One safe and simple solution to more timely care for vets

The complications and long wait times that veterans routinely experience at Veterans Health Administration (VHA) facilities are no secret to their families. I experienced them firsthand when my father, an 85-year-old Arizona native and U.S. Army veteran, could not get the timely care he needed. While this ordeal showed me just how much the current system is lacking, it also helped me realize what can be done to improve it.  

He had a long road ahead before he would get the care he needed, and earned, as a veteran.


During my father’s visit to his local VHA facility early last year for an exam, the clinician recommended that he see a VA dermatologist in Phoenix. This meant waiting an entire month before he could be seen by the physician, and a three-hour drive from his home in Snowflake.

As my father waited to receive care, his condition worsened, and we became increasingly worried about how long the process was taking. We were also concerned about the six hours of driving and potential for additional wait time once at his appointment. After a follow-up visit at the VA clinic in Show Low, it was clear that my father needed more immediate care.

We decided it was best to cancel the Phoenix appointment and instead find a doctor outside of the VA system. Numerous phone calls, piles of paperwork and weeks of delays later, we finally received approval to visit a non-VA doctor.

It was determined that surgery was necessary, and in just a week, my father’s surgery was scheduled and performed at a local, non-VHA medical center. The care he received there was excellent, and while the surgery was a success, it revealed that his condition had deteriorated more than we realized. Had he waited any longer to receive care, he would have needed to undergo a much more invasive procedure.

This left me wondering how much worse the situation could have been if we remained in the VA.

The process at the VA was so lengthy, overwhelming, and seemingly impossible that I wanted to dig deeper to the root of the problem.

Impressed with the care my father received, I did some research and learned that the medical center where he was treated is a facility that allows certified registered nurse anesthetists (CRNAs) independent full practice authority. This means that, as advanced practice registered nurses (APRNs), CRNAs are not required to be supervised by a physician – including an anesthesiologist – when providing anesthesia to patients. This allows for much more timely access to care and was a large factor in my father’s quick and successful surgery.

However, I still wanted to learn more to better understand the challenges that CRNAs face at their jobs every day. One of the caregivers during the surgery was Mike MacKinnon, a CRNA who provided the anesthesia. I inquired further and was given permission to shadow Mr. MacKinnon for a day as he provided preoperative anesthetic care to his patients.

As he worked collaboratively with a surgeon, he explained that CRNAs are trained to treat an extensive range of cases, from a routine tonsillectomy to a complex open heart surgery. 

After the surgery, we spoke about the importance of CRNAs and the ability for some to practice at the full scope of their education and training where state laws permit it. We also discussed the current situation in the VA concerning CRNAs and access to care. I had been aware that this issue played a role in the VA’s struggle to provide timely care to Veterans, but the experience with my father allowed me to understand this problem more clearly.

As I studied what the federal government is doing to expedite access to care, I was encouraged by a rule recently published in the Federal Register to grant full practice authority to most APRNs. This is a step in the right direction, but it has a major flaw: the rule denies CRNAs the same full practice authority.

This is based on the premise that there is not currently a problem with Veterans having access to anesthesia care at the VA. After my father’s experience, I beg to differ. 

There is a front-line solution at the ready.

My father’s story is only one example of the access problems that continue to plague the VA. He was unable to receive timely care close to home, requiring him to undergo surgery at a community hospital where, thankfully, a CRNA with full practice authority administered his anesthetic. I’m sure there are countless other stories like his, yet the VA would have you believe there are no access issues and that CRNAs with full practice authority would not improve the efficiency of care in VA facilities.

By ignoring this problem, the VA is failing to recognize that it has a readymade solution in the more than 900 VA CRNAs who are waiting to provide the same high-level of care that Mr. MacKinnon provided to my father. The professionalism, dedication and sympathy I witnessed during my time shadowing Mr. MacKinnon is exactly what our nation’s veterans deserve.

The VA should be doing all it can to provide the quickest, highest-quality care possible for those who have served our country in uniform. I support changes to the system that improve efficiency and timeliness with an “all-hands-on-deck” approach so veterans like my father don’t have to wait for the care they earned with their service.

Jeff FlakeJeffrey (Jeff) Lane FlakeGrassley defends acting AG against calls for recusal Former NY Times book critic: I take back my positive review of Jeff Flake's book Majority say Trump should face primary challenge, poll finds MORE is a United States Senator representing the state of Arizona. Prior to his election to the U.S. Senate in 2013, he served in the U.S. House of Representatives from 2001-2013 representing the East Valley.

The views expressed by this author are their own and are not the views of The Hill.