Printer Friendly Page
FORT WORTH VA CLINIC, CLOSED TO ENROLLMENT FOR
EIGHT MONTHS, READY TO EXPAND -- "If the
Congress
would fund the VA to build additional
facilities and
fund the cost of staffing those, then that
would
help a patient like me get a timely
appointment."
Forth Worth VA clinic
Story here...
http://www.star-telegram
.com/news/story/192096.html
Story below:
-------------------------
Packed VA clinic ready to expand
By CHRIS VAUGHN
Star-Telegram staff writer
FORT WORTH -- Joe Dalpiaz had barely settled into his new office as
director of the Veterans Affairs medical system in North Texas before he
encountered the eye rolls from Fort Worth veterans.
Dalpiaz, the third director in less than three years in the executive
offices of the Dallas hospital, would try to talk about plans for the
new outpatient clinic in Fort Worth and the expansion of services on
this side of the Trinity. But he met with a lot of
we've-heard-all-this-before looks, and occasionally talk, too.
"There are a lot of Doubting Thomases out there," he said. "I'm afraid
some people have lost hope that anything will happen."
The veterans of Tarrant, Johnson, Parker and Wise counties can hardly be
faulted for their suspicion. The VA's clinic on West Rosedale Street has
been acutely overcrowded for close to a decade, and officials have
talked about needing a larger one for at least six years.
This time, though, they don't appear to be just talking. The VA has
closed a real estate deal in south Fort Worth and drawn up conceptual
plans, and money has been set aside in the budget. Officials expect to
break ground by the summer or fall of 2008.
As enthusiastic as Dalpiaz is about the new clinic, the VA system in
North Texas is confronting a daunting array of problems -- overwhelming
demand for services, long waits for appointments, complaints about rude
employees and scathing reports from its own inspector general.
Dalpiaz, 49, who took over in May as part of a management overhaul, vows
to work on getting it right.
"I bring with me a strong sense of commitment to serving veterans," he
said. "I believe that a capable work force will serve veterans well. ...
I cannot say all of the problems have been fixed, but I can say that
most are well on their way."
The North Texas system -- the Dallas hospital, Fort Worth clinic and a
hospital and nursing home in Bonham -- is the fifth-largest VA system in
the nation, drawing from a pool of 481,000 veterans in 40 counties. This
year's budget is $511 million.
Even as it has struggled, and sometimes failed, to handle the World War
II, Korean War and Vietnam-era veterans, hundreds of veterans from the
Iraq and Afghanistan wars have further burdened the system.
Thirty percent of the new enrollees are young men and women, many with
complex mental health or brain injuries that require considerable time
and care.
There are plenty of people with positive experiences, and then there are
people like Joe Washam, who illustrate that the VA in North Texas has a
long way to go.
Washam, a soldier from Keller who suffered third-degree burns on 40
percent of his body from an explosion in Baghdad, said his experience
with the VA has turned him off to the point that he doubts he will
return, at least for any surgeries.
"I spent 20 months at [Brooke Army Medical Center], and I've been
through more than 15 surgeries, so I've been through a lot of this,"
Washam said. "The Dallas VA bragged about how good their plastic
surgeons were, but I felt they were behind the curve compared to the
care I got at BAMC."
No more room
Eight months ago, the Fort Worth clinic closed its enrollment to
veterans.
No more veterans -- no matter their health problems, no matter how poor
they are, no matter whether they were wounded in Iraq -- could be
treated at the facility, an extraordinary step.
The 45,000-square-foot building, opened in December 1991, was designed
for 45,000 outpatient visits a year.
But just a few years after the facility opened, the squeeze started, in
part because the Air Force closed the hospital at Carswell Air Force
Base.
Patient numbers rose after a congressional decision to open VA
healthcare to any veteran, the managed-care crunch and ballooning cost
of prescription drugs.
Last year, the facility recorded 149,429 outpatient visits -- three
times more than it was designed to handle.
In December, officials at the Fort Worth clinic decided to close
enrollment to new veterans when the patient workload per doctor exceeded
standards for care. There are only 13 doctors and physician assistants
working in the building.
Mike George, the newly named clinic administrator, said "there's a
ripple effect" on the entire facility if a doctor falls behind, a
suicidal patient shows up, a doctor calls in sick or a crush of veterans
drop in without appointments.
Anyone new who joins the system must drive to the Dallas hospital in Oak
Cliff.
"That's not good," Dalpiaz conceded.
That's because the Dallas facility is no less crowded than the Fort
Worth clinic. The Dallas facility sees close to 91,000 veterans annually
and recorded more than 700,000 outpatient visits last year.
Just trying to park at the Dallas facility can take half an hour or more
and involve a 10-minute walk.
The VA's requirement that a veteran get an appointment within 30 days is
being met only half the time. Eldon Armstrong of Grand Prairie, adjutant
of the state Disabled American Veterans chapter, said more funding is
the answer to the VA's problems.
Other than an overburdened system, he characterized VA care in North
Texas as "outstanding."
"If the Congress would fund the VA to build additional facilities and
fund the cost of staffing those, then that would help a patient like me
get a timely appointment," Armstrong said.
David Thornton, a 54-year-old Navy veteran who lives in Arlington, has
found plenty of problems with his care in the VA.
A hepatitis C patient who believes he contracted the disease from
inoculations in the early 1970s, he started going to the VA several
years ago when he lost his health insurance.
He said the physicians never aggressively treated his disease, allowing
it to worsen.
He said he too frequently saw a new doctor, and he said it took too long
to get an appointment.
But he also finds fault that the nation, in his view, inadequately funds
veterans healthcare and creates that situation.
"The problem isn't that the healthcare isn't any good," he said. "It
hasn't been good enough. I know a lot of veterans get good healthcare
there, but if one veteran like me does not, something is wrong."
Room to grow
The new Fort Worth clinic will dwarf the existing building -- 193,000
square feet larger, hundreds more parking spaces, a lunch cafe and
expansion room just off Interstate 20.
The two-story building will have room for 32 doctors, more than a
twofold increase.
The VA also hopes to start offering cardiology, endoscopy, pulmonary and
dermatology services in Fort Worth and would like to open a women's
clinic.
The VA also plans to move mental health services back into the facility.
"It will be the largest leased clinic in the entire VA system," said Bob
Bearden, a facility planner for the system.
Like the facility on Rosedale, the VA will lease it from a private
developer for 20 years. Officials believed that they could no longer
wait for VA construction money to build it.
But that means that the estimated $4.2 million lease will come out of
the North Texas system's operating budget -- the same money used to buy
drugs and pay nurses.
The VA will increase doctors, nurses and support staff in Fort Worth,
but whether it can afford to fully staff the clinic remains to be seen.
In search of a plan
Dalpiaz seemed surprised when he took over the North Texas system to
discover there was no strategic plan, no blueprint for where to go or
how to get there.
"We have to have one," Dalpiaz said.
Given the problems with the North Texas VA system in 2004 and 2005, it
would seem that it needed a plan. A VA inspector general report in late
2004 ranked the Dallas hospital the worst in the nation because of
filthy conditions, an unsafe environment and lax management.
Several months later, the Joint Commission on Accreditation of
Healthcare Organizations released a similar report, skewering the
hospital for not dispensing medications correctly, insufficient
maintenance of fire protection and a lack of attention to cleanliness.
Shortly after, many of the hospital's top managers retired or were
dismissed.
The hospital also has not fared well in so-called customer-service
surveys, ranking near the bottom in the country.
Washam, 27, said most of the nurses and staff he met at the hospital
were professional and caring, but that made a few negative experiences
all the more memorable.
He said one nurse stared at him and his burns like a child would, and he
said his wife was approached by patients at the hospital begging for
money and making catcalls at her.
More significantly, though, he expressed reservations that the hospital
was equipped to handle veterans with major problems like him.
A reconstructive surgery above his lip last summer resulted in multiple
infections, skin graft sites that did not heal properly and weeks in the
hospital.
Some of that time, he said, he had to share a room with two other
people, including one with a terrible cough.
At Brooke Army Medical Center, he said, the burn patients were kept
segregated for fear of infection.
"The doctors at the VA would tell me, 'The literature says this, the
literature says that,' when one would expect that they wouldn't need to
refer to the literature, that they had done this long enough [that] they
had some experience," Washam said.
"When Parkland is 15 minutes away, I would have expected there to be
some coordination with burn experts," he said. "The fact that they
didn't confer with anyone else blew me away."
Dalpiaz insists that veterans must be treated better by employees.
The hospital terminated 150 employees in the last year as a "result of
stricter performance and customer-service expectations," and the
hospital is actively seeking more and better nurses, Dalpiaz said.
He would like to improve the morale of nurses and physicians, and he
said he is working to improve pay in a brutally competitive medical
market in North Texas.
He also expects to hire more people to answer the phones and reduce the
wait time for a doctor appointment, all of which he believes would
improve people's perceptions of their care.
George, the Fort Worth administrator, agrees.
"At least once a day someone tells me that they've been on the phone for
45 minutes or an hour trying to get an appointment," George said.
"That's not good, and we're trying to get that fixed."
George, who only started at the Fort Worth clinic two months ago, has
been most surprised at one thing -- the constant buttonholing by
veterans passionate about the facility.
"The veteran service organizations are closely watching us," he said.
"They're very supportive of this clinic, very protective."
cvaughn@star-telegram.com
CHRIS VAUGHN, 817-390-7547
-------------------------
Larry Scott --
