Trans News/ Issues

[theoddz]

Nadeest, as you know, I work for the VA, and have worked in 2 different VA Health Care systems (Sacramento, CA, and here in Las Vegas, NV). When the VA decides to offer these services, and I believe that they eventually will, in time, I look for it to happen this way:

There are 22 VISN's (Veterans Integrated Service Networks) in this country and its territories. A VISN is similar to a "region", so to speak, and encompasses several, if not quite a few, individual health care systems, or facilities, with a VAMC and its collection of affiliated outpatient clinics. The big VAMC's are usually, but not always, sitting right beside and are directly affiliated with a state University medical school complex. The VAMC usually takes advantage of the teaching environment and its huge pool of medical residents, students and attending physicians, in addition to facilities and resources. By and large, the care in these VAMC's is usually only as good as the medical school that it is associated/affiliated with. Here in Nevada, for example, the state medical school is located in Reno, which is in northern Nevada, and only has a limited "satellite" type presence here in Las Vegas. The University of Nevada Medical School is not usually considered to be one of "the best" medical schools in this country, and that fact, combined with the fact that the school is not here in Las Vegas, has (IMHO) resulted in a "not so good" quality of care here at the Las Vegas VA. Because of this, I would not want to have any kind of surgery performed on me in this particular VA system. Now, when I worked at the VAMC in Sacramento, CA, we were affiliated with the University of California (Davis) School of Medicine. The care in our VAMC was second to none and the Veterans at the VAMC Sacramento had top-notch care. I would have gladly had surgery at that VAMC. Now, that being said.......

When gastric bypass surgery became popular in the private sector, the VA began offering it to veterans through the VA system, but it wasn't something that every VAMC offered. For the most part, a certain medical center in the VISN was chosen to perform that surgery and when a Veteran chose to undergo it, they were referred and sent to that VAMC for the procedure. The followup was then continued in the Veteran's local facility. The reason for this has to do with the financial resources. I think the VA is still managing these services this way and it's the same for all VISNs nationwide. When the VA begins offering SRS to transgendered Veterans, I look for them to handle it in the same way, but it may turn out to be so limited that it may only be offered in one VA facility, nationwide. I wouldn't be at all surprised if it was only offered at the San Francisco VAMC. Remember, the VA health care system is a teaching institution, relying on medical teaching systems for a large part of its provider base. Any kind of lucrative surgical procedure or service will be taught to surgical residents and trainees who want to be able to make money off of it in the private sector. What the VA will do is offer it to Veterans in a teaching scenario for these student doctors at state medical schools. As with other procedures, the quality of that care will be largely dependent on how good the training program and its instructors are.

I wouldn't be one bit surprised if it turns out that the San Francisco VA will be the only facility participating in this kind of a training program and that it will be the referral center for transgendered Veterans seeking SRS, nationwide. Even though that would be inconvenient for many Vets, it would still be a wonderful thing if the VA would offer it. I certainly hope that it does come to pass and that we transgendered Veterans could take advantage of it.

~Theo~