Improved Emergency Care for Illinois’s Veterans: How Patient Advocacy Can Effect Big Change


  • Supervising Editor: Brian Zink, MD.

It was a cold December day in Chicago outside the Jesse Brown VA Medical Center. Blustery snow fell out front our tertiary care VA hospital. I remember it vividly as the entire emergency department (ED) staff came together that day in a valiant effort to bring a Vietnam veteran back to life. Reluctant to call 9-1-1, as his doctor and records were at the VA, Mr. V. decided that he would drive to the VA medical center with crushing chest pain. Unfortunately, by the time he arrived from his South Side residence, he was cold, blue, and barely breathing.

As a resident next to me finished up a suture repair and I interviewed a patient complaining about retrobulbar pruritis for the past 3 months, a blaring “code blue” came across the loudspeaker: “Code blue, Damen entrance, code blue, Damen entrance.” The team raced outside to drag a 300-pound man out of his car and onto a stretcher. For the rest of the night I thought to myself, “If only he had called an ambulance.” He had not made that call, though, and I will never forget the day that patient died.

As per Illinois state law at that time, VA hospitals were not licensed under the Illinois Emergency Medical Services Act to receive veterans or any other patients via 9-1-1 ambulances. If Mr. V. had called 9-1-1, he would not have been brought to my ED. It was the status quo from an outdated Act that was about to change!

In the past 10 to 15 years, emergency services in VA hospitals have advanced, not only in Illinois, but nationwide. Board-certified emergency physicians now staff many departments alongside nurses with Certified Emergency Nursing (CEN) credentials. No longer do I have to follow a patient up to the ICU to check tube placement after an intubation. No longer do I have to call a code blue in my own ED! Yet, we still could not receive 9-1-1 ambulances with veterans.

With the previous day’s events indelibly stamped in my mind, I took action. I remembered a conversation with a colleague who was a strong veterans’ advocate. He had shared similar stories about when his father fell ill and would not be taken to the VA hospital. Later that month, we broke bread with the Alderman of the 11th ward and subsequently met with his legal team and the Chicago Fire Department. We discussed many issues, including the fear that some veterans have about being transported to outside hospitals because of potential hospital bills. In many cases, this is such a strong driver that those patients self-transport to the VA, often times in extremis, much like Mr. V. Working collaboratively that day, we created an amendment for an antiquated law.

We recruited State Senators and State Representatives to work with us on what would become Illinois Senate Bill 3637 to correct a barrier our nation’s heroes faced in obtaining emergency care. Under SB3637, all Illinois VA hospitals are part of the statewide EMS system, and veterans can be transported emergently to their VA hospital.

As I stood at the podium next to the Illinois Governor at the signing ceremony of SB3637, it all felt so surreal. Weeks before, SB3637 was motioned and unanimously passed by the Illinois General Assembly. Watching the Governor sign our bill into law with my wife and two children on the lawn, I could not think of a better way to spend the weekend of our nation’s birthday.

As I peered at the reporters, veterans, and political leaders in attendance, everything felt perfect. I felt an overwhelming sense of pride. What began as an idea had transformed into law, a law that would affect the lives of countless veterans who had sacrificed so much for our country and our freedom.

No longer will Illinois veterans hesitate to call 9-1-1 in an emergency for fear of financial debt. No longer will I have to pull a veteran out of his car because he was afraid to call 9-1-1. The moral of the story is that the status quo is not good enough. Advocate for your patients, advocate for the change needed to improve emergency care for all of our patients!