April 2013

Al Pike – Clinical Prosthetist

Most individuals and organizations outside the VA (Department of Veterans Affairs) think artificial limbs when they hear the word prosthetics. The term VA Prosthetics is misleading to many people and organizations’ including members of Congress as VA Prosthetics (Prosthetic and Sensory Aids Services) represents mostly DME (Durable Medical Equipment) and other items dispensed out of VA medical centers.

During my many years as a prosthetist we have gone from small artificial limb shops making wooden legs to endoskeleton prostheses with microprocessor controlled knees and ankles provided in modern accredited patient care facilities. Prosthetists in the VA fitting veterans with this 21st Century technology today require at the least a master’s degree in the art/science of prosthetics and orthotics to become board certified, and board certification is a requirement of VA prosthetists.

In 2008 the VA established the Amputation System of Care in part because of an increase in the number of veterans seen for new artificial limbs and repairs to current artificial limbs by 51% from FY05 to FY06. With this is added the need of artificial limbs for a younger more active population of amputees from OEF/OIF expecting and deserving the latest in prostheses technology.

The Amputation System of Care establishes seven Regional Amputation Centers (RACs) and an organizational structure which includes a National Program Director of Prosthetic & Orthotic Clinical Services, and seven RAC Prosthetists. However at the seven Regional Amputation Centers and the O&P Clinical Services in those RAC regions there is no line authority from the national program director or the seven RAC prosthetists to the O&P Clinical Services providing direct care to amputee veterans. Instead O&P Clinical Services in VA Medical Centers are under the direction and supervision of a Chief of Prosthetics (PSAS) with no formal expertise in the art/science of prosthetics and orthotics and who is more focused on the larger DME aspects of VA Prosthetics. It is time for this organizational structure to change and to match the organizational structure of the Amputation System of Care to assure amputee veterans receive the highest level of O&P clinical services.

Al Pike, CP(E)

Al Pike, CP Consultation

In addition to clinical prosthetist I was liaison between the medical center and community providers of prostheses and their services.

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