October 26, 2021


veterans3But this Veterans Day, I believe we should do more than sing the praises of the bravery and patriotism that our veterans have embodied in the past. We should take this opportunity to re-evaluate how we are treating our veterans in the present.
Nick Lampson

I had lived in freedom, and as a young man experienced what it was to lose that most important human right to a communist tyranny. My love for my adopted country, admiration for the unique concept espoused by our forefathers, made me realize that none of these privileges could have been possible without the valor, sacrifice and dedication of our armed forces. The above was an important factor in my decision to abandon a lucrative medical practice and join the staff at the Miami VA Hospital and the University of Miami faculty. I found an intellectually able staff, with desire to help the veterans but overwhelmed by the rules, regulations, and political interference. The same defeatist attitude was prevalent among the central office staff that I met when attending multiple meetings that were available, but lacking volunteers. When we were lucky enough to assume the leadership of the Psychiatry Service, we were able to bring a few new staff members in order to improve moral, adding also funding for special programs like PTSD treatment. It is because of that background that it pained me to read in The Miami Herald opinion segment, a piece written by a veteran suffering from PTSD, named Dalton Narine, of the closing of one of the units that we had started. With the addition of individuals like Dr. Thomas Mellman, Dr. Elizabeth Jackson, Dr Daniela David, one of our own, and the existing staff in Psychology, the PTSD programs became nationally renowned.

The Cognitive Processing Therapy (CPT) is not new and it is effective. The idea of “one size fits all” is not the right philosophy for the treatment of our veterans, and obviously not in such multifaceted illnesses like stress disorders. Precisely the success of our programs when directed by Dr. Mellman, was based on a comprehensive, individualized, and long term approach. Unfortunately, when reading the latest news about the nation’s VA Hospitals problems, and the persistence avoidance of openness, we have to surmise that the bureaucracy dominates once more. To prove that point I quote from the response given by the local Hospital “The Miami VA Healthcare System has worked with our patients during the last two years to gradually move into evidence-based PTSD therapeutic interventions. Although this VA-wide decision to move toward evidence-based therapy programs will impact veterans across the country, we feel confident that South Florida veterans will continue to have access to the quality programs and services that have helped so many make the successful transition to civilian life.”

Evidence Based Medicine (EBM), is based on rationing of care. The merits of this approach is widely discussed, and it does improve the treatment of the majority of patients by using the most advanced and proven diagnostic and treatment methods. Our objection when advised in the late ‘90s that this was a future possibility, which we refused then to implement, is that every qualified professional should be able to use the latest advancements as part of their care, but in order to help all, not only the many, a forced implementation advised by accountants, politicians, and biased physicians, is not the correct way. Socialized medicine is based on the collective vs. individual needs and the individual right to choose what is best for their bodies is sacrificed. Caregivers should be able to judge what is best for their patients independently from government interference. Veterans will not be best served by this approach, and the general public will soon find out what it is like to lose another of their basic rights, to be in charge of their healthcare.

Fernando J Milanés MD
ACOS for MH, Miami VA Hospital (ret.)
Vice-Chairman Dpt. Of MH, UM, (ret.)