VA Says It Loud and Clear, Patients Will Get Prosthetics Ordered By Their Physicians

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By Sandra Basu

WASHINGTON — It should always be what the doctor orders.

 That was the message that VA delivered to a House subcommittee concerned about procuring the best prosthetics for patients who need them.

“We understand the critical value these devices offer, and the independent clinical judgment of our providers will and must remain fully intact,” Robert Petzel, MD, VHA undersecretary for health, told the Committee on Veterans’ Affairs Subcommittee on Health.

Petzel testified at a recent hearing where lawmakers wanted an update on VA’s planned prosthetic procurement reforms.


Orthotist Scott Gray adjusts the prosthetic leg of Tristan Wyatt during a fitting at the VA San Diego Healthcare System. Wyatt, who was wounded in Fallujah, Iraq, in 2003, is now assistant chief of prosthetics at VASDHS. VA photo by Christopher Menzie

The new policy requires prosthetic items that cost more than $3,000 to be purchased by a contracting officer, rather than the prosthetics service purchasing officers who usually handle these purchases.

The changes are designed to save money and provide better oversight for purchasing prosthetics. Some veterans’ groups complained at a hearing earlier this year, however, that the new process might cause unneeded delays in delivering prosthetics and could even mean the contracting officer’s judgment would override clinical judgment, if price is an issue.

Petzel told the subcommittee that the VA expects 100% compliance from contracting officers when it comes to the physician’s order.

“The contracting officer’s responsibility is to see that we get a fair price for it. He or she will not buy something different because it is less costly. We look at what is the physician’s order, and that is what we buy.”

Subcommittee chairwoman Rep. Ann Marie Buerkle (R-NY) opened the hearing by stating her concerns “that the reforms were developed without careful and thorough consideration” had not been quelled by a recent review of information provided by the VA.

Petzel explained, however, that the procurement reforms are a “systemwide effort” to ensure that VA has professional, certified contractors doing procurement. Prosthetics is “the last area” of procurement within VA that has not had certified warranted procurement officers handling items that cost more than $3,000, he said.

“We have been criticized in the past by organizations such as the [Inspector General] for not having a professional procurement force and for not following, in all instances, the federal regulations or VA’s acquisition regulations,” he said. “The effort is in no way directed specifically at prosthetics.”

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