The scandal that rocked the VA means major changes here as well
"Turning lemons into lemonade.” In this most succinct analogy, that is what has happened with the Veterans Administration in the wake of the scandal that erupted earlier this year, beginning in Phoenix. The list of falsified documents and accusations of veterans dying while awaiting care from the VA led to a bipartisan agreement, resulting in the “Veterans’ Access to Care Through Choice, Accountability, and Transparency Act of 2014.” To save ink, we’ll just call it “the Bill” from here on out.
“I’ve told lots of folks that the attention that the VA has received is probably the best thing that ever happened to the VA—and to our veterans,” says Chattanooga Clinic Manager Christopher Marcus. “It has highlighted a lot of training deficiencies.” With a price tag of nearly $17 billion, more than training is being addressed by the sweeping multi-year law.
“We just started the real planning now that the bill has become law,” Marcus continues, “and the plan is for a 75,000-square-foot outpatient clinic.” Marcus also notes that the plans for a larger clinic here are not a result of the scandal earlier this year, but that that event may have helped get the already-existing plans off the back burner. Earlier media reports of a 100,000-square-foot facility may include hopes of a 25,000-square-foot ambulatory surgical clinic being added later.
For veterans like Paul Gardner, who served in the U.S. Marine Corps and the Tennessee National Guard, it’s welcome news. “I’ve been waiting a year and five months now on my claim to be approved,” says Gardner, “They are still in the ‘gathering information’ process, they say.”
Gardner’s complaints are among the most common against the VA. He has no particular problem with the medical staff. In fact, he’s rarely seen a VA doctor. All of his medical treatment has been fee-based out to local civilian physicians because of the limitations of the Chattanooga facility. (“Fee-basing” means the VA agrees to contract with a local medical facility or physician to treat veterans who would have to wait too long for care at the Chattanooga clinic.)
Gardner’s injuries are service-related and date back to a truck accident at Fort Campbell in 2003. He was in the National Guard preparing for deployment to Iraq when the crash occurred. “My shoulder—the rotator cuff was three-quarters ripped apart,” Gardner describes. He is still dealing with the effects of that. “Since it’s been so long since my shoulder’s worked right,” he explains, “my brain has forgotten how to tell the muscles in my shoulder how to move.” As a result, he can raise his right arm no higher than the shoulder and other mobility is also compromised. Since he has seen only private-sector doctors, his belief is that the administration of the VA is at fault. “In my personal opinion, they need to get an old sergeant-major instead of a four-star general to run the VA.”
Clinic Manager Marcus agrees that administration is a lingering problem in the system. He is currently at 60 percent staffing, and while he is authorized to hire more, he is limited by available space. “Since I have been here, in six months, we’ve added a lot of staff that I don’t have space for,” he says, “So we have put together a plan to optimize the space, which is going to require some minor construction.” It also means re-arranging some existing space. “I’m emptying out our linen closet and we’re going to disperse our linen into carts and things and I’m going to put two people in our linen closet.”
In April of this year, the Chattanooga facility received a gift, of sorts, in the form of a new clinic in Athens, Tennessee. Veterans who lived in McMinn and surrounding counties were making the drive into Chattanooga to receive their care. This was not only a burden on the vets, but also on the already over-extended Chattanooga clinic. The addition of the Athens clinic and its one Patient Aligned Care Team has taken more than 400 patients off the rolls of the Chattanooga facility. The teams consist of a primary care physician, nurse care manager, clinical associate and an administrative clerk. The Athens clinic is authorized to add another team before the end of the year. The facility was built to house three such teams.
The Tennessee Valley Healthcare System is in the process of hiring 300 more staff members before the end of the year. Some of those will be in Chattanooga. Yet just putting warm bodies in linen closets won’t be enough for Marcus. “The first thing on our mind when we get this new staff is training, training, training,” he says. Referring to the problems exposed in Phoenix, Philadelphia and other areas of the country, he adds, “It wasn’t providing poor health care, but when it comes to tracking how long a patient’s waiting, there’s some people not doing things the way they were supposed to.” He’s quick to add, “But it wasn’t out of trying to hide anything or maliciousness, they just hadn’t been properly trained.”
Twenty-three-year Air Force veteran Dennis Norwood agrees that the medical staff does a fine job. He can’t even find fault with the administrative staff. “I was in there yesterday morning to see Dr. Clarion,” he explains,” and my appointment was for 8:30...they saw me at 8:15.”
Norwood is still fairly new to the VA. “I had been eligible for quite a few years, but to be honest, I never felt like I had earned the right,” Norwood confessed. “I had never been a combat veteran and I figured there were people ahead of me that really need that.” Yet, when neuropathy from diabetes became a more serious problem, Norwood checked into his options with the VA. “Well, whoever hears about getting diabetes in the military and qualifying for the VA?” he asks incredulously. “I’m 90 percent disabled but I’m paid at 100 percent unemployability.”
And because of his diabetes, Norwood is also eligible for other medical services. “I just got a letter in the mail,” he says “that because of my ophthalmology requirements, I can pick any ophthalmologist I want in Chattanooga, make an appointment, and the VA’s going to pay for that.” Norwood is being given the option of choosing a civilian ophthalmologist because there are none at the Chattanooga VA. But that could soon be changing.
“We are going through a large hiring initiative,” explains TVHS Public Affairs Officer Jessica Schiefer, “And we’re hiring for cardiologists, dermatologists, gastroenterologists, ophthalmologists, optometrists, orthopedic surgeons, primary care physicians as well as psychiatrists.” In the mid-level staff areas, they’re also hiring nurse practitioners, physical therapists, psychologists and social workers. Until all those are hired, and—at least in Chattanooga’s situation—until there’s room for them, more than $15 million dollars has been allocated in “the Bill” to pay for fee-based referrals for veterans to see local, private doctors in the interim.
Charles Lusk is another veteran who says his care at the local VA clinic has been exemplary. “It took me about six or seven months to get everything into the system,” Lusk told The Pulse, “but after that I’ve had an excellent relationship with the local VA clinic, headed up by Dr. McCoy. He and his staff have just been great to me. I couldn’t ask for better care.” And Lusk had even more praise for the system in saying “I’ve also made two trips to the VA clinic in Murfreesboro. They have been, likewise, very great.”
Lusk was diagnosed with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s Disease. He was shocked and pleased to learn that the Veteran’s Administration has determined that even though the exact cause of ALS is still unknown, the VA considers it a 100 percent service-connected disease, entitling Lusk to full benefits.
Lusk is already experiencing diminished motor skills, but that will soon progress to loss of mobility and even the ability to speak. “[The VA] is now in the process of building a motorized wheelchair for me,” says Lusk, “And also many other things to make me comfortable.” One of those things will be a grant to remodel his Rossville, Georgia home to comply with the Americans with Disabilities Act and a $20,000 computer which he will use to communicate as the disease advances.
In the coming years, the bill will provide veterans like Lusk and the others who shared their stories with The Pulse more facilities nationwide, more medical and clerical staff and better accountability to those the VA services. The cost will be great and not all of the funding is guaranteed. According to the Congressional Budget Office, the $10 billion funding of a key provision of the bill would last only until the early part of fiscal year 2016.
Republican Senator Bob Corker of Tennessee, one of only three senators to vote against the bill, said in a statement, “Our veterans deserve solutions to the deep-rooted problems plaguing the VA, and they also deserve a Congress that has the discipline to pay for legislation it passes.” Corker felt Congress rushed through a piece of legislation “without thoroughly reviewing its full fiscal impact on future generations and without knowing if it will address the systemic problems that exist at the VA.”
The senator said that instead, Congress should have taken time to work with the recently confirmed Secretary of the VA, former Procter & Gamble CEO Robert McDonald, on cost-effective reforms that “don’t put in place yet another long-term unfunded liability.”
The Chattanooga VA Outpatient Clinic currently serves 14,600 patients. There will be a town hall meeting held in which veterans and the public can express their feelings, good and bad. That meeting will take place between 2 and 4 p.m., Wednesday, Sept. 24 at the Chattanooga clinic, 150 Debra Rd., Ste 5200 (off Brainerd Road across from Eastgate Town Center). TVHS Director Juan Morales will be there to answer questions.