the 27 million veterans throughout the nation.
Aside from operating 113 national cemeteries in 38 states and Puerto Rico, the VA spends about half of its $30-billion annual budget administering compensation and pension programs to millions of veterans, spouses and children--including, even today, 2,700 surviving spouses of veterans of the Spanish-American War and six from the Civil War.
The VA also runs an independent, if much-criticized, health-care system, which employs 12,000 physicians and 60,000 nurses at 172 medical centers, 233 outpatient clinics and 119 nursing homes throughout the country. It treats about 4 million veterans a year.
It is these medical facilities, particularly 80 of the hospitals, that have been designated as the primary backup to Department of Defense hospitals in treating wounded soldiers right off the battlefields. The plan calls for all casualties to be transported directly to the military hospitals, but if the 16,000 military hospital beds are filled, the excess would be airlifted to the VA facilities.
Some VA critics, such as Rivers, worry that the department's hospitals and medical personnel are ill-equipped to deal with what may become an avalanche of wounded soldiers. Because the VA has been "chronically underfunded," he says, many VA hospitals are deteriorating and have antiquated equipment.
Even though the department has enjoyed modest budget increases in recent years, that funding has not kept up with the double-digit inflation in health-care costs. As a result, Rivers says, the VA has had difficulties attracting and retaining top-notch medical personnel, especially in specialties such as orthopedic surgery.
"That has created all sorts of problems that may undermine the VA's role as backup to the Department of Defense," Rivers said.
But Derwinski disagrees, saying that half of the doctors in training spend some time in a VA facility. He notes that more than 100 VA hospitals now are affiliated with medical schools. "So we have access to some of the best medical expertise in the country," he said.
Another major concern, expressed earlier this month by Sen. Alan Cranston (D-Calif.), is whether the VA, in making bed space available for those wounded in Operation Desert Storm, might unnecessarily displace already hospitalized veterans, creating hardships.
"We want to know how they are going to deal with the veterans already there," Rivers said. "Many of the hospitals are at capacity now. The VA says it's ready. But we're not really sure that's the case."