WASHINGTON – In the middle of December 2021, Bernadine Bank handed a letter to the chief of medicine at Mann-Grandstaff VA Medical Center.
After thanking her supervisor for the opportunity to start the Spokane hospital’s gynecology clinic five years earlier, Bank got right to the point.
“It is with a heavy heart that I write to inform you of my resignation from the VA,” the doctor wrote. “I think it will come as no surprise that I am leaving mainly because of the Cerner EMR.”
By then, it had been more than a year since the Department of Veterans Affairs began using Spokane as the testing ground for an electronic medical record system, or EMR, developed by Cerner Corporation under a $10 billion contract signed by the Trump administration in 2018.
While the project has been sold as an overdue update to the VA’s existing computer system, flaws in the Cerner system have left health care workers exhausted and demoralized, while the problems have also harmed scores of veterans in the Inland Northwest, according to the VA Office of Inspector General.
“I had hoped to be at the VA another 8 years before retiring as I get huge satisfaction from caring for female veterans,” Bank continued in her letter. “I was rewarded on a regular basis by patients who expressed gratitude for the care and attention our gynecology team provided. However I am mystified by and beyond disappointed at the Cerner product.”
More than two years after its launch in Spokane, employees at Mann-Grandstaff say the system has exacerbated staffing problems, pushing people like Bank to leave key roles and making hiring more difficult. The hospital’s decreased capacity has left more veterans to seek care in the private sector, which can mean longer wait times and higher costs to the taxpayers who fund VA care.
Although VA leaders in the Biden administration have paused the system’s rollout, acknowledging it is not ready to safely deploy in other facilities, it continues to be used in clinics and hospitals across the Inland Northwest, plus sites in the Midwest and southern Oregon.
In the year since Bank turned in her resignation letter, employees in Spokane say the system has shown little improvement, despite a change in tone from top VA officials and a change in ownership of Cerner, which was acquired by the tech giant Oracle in a $28.3 billion deal that closed in June.
The system made by Oracle Cerner, as it is now known, has been beset by prescription errors, incorrect patient information and delays in follow-up care caused by lost referrals. Inefficient “workflows,” the series of steps a user follows to complete each task, result in more time on the computer and less time with patients.
To offset the decrease in productivity caused by the Oracle Cerner system, the VA authorized hiring extra employees in Spokane. But in July, facing a budget crunch worsened by the increased payroll and reduced revenue due to the new system, regional VA leaders asked Mann-Grandstaff to shrink its staff by eliminating positions as they became vacant, according to emails obtained by The Spokesman-Review.
In interviews with The Spokesman-Review, more than two dozen current and former Mann-Grandstaff employees said the system’s flaws make working at the hospital physically and mentally draining and continue to threaten the safety of veterans in the Inland Northwest. VA leaders acknowledge the system is not ready to safely deploy in places like Seattle, Boise and Portland.
Most of the employees asked to remain anonymous, fearing reprisals for speaking out, but nine chose to come forward in hopes of preventing harm to veterans and highlighting the system’s impact in Spokane. Many said they worry it is accelerating a trend toward privatizing the VA, the nation’s biggest health care system, which more than 9 million veterans rely on for care at nearly 1,300 clinics and hospitals across the country.
Some, like Bank, have chosen to leave Mann-Grandstaff. Those who have stayed said their dedication to their co-workers and the VA’s mission has so far outweighed their frustration with the Oracle Cerner system, though nearly all of them said it has made them consider quitting.
The doctors, nurses and phlebotomists describe a hospital struggling to meet the needs of Inland Northwest veterans, despite a committed workforce that is learning to work with – or work around – a burdensome computer system that could cost taxpayers nearly $50 billion, according to a new cost estimate.
Their accounts are supported by reports from federal watchdog agencies, internal documents and emails obtained by The Spokesman-Review and congressional testimony by VA officials, who in recent months have expressed growing frustration with the Oracle Cerner system’s performance.
VA Press Secretary Terrence Hayes said in a statement the department recently established a team dedicated to quickly addressing “high-priority needs” of the facilities already using the system during what the VA is calling an “assess and address” period, to enable launching it at new sites in 2023.
“Patient safety is our top priority at VA,” Hayes said, adding that the department is working with Oracle Cerner to resolve problems. “VA will continue to focus on the five facilities where the new system has already been deployed to provide the support they need to ensure every patient is getting the world class health care they deserve.”
Mike Sicilia, executive vice president of Oracle Global Industries, said in a statement that since acquiring Cerner in June, Oracle has been working on technical fixes that have improved the system’s performance and reduced the frequency of outages. He added that Oracle has completed a fix for a referral routing problem tied to 149 cases of harm, and that fixes to the system’s pharmacy module are being reviewed by the VA.
“We expect VA staff to see steady improvements in performance and usability as we continually update the existing system over the coming months,” Sicilia said, adding that Oracle is on schedule to deliver a beta version of a new, cloud-based system intended to address many of the current system’s flaws sometime in 2023.
‘I’ve enjoyed my career. … Until Cerner’
In her 35 years as a physician, Dawn Gertson has used a half-dozen electronic health record systems, so she knew there would be a learning curve when the Oracle Cerner system launched at Mann-Grandstaff in October 2020.
But more than two years later, Gertson, who works in the hospital’s urgent care clinic, said the system’s problems go beyond the usual challenges of getting to know new software.
“It has made a difficult job at times impossible, and at best miserable,” she said. “Everything that you do within the system is a struggle, whether it’s prescribing simple medication, or trying to order critical care therapies, or trying to find out if something was discussed in a previous visit, or even to find out if something was previously prescribed.”
Gertson described a “near miss” in November when an extremely ill patient came into the clinic, which effectively functions as an emergency room, and she ordered a CT scan to determine the best course of treatment.
Wary of the risk of an error in the system, she double-checked that the results matched the patient’s information before starting treatment, only to see the image disappear from the system minutes later. When a different set of results later appeared with the same patient information, Gertson and her colleagues couldn’t figure out the source of the problem, so she filed one of the patient safety reports that have become a near-daily occurrence at Mann-Grandstaff.
Fortunately, Gertson said, she caught that mix-up fast enough to give the patient the correct care, but she said frequent problems with the new system have taken a toll on her and her colleagues.
“When you have enough instances like that, you begin to get constantly anxious,” Gertson said.
“It’s exhausting,” she added, getting choked up. “I’ve enjoyed my career. I’ve provided good care to my patients over the years and I’ve had a long career that I’ve absolutely loved. Until Cerner.”
Lorraine Anger, a nurse in the urgent care clinic, said higher-ups at the hospital have been more willing to accept the new system because they don’t have to use it or deal with frustrated patients.
“I’m tired of being the face of all the brokenness,” she said. “I’m the one who has to tell the patient, ‘Sorry, I can’t find that in the system.’ So guess who everyone’s mad at. It’s the doctors, the nurses.”
Gertson said for a time she considered transferring to the VA medical center in Roseburg, Oregon, near where she grew up. But after that hospital adopted the Oracle Cerner system in June, she has resolved to stay at Mann-Grandstaff as long as she can.
“For the first time, there are many days when I’ve almost walked out,” she said. “It’s devastating to me, as a physician, to want to leave. I’ve never wanted to retire, because I love what I do. But now I’m thinking, ‘Life is too short to be in this mental state all the time.’ ”
In a September survey, obtained by The Spokesman-Review through a public records request, 71.7% of Mann-Grandstaff employees said their morale had worsened as a result of the Oracle Cerner system. When asked for the reasons for the low morale, 92.5% cited less-efficient work processes, 82% said the system increases the time it takes to document a patient’s care and 76.7% said it makes it “more difficult to ensure patient safety.”
Of the 742 employees who responded to the survey, 71.5% said the system had worsened their level of burnout and 81.4% said there had been no or minimal improvement in the system since they started using it. Each of those results showed a slight improvement from a similar survey conducted about a year earlier.
Asked to respond to those survey results in a briefing with reporters on Dec. 1, VA Secretary Denis McDonough said the department has “the best workforce in the federal government.”
“I want that awesome workforce to stay working for us,” McDonough said. “And we’re going to keep investing in our personnel and keep making sure that they have the clinical tools to match their clinical excellence, to ensure that veterans get the world-class care that they’ve earned.”
‘Especially long wait times’
When the Oracle Cerner system launched in Spokane in October 2020 amid a local surge in coronavirus infections, VA leaders had authorized Mann-Grandstaff to hire extra employees to offset the impact of both COVID-19 and the lost productivity that is normal during a transition to a new electronic health record system.
Hayes, the VA press secretary, said in a statement the Spokane hospital increased its staffing level by about 20% between October 2018 and September 2022, primarily to respond to COVID-19 and mitigate the impact of the Oracle Cerner system.
VA Deputy Secretary Donald Remy told reporters in March that productivity at Mann-Grandstaff had returned to pre-Cerner levels. But in response to questions from The Spokesman-Review in September, Hayes said the hospital’s productivity was still “returning to pre-deployment levels,” indicating it hadn’t fully recovered.
Bank, the gynecologist, said by the time she left Mann-Grandstaff at the end of February, she could still see only about two-thirds of the patients she saw prior to the Oracle Cerner system’s launch, due to its “clunky” interface and frequent crashes.
“You have to give up either quality or efficiency” in the Oracle Cerner system, Bank said, compared to the half-dozen other systems she has used. “You can’t have it both ways, and that’s unfortunate.”
Hayes confirmed on Sept. 26 that the new system had caused a budget imbalance by making VA-provided care more expensive while requiring the VA, because of the decreased capacity at Mann-Grandstaff, to pay to send more veterans to private-sector hospitals. Meanwhile, he said, revenue had fallen due to seeing fewer patients and because the Oracle Cerner system couldn’t correctly process insurance payments.
In a statement Monday, Hayes said Mann-Grandstaff is projecting a budget deficit of $30 million in the fiscal year ending Sept. 30, 2023, with $10.5 million of that due to positions added to mitigate lost productivity from the Oracle Cerner system.
In a Sept. 26 statement, Hayes said no hospital in the VA’s Northwest region had been directed to reduce its staffing levels as a result of budget imbalances related to the Oracle Cerner system. But Mann-Grandstaff employees said that is exactly what has happened over the course of 2022, and their accounts are supported by emails obtained by The Spokesman-Review.
In a March 18 email to department leaders, Mann-Grandstaff Director Robert Fischer explained that additional staffing, both for COVID-19 response and for “Cerner mitigation,” had created “a significant budget deficit” at the hospital. Because the budget for each VA medical center is based on a formula that doesn’t take the new computer system’s impact into account, he wrote, the regional VA administrative division was “left with few options” to rein in spending and would “aggressively review” new hires to reduce the budget shortfall.
In a July 8 email, Fischer asked department leaders to identify positions that could be cut to reduce the hospital’s staff to its pre-COVID, pre-Cerner level. While employees wouldn’t be laid off, he wrote, vacant roles would be eliminated.
“The purpose of this plan is not to arbitrarily remove positions from your Org Chart,” Fischer wrote, adding that if removing a position would “result in an inability to complete your current healthcare mission or would represent a serious patient safety risk,” department leaders should put in a request to keep the role. But employees said the request process is onerous and often takes so long that potential hires fall through.
In a statement, Hayes said the turnover rate at Mann-Grandstaff was 11.1% in fiscal year 2020, 14.1% in fiscal year 2021 and 15.1% in fiscal year 2022, figures he said compare “very favorably with the private sector.” He attributed the increased turnover rate to both COVID-19 and the transition to the new computer system.
Gary Bilendy, a nurse in Mann-Grandstaff’s urgent care clinic, said his department has eliminated three nurse positions this year. Despite officially having no open positions, he said, “We’re short-staffed.”
Those staff cuts, employees said, have compounded the problem of caring for fewer patients due to the extra time it takes to complete tasks in the Oracle Cerner system. The result is more veterans being referred to private clinics and hospitals in the area, which are struggling with their own capacity problems due to the pandemic and pervasive staffing shortages throughout the U.S. health care sector.
In the wake of a 2014 scandal over long wait times for VA-provided care, the department began publishing average wait times at each of its facilities. While there is still controversy over how that data is measured and reported, there is far less transparency around wait times in the private sector.
In an email to clinicians on Dec. 6, the head of Mann-Grandstaff’s Office of Community Care, which handles referrals to non-VA providers, said the number of “priority referrals” asking for urgent appointments at private hospitals had increased by 433% since the previous fiscal year, creating such a large backlog that the office was still processing non-urgent referrals from September.
“The community is saturated,” the office’s chief wrote, referring to private clinics and hospitals. In an attached document, she showed just how long veterans have to wait for specialty care outside the VA.
Mann-Grandstaff has no endocrinologist on staff, despite high rates of endocrine disorders such as diabetes among veterans. While they could be referred to an endocrinologist at the Seattle or Portland VA, they need to wait six months to see one nearby at Providence, MultiCare Rockwood or Selkirk Endocrinology in Post Falls.
For gastroenterology, veterans need to wait six months at Providence or MultiCare Rockwood and at least three months at Kootenai Health, according to the document.
For behavioral health – critical for veterans affected by post-traumatic stress disorder and other issues – many providers in Eastern Washington and North Idaho are not accepting new patients, while others have waiting lists of between three months and a year, according to the document. Veterans have a 57% higher rate of suicide than adults who aren’t veterans, according to the VA.
Since Bank’s departure at the end of February, Mann-Grandstaff hasn’t had an in-house gynecologist, although spokesman Bret Bowers said in a statement the hospital recently hired one who will start work in July . Bank worked two days a week at Mann-Grandstaff in a part-time role. Fischer, the hospital’s director, is a licensed OB-GYN who sees roughly two patients per month, Bowers said.
While some employees said they were frustrated by Fischer’s leadership, Bank, who said she helped him learn the new system so he could occasionally see patients, expressed sympathy for the hospital’s director, who began his job in December 2017.
“To have Cerner thrown on him in the middle of COVID was just downright abusive,” she said. “They just dumped an awful lot on him in a short time, when he was still learning the ropes as an administrator.”
Carrie Farmer, a veterans policy researcher at the RAND Corporation, a nonprofit research organization, said those wait times are unacceptable but unsurprising.
“The fact that there are such long wait times for Community Care for these specialties is terrible,” Farmer said in an email. “Anecdotally, it’s hard for anyone to get timely care right now, but these are especially long wait times, which suggests that the Community Care Network contractors may need to focus on expanding the network to ensure there are enough providers in network to meet the demand.”
In a statement, Hayes said implementing the Oracle Cerner system “has increased the amount of care referred to the community,” but he added that as the VA addresses the system’s challenges, “we expect it to eventually increase efficiency and allow us to directly serve more Veterans at Mann Grandstaff.”
Donkey, goat, sea lion – or veteran?
Joni Yuhaus used to have a certificate hanging on the wall of the Mann-Grandstaff lab that said “the fastest (and safest) draw in the West,” a gift from her fellow phlebotomists in a nod to her efficiency. After the Oracle Cerner system arrived at the hospital, she took it down.
Michael Sherriffs Hall, another phlebotomist in the lab, said a process that used to take two or three minutes – pulling up an order on the computer, printing a label for the specimen and drawing blood – now often takes 10 to 20 minutes.
Like employees in other parts of the hospital, the lab workers attribute much of that extra time to poorly designed workflows in the system. Tasks that took just a few clicks in the old system, called VistA – which was developed by VA employees and is still used in nearly all VA facilities – now often take several times longer.
Whereas VistA can be customized for each hospital, the Oracle Cerner system is shared with the Defense Department and designed to be identical in all facilities, resulting in extraneous steps and irrelevant drop-down menus.
In one bizarre example, a drop-down menu in the system’s lab interface asks users to choose the patient’s species. The options include monkey, dog, dolphin, goat, horse, cat, donkey, mule, sea lion, “other/unknown” and – thankfully – human.
Asked to explain the purpose of that menu, Hayes, the VA spokesman, said in a statement that the system is shared with the Pentagon, which “requires the care of service animals to be documented.” The VA office in charge of implementing the new system had not received reports of similar issues, Hayes said, but would listen to providers and continue to address problems with the system.
“We understood from pretty much day one that this program was not designed for us,” Sherriffs Hall said. “Instead of designing it for us, they want us to adjust to the program.”
Aurora Burns, another phlebotomist, said the system often doesn’t correctly print labels for special tests that need to be sent to Portland or Seattle for processing.
Another problem that has developed recently, the phlebotomists said, is that as a result of staffing shortages elsewhere in the hospital, patients often come into the lab without orders entered in the system for their tests. That leaves veterans frustrated and requires the lab staff to call clinicians to get orders entered, adding to delays.
Staffing trouble, already a problem due to the relatively low pay the VA offers, has been worsened by the new system’s reputation.
“We can’t attract people because of what the pay looks like,” Burns said. “But now the word has gone out about how poor the Cerner system is working and how frustrating it is to try and help our patients.”
Yuhaus, 56, said she often thinks about quitting but has stayed on because she and her husband, who is retired, need the health insurance her job provides.
“I have seven years to retire,” she said. “Every day, I say to my husband, ‘We’ve got to win the lottery. I need out.’ ”
For doctors and nurses who provide direct care to veterans, the new system’s inefficiency means more time at a computer and less time with patients.
“I went into nursing because I want to help people and I want to take care of people, and all that electronic health records like this have done is taken me away from the bedside,” Anger said.
“I’m at the computer more than I’m at the bedside. That’s not the type of nurse that I want to be, and that’s not the type of nurse that people deserve.”
Stephanie Jamison, medical director of Mann-Grandstaff’s home-based primary care department, said her biggest concern with the Oracle Cerner system is how much harder it is to quickly and reliably find important information about a patient’s medical history.
“You are in the dark on very important details in your decision-making,” Jamison said. “You could potentially make a decision without having the full information that you need, and that’s a patient safety risk.”
For all their frustration with the new system, several employees said they remain committed to working at Mann-Grandstaff because they believe in the VA’s mission and have formed a bond with their co-workers.
“We’re the catch-all for all of these veterans that have gone years without the care that they need,” said Monica McLaughlin, another nurse in the urgent care clinic. “We’re their last stop, and we get along and we support each other. We’ve been trauma-bonding for years and we have an important mission.”
Studies have consistently shown patients generally have better health outcomes in the VA system than in the U.S. private health care system. Some observers have attributed that partly to VistA, which, unlike commercial electronic health record systems like Oracle Cerner’s, was designed for the VA’s integrated health system rather than for billing insurance companies.
But McLaughlin said she worries the combined stress of working through the pandemic and the Oracle Cerner transition could push some of her older co-workers to leave the VA earlier than they would otherwise.
“When you combine COVID and Cerner, the physical toll of the stress on our bodies, it will shorten many of our careers if not our lives,” she said. “You can’t be dumping those stress hormones into your body over and over again without there being consequences down the road.”
A final plea
Charlie Bourg and Charlie Monroe boarded a plane bound for D.C. on Dec. 12 with a simple message to deliver to members of Congress, Bourg said: “Shut Cerner down before you kill any more veterans or injure them, and hurt their families.”
Bourg, 68, was diagnosed with terminal prostate cancer after multiple problems with the system contributed to a roughly yearlong delay in treatment, according to an internal VA investigation.
“The Charlies,” as they’re known to fellow veterans and VA employees in Spokane, made the trip with the help of Ed Meagher, a vocal critic of the Oracle Cerner system who served as the VA’s chief technology officer during the George W. Bush administration.
Over three days, the three Vietnam War veterans met with representatives of veterans service organizations and members of Congress, including Rep. Cathy McMorris Rodgers, R-Spokane, and Sen. Patty Murray, a Washington Democrat who is set to control the VA’s funding when she becomes chair of the Senate Appropriations Committee in January.
Speaking on the House floor Dec. 14, McMorris Rodgers recognized Bourg for making the trip.
“Charlie is here sharing his story this week, and I’d like to make him a promise,” she said. “No matter how long it takes, we will fix this system. You will be the reason that it never happens again. You will not be forgotten.”
In an interview Dec. 14, Murray, who also sits on the Senate VA Committee, said she opposes any staffing cuts at Mann-Grandstaff.
“They’ve been trying to cut back staff through various different proposals and all kinds of things,” Murray said. “They know my position. I’ve told them, ‘Absolutely not. No way.’ ”
Meagher said the VA’s justification for giving Cerner the $10 billion contract in 2018 without an open bidding process was based on what he calls two lies: that it was necessary to improve coordination between the VA and the Defense Department, and that the existing VistA system can’t be modernized. He wants the VA to transition to a cloud-based version of VistA, which he said has been used on a trial basis, at least until the department finds a better solution.
The VA estimated in 2019 that implementing the new system would cost $16.1 billion over 10 years. But an independent cost estimate developed by the Institute for Defense Analyses at the VA’s request, completed in October and obtained by The Spokesman-Review, projects the system will cost $32.7 billion to implement over 13 years and another $17.1 billion to sustain over the following 15 years, for a total of $49.8 billion.
Unlike the original VA estimate, the Institute for Defense Analyses – a nonprofit, federally funded research corporation – factored in the cost of extra staffing, decreased revenue and sending more veterans to private hospitals.
Sicilia, the Oracle executive, objected to that estimate in a Senate hearing in September, promising the company would deliver the VA a new version of the system at no extra cost that could eventually cut expenses in other areas.
While members of both parties in Congress have wrung their hands over the Oracle Cerner system’s flaws, most have so far rejected the idea of scrapping the program.
Murray worked with other lawmakers to include language aimed at holding the VA accountable for the system’s rollout in the annual appropriations bill Congress sent to President Joe Biden on Friday, which gives the department roughly $1.76 billion for the effort.
The legislation requires McDonough to send Congress a report within 60 days on the status of the project and withholds 25% of the funding until the VA chief certifies in writing that problems with the system have been “suitably resolved or mitigated in a manner that will enhance provider productivity and minimize the potential for patient harm.” He also has to certify that the system is “stable, ready, and optimized” before it deploys at other sites.
In an explanatory statement that accompanies the bill, appropriators wrote that while they “remain supportive of the need to modernize VA’s electronic health record system, there continue to be wide-ranging and alarming implementation issues with the new system.” Still, they expressed hope that the VA “will resolve outstanding issues expeditiously and in a manner that will allow the Department to resume rollout of the new system safely and efficiently in Summer 2023,” when it is scheduled to launch at Michigan hospitals in Saginaw and Ann Arbor.
Bourg said he was glad the lawmakers listened to what he, Monroe and Meagher had to say, but he worried “they’re missing the main point.”
“All I keep hearing is, ‘We’ve got to give Cerner a chance,’ ” Bourg said. “They’ve had their chances. Now it’s time to give us a chance. I don’t have a chance. My wife and kids and grandkids, they don’t have a chance. But what about all the other veterans?”
In response to the problems in Spokane, McDonough ordered a “strategic review” of the project in March 2021. A year later, the department launched the new system at the VA hospital in Walla Walla, followed by sites in Ohio and Oregon in April and June, while the secretary told members of Congress in April he would stop the system’s rollout if he ever had “any reason to think that this is creating risk for our patients.”
When The Spokesman-Review reported in June that a draft Office of Inspector General report revealed a safety review ordered by McDonough had found nearly 150 cases of harm caused by the system, the VA announced it would postpone the system’s planned launch at facilities in Western Washington and the Midwest until January . It delayed the system’s rollout in Boise a month later, just days before it was set to deploy.
The report also revealed that Remy, the department’s No. 2 official, was informed of cases of harm in October 2021 but made no mention of the findings in congressional testimony the following month. Months after Remy forwarded emails that included those findings to the VA official in charge of the Oracle Cerner rollout, Terry Adirim, she told lawmakers in April, “I don’t believe that this system, that there’s any evidence that it has harmed any patients, or that it will going forward.”
In October, the VA announced another delay, promising the system’s rollout wouldn’t move forward until at least June , and not until the problems are fixed. At the same time, the department mailed letters notifying more than 71,000 veterans that their care may have been disrupted or delayed by the Oracle Cerner system, according to updated numbers the VA provided on Nov. 7.
According to an email to employees from the director of the VA’s Northwest regional division, obtained by The Spokesman-Review, the system won’t come to any other sites in the region, including Western Washington or Portland, until 2024. But that pause is cold comfort for employees in Spokane.
“They’re delaying it everywhere else, so imagine what a slap in the face that is for us,” Anger said.
“The system is so broken that other people get to say no, but you don’t get to say no.”
After meeting with lawmakers, Monroe emphasized that he and Bourg had come in solidarity with VA employees in Spokane.
“The employees don’t deserve the stress they’re being put under,” he said. “The veterans deserve better care. And that can only be accomplished by first making sure the employees have what they need to take care of that veteran.”
Before Bourg and Monroe flew back to Spokane, Meagher said he worried the trip was too much for Bourg, who postponed a hormone therapy shot that’s helping extend his life in order to travel to D.C.
“I don’t know if it was worth putting Charlie through this,” Meagher said. “I feel a little bit of guilt about that.”
“Oh, yeah it was,” Bourg replied. “If it saves one veteran’s life and keeps one family from suffering, it was worth it.”
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