By Stephen Spotswood
TAMPA, FL — It was the churches and sidewalks that did it. The James Haley VAMC in Tampa used them to coax Steven Scott, DO, the center’s current chief of physical medicine and rehabilitation, away from his position at the Mayo Clinic in 1990.
- “I was looking to redirect my priorities,” Scott explained. “I wanted a place with a good church and good sidewalks for my young kid. When the person interviewing me said that they tried to get everybody out by 4:30 in the afternoon, my wife said, ‘You’re taking this job.’”
The shortened schedule didn’t last long, but Scott has never regretted his choice. He spent the first five years in Tampa as a staff doctor and researcher, then in 1996 became the chief of physical medicine and rehabilitation, as well as the chief of spinal cord injury — two of the hospital’s biggest services.
“We established a very high standard of care,” Scott said “At the end of the 1990s, when the under secretary for health established the VA Centers of Excellence, we became one for spinal cord and rehab. In the early 2000s, before the war started, we became a Research Center of Excellence.”
This put Scott and the Tampa VA in a unique position to care for the first waves of injured veterans evacuated from Iraq and Afghanistan. In 2003, it was considered a blast injury clinic. Thanks to improvements in body armor and battlefield medicine, more soldiers were surviving firefights and encounters with improvised explosive devices (IED). However, they were returning with grievous injuries and needing extensive care.
Scott oversaw teams of physicians treating veterans suffering from a combination of traumatic brain injury (TBI), post-traumatic stress disorder (PTSD) and other serious physical injuries. By late 2004, the facility’s work began being called “polytrauma” care. Rather than move the patient from one specialty to another, polytrauma care brings all the specialists together to provide simultaneous, complementary care.
“That’s the secret to our success. We have mostly stable teams. Knowing how to work together, it makes the impossible possible,” he said. “With polytrauma, you can manage most anything coming in the door — amputations, spinal cord injuries, brain injuries. It’s the perfect system for managing war-related injuries. It also allows us to develop the skillsets to treat [veterans of] future wars.”
Scott has made a point of not turning any veteran away, no matter how complex or extensive their injuries.
“We’re always trying to stretch the staff by taking more difficult patients — patients [whose problems] we’ve never seen before,” he said. “We rarely say no to patients referred. That greatly improved our skillset to manage really complicated injuries and problems. Another thing we started doing is, we don’t use the word ‘can’t.’ We never give up.”
When it comes to treatment goal-setting, Scott takes his cues from the individual patient. “I always try to ask the injured person, ‘Close your eyes and tell me your dreams.’ And that’s what we try and fulfill. Whether it’s going back to the military or something else. We try to meet their dreams, as well as their families’.”
Scott understands that this goal is more than his team alone can meet, which is why he’s made an effort to make patient rehab a community effort. “We really worked with the community to make this more of a Tampa rehab issue and not just the VA hospital. The University of South Florida is across the way. We go to all the different veterans and service groups. We’ve got MacDill Special Operations Headquarters. We get everybody involved in the community to help with rehab.”
Scott is intensely aware that the patient’s struggle does not end when he or she leaves the hospital. Looking to the future, it’s the veterans’ continued care that concerns him the most.
“There are many seriously injured veterans with their caregivers and their families. If their mothers and families pass away, how are we going to manage and care for these individuals?” he asked. “My thought is how we can provide the highest quality of lifelong care for these individuals.”
Being so close to MacDill has cemented in Scott’s mind that VA is not only an afterthought to war but a part of the country’s national security.
“It’s part of our ability to manage and protect our country,” he said. “It is a higher mission. We take too many things for granted. Working here, you really do see the price of freedom.”
A facility-specific survey found that 138 of 140 VA facilities reported shortages of medical officers, with psychiatry and primary care positions being the most frequently listed.
When Terrence O’Neil, MD, retired as chief of nephrology at the James H. Quillen VAMC in Johnson City in December 2016, he left in his wake decades of work treating kidney disease—nearly 35 years in the Air Force and DoD, plus 11 more at VA.