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A MICRO-LOOK AT A MACRO-PROBLEM: VA HEALTHCARE --

Problems facing veterans at the Togus, Maine VA are

happening all over the country. Four articles explore

the record number of vets seeking treatment,

problems with mental health care, difficulties with

traveling for VA care and issues of VA eligibility.

 

 

These four stories sum up what is happening at VA facilities all over the country.

First story here... http://pressherald.
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Maine VA treating record numbers

Returning Iraq troops join aging veterans of earlier wars in seeking care from the medical system.

By JOSIE HUANG and KEVIN WACK
Staff Writers

 

Wayne King thought he had a clean bill of health after returning from Iraq with the Maine National Guard.

Then an itchy, scaly rash started to creep up his arms and legs. Soon it covered his body from the neck down, keeping him up at night, scratching and writhing in bed.

King turned for help to the U.S. Department of Veterans Affairs, a year after coming home. "It took me awhile," said King, who is 55 and works in the warehouse of a liquor distributor. "I just didn't want to admit I wasn't doing well."

King is among the 1,050 new combat veterans in Maine who have streamed into the VA health care system in the five-plus years since the United States went to war in Afghanistan and Iraq.

The vast majority of those veterans are returning home without visible wounds. But over time, they can expect to develop a wide range of maladies, including combat-related conditions such as post-traumatic stress disorder, and the same illnesses that affect the general population, such as diabetes and heart disease. They are entering the VA health-care system at the same time as aging vets who served in Korea and Vietnam, sending enrollment in Maine to its highest levels ever.

Now some people are worried about whether the VA system is prepared to handle the strain.

"We're concerned the system is going to be completely overwhelmed," said David Autry, a spokesman for the Disabled American Veterans in Washington, D.C.

King has experienced the strain himself. It took him about two months to get an appointment with a dermatologist, he said. And when he got an appointment, it was with a doctor in Massachusetts, where many veterans are sent to see specialists. King traveled to the Jamaica Plain section of Boston -- about an hour and 40 minutes away from his home in Wells. By then, his rash had faded, but the itching persisted. King left the appointment without a diagnosis, he said.

SOME SAY SYSTEM ALREADY STRAINED

Some older veterans in Maine complain that the Togus VA Medical Center, the VA's 500-acre complex on the outskirts of Augusta, is already overtaxed and does not have enough clinicians to accommodate the 38,000 veterans actively using the system, an all-time high since Togus admitted its first veteran in 1866.

"If they can't treat us old vets right, how are they going to treat the new ones?" asked Donald Staples, a 59-year-old Vietnam War veteran from Windham who said he is frustrated that he has to travel outside the VA system for X-rays and CT scans because the Saco clinic he visits does not have the necessary equipment.

Last week, the VA in Maine came under criticism from the state's congressional delegation when it acknowledged that thousands of veterans are now being billed for prescription-drug charges that were mistakenly omitted from prior bills.

Across the country, the health care provided to former members of the military has come under scrutiny following revelations about shoddy living conditions for outpatients of the Walter Reed Army Hospital in Washington, D.C.

The Department of Veterans Affairs operates separately from Department of Defense hospitals like Walter Reed. The VA got a tarnished reputation during the Vietnam War, but today has won praise for reducing its rate of medical errors by standardizing practices and computerizing patient records. The VA's ability to obtain inexpensive prescription drugs by negotiating with drug companies has been held up as a model by advocates who want Medicare to follow suit.

The VA runs a network of 154 medical centers across the country. In Maine, Veterans Affairs has 67 beds at Togus, plus outpatient clinics in Bangor, Calais, Caribou, Rumford, Saco and Lincoln.

Maine has more than 154,000 veterans -- nearly 16 percent of the civilian population over age 18 and the fifth-highest percentage of veterans in the country, according to the U.S. Census Bureau. About one-quarter of them receive health care from the VA, and system officials say they expect enrollment in Maine to grow by about 10 percent over the next five years.

In some respects, the Veterans Affairs health care system appears to be performing better in Maine than it does nationwide.

The most recent customer service survey conducted by the VA shows that patient satisfaction at Togus is above the national average in all five categories. Correspondingly, a majority of 32 Maine veterans interviewed for this article said they are generally pleased with the health care they receive from the VA.

Walter Martin, 75, has been a patient at Togus since he returned to his native Lewiston after spending most of his adult life in California. Martin, who struggles with lung congestion, said his care in Maine has been comparable to what he received at a Veterans Affairs hospital in San Francisco.

"I've had excellent experiences," Martin said.

But others have complaints about issues ranging from long waits for appointments and problems reaching VA staffers by telephone to budgetary needs and staffing levels.

James Bachelder, a disabled veteran from Acton, recalled that he was once driving to Togus when he called the hospital on his cell phone, only to discover that his doctor's appointment had been cancelled.

He said it took another couple of months before he got in to see his doctor.

"They don't have enough staff, so if an emergency comes up and calls away the doctor, then everybody scheduled for an appointment doesn't have one," Bachelder said.

As recently as 2002, Maine veterans could expect to wait up to a year to get their first appointment with a Veterans Affairs doctor. That backlog followed a decision during the 1990s to expand eligibility for VA health care.

In 2003, eligibility was tightened again, and Veterans Affairs officials in Maine say they've made progress in reducing wait times.

"Our goal is less than 30 days," said Jack Sims, the former director of Togus who retired last month. "Do we hit that all the time? No, however, we're trying hard."

FUNDING FALLS BEHIND INFLATION

Rep. Mike Michaud, D-Maine, chairman of the House subcommittee that oversees Veterans Affairs health care, doesn't put much stock in the wait-time data that VA officials have provided to Congress.

Michaud explained that the VA measures the amount of time it takes for a patient to schedule an appointment, not the amount of time it takes for the patient to actually see a doctor.

"You can schedule a veteran to have an appointment," he said, "but then after they're scheduled, they get rescheduled."

Some have also said they are concerned about the size of the VA's health care budget in Maine. For the current fiscal year, the budget is $184 million, which is more than twice what it was nine years ago. But enrollment in Maine has more than doubled during the same period -- a rate of increase that exceeds the national average -- and per-patient spending has not kept pace with inflation.

"The problem is that, unlike much of New England, Togus has experienced significant patient growth over the years, but with only sporadic increases in resources," the American Legion stated in a report released in January 2006.

In addition, an examination of Veterans Affairs health care spending nationally shows that Maine's budget trails the national average by about $800 per patient, or roughly 17 percent. The VA warns that such comparisons are perilous because its funding formula considers many factors, including what medical services are provided at each location. It also contends that the quality of its health care in Maine has not suffered as patient enrollment and inflation have outpaced its budget growth because it can now make more efficient use of resources.

Togus is the nation's oldest Veterans Affairs hospital, and in a sign of its fiscal constraints, last year's American Legion report identified $61 million in deferred maintenance needs for areas such as roofs, roads and parking lots. Since then, the VA says it's addressed some of the report's concerns.

Budget shortfalls also have affected VA staffing in Maine, the Legion report said. The report cited shortages of housekeepers, groundskeepers and nurses, who have had to adjust by working more double shifts.

There are currently about 1,000 Veterans Affairs health care employees in Maine, including 68 doctors, according to VA spokesman Jim Doherty. He said that officials are advertising to fill about 35 positions.

But Maine's weather and its geographic isolation have made it hard for the Department of Veterans Affairs to attract and retain health care professionals, according to K. Robert Lewis, who wrote the Legion report.

Over the past few years, the influx of new veterans has in some cases led to tension over who's first in line for health care.

Louis Peterson, 66, of Biddeford praised the care he receives at the VA clinic in Saco, but he also said he's concerned that the newer vets are getting higher priority than older vets.

"We definitely want the returnees treated the way they're supposed to be, and not the way we were when we returned from Vietnam," Peterson said, referring to how veterans feel they were mistreated after that war. "But there's a place for everybody in line, so to speak."

Whether newer veterans are getting more favorable treatment than others is up for debate.

If a new veteran and an older one have similar medical conditions, and they both want the same time slot, a VA scheduler would favor the newer veteran, according to Autry, from the Disabled American Veterans.

"They have been told in no uncertain terms that you will give these folks top priority," he said. "They don't want any stories of these people saying they're not getting care."

But Veterans Affairs officials in Maine say they serve those with the most severe medical needs first. "We take care of all of our veterans," Doherty said.

King, who waited about two months before a Veterans Affairs dermatologist was available to look at his rash, expressed disappointment with the length of the process.

He could have gotten care outside of the VA but he said he prefers to see VA doctors because the care is free and because many of them have served in the military themselves.

"I'm not going to see a civilian doctor who might not even have a clue," King said.
 

Staff Writer Josie Huang can be contacted at 791-6364 or at:
jhuang@pressherald.com
Staff Writer Kevin Wack can be contacted at 791-6365 or at:
kwack@pressherald.com 

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Mental-health care receives mixed diagnosis

Maine's VA leads in some respects, but there are questions about care for serious psychiatric cases.

By KEVIN WACK and JOSIE HUANG
Staff Writers
 

AUGUSTA — Military homecomings are like time capsules of pure joy.

So when the 240th Engineering Group arrived at the Maine State Armory in early April following a yearlong tour in Afghanistan, the soldiers were embraced by hundreds of friends and relatives.

Fathers hugged their children, wives clasped their husbands' hands, and the room echoed with the sounds of an enormous family reunion.

But unbridled happiness doesn't last forever, which is why the returning troops were required to meet that same day with a mental-health counselor.

"We sit down with every soldier," said Maj. Mike Backus of the Maine National Guard. "It can be however long they deem."

The wars in Iraq and Afghanistan have led to a rising demand for mental-health services among veterans. And while Maine officials say their counseling program offers an innovative example for other states to follow, there are also questions about the state's readiness to care for veterans with the most serious mental-health problems.

"Maine really needs more mental-health care for veterans, and it needs it here at Togus," said Ralph McFee, president of the hospital's union, Local 2610 of the American Federation of Government Employees. "They're really going to see an increase in need in the next four, five years. They're already seeing an increase now."

A 2006 survey of 292 Iraq war veterans from Maine offers a glimpse of the emerging need.

The survey, by the Portland-based Community Counseling Center, found that 80 percent of respondents said they'd come under enemy fire. One-third of them said they'd fired rounds at the enemy.

And one in four reported significant mental-health issues, including symptoms of post-traumatic stress disorder, alcohol abuse and depression.

"The good news is that we now have treatment for these kinds of stress reactions that are really effective," said Laura Gottfried, Community Counseling's vice president for program services.

Mental-health counseling is available for veterans at the Togus VA hospital, plus two mental-health clinics in Portland and Bangor, and several vet centers around the state.

According to the VA, its mental-health staffers are able to spend more time talking with patients than their counterparts in private practice.

"Here, you have the luxury of time to work with people," said Kathryn Yung, the psychiatrist at the Portland clinic.

The confidential, one-on-one sessions for returning troops are part of a Maine National Guard program aimed at early detection of mental-health issues in veterans of the wars in Iraq and Afghanistan.

The visits are mandatory, which is seen as a way to overcome the reluctance among many troops to report mental-health problems because of the stigma involved.

Three months after the troops return home, follow-up visits are held, since mental-health problems may be easier to spot by that time.

Counselors ask questions such as, "Are you sleeping OK? Are you feeling anxious? Are there things in your head that you just can't get out," according to Amy Marcotte of the Sanford center.

Marcotte said that most states ask returning troops to fill out a computerized questionnaire to detect mental-health problems, adding that Maine's one-on-one approach is being held up as a model for other states to follow.

But at the same time, there are doubts about whether the Veterans Affairs system is providing adequate resources to care for its sickest psychiatric patients.

Across the country, the VA has not adequately funded mental-health services, according to David Autry, a spokesman for the Disabled American Veterans in Washington, D.C.

Togus has 16 inpatient psychiatric beds, and it sometimes has to refer patients to hospitals elsewhere in Maine and Massachusetts.

In a report released in 2004, an independent commission identified a need for 20 additional psychiatric beds by 2012, though the VA in Maine contends that the projections were based on assumptions that are now out of date.

A more modest proposal -- to replace the existing psychiatric ward at Togus with a new ward that would have two additional beds -- has yet to be approved.

Jim Doherty, spokesman for the Department of Veterans Affairs in Maine, praised the mental-health care that's provided to Maine veterans.

He said that most of the patients that the VA sees do not have severe mental-health issues like bipolar disorder and schizophrenia, since sufferers are usually weeded out during boot camp.

"We're in very good shape on the mental-health side," Doherty said.

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Third story here... http://pressherald.
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For many Maine vets, getting to Togus can be headache

The state's expanse makes it impractical for them to use the hospital as their primary care provider.

By KEVIN WACK
Staff Writer

LEWISTON — John Daniels has no complaints about the medical care he receives at the Togus veterans hospital. Still, the 53-year-old Vietnam-era vet avoids the place as much as possible.

Why? Because it takes him half a day to make the trip to Togus from his home in Lewiston.

"I don't want to travel all the way up there unless I absolutely have to," Daniels said. "It's just too far to go."

Compared to many Maine veterans, Daniels is actually fortunate. His round trip to the veterans hospital takes about 90 minutes. Some of his fellow veterans travel eight hours or more. Some even stay overnight because they can't make the trip in a single day.

The difficulty of accessing health care is a nettlesome problem for many of Maine's 150,000 veterans. Although Togus is centrally located in Augusta, the state's geographic expanse makes it impractical for many veterans to use the hospital as their primary health-care provider.

In a 2004 report, a government commission expressed concern that only 59 percent of Maine's veterans were living within its geographic guidelines for access to care, which ranged from 60 minutes for urban areas to 120 for highly rural areas.

In fact, that statistic may understate the problem, since Maine veterans must sometimes travel to Massachusetts for specialties such as vascular surgery and organ transplants.

"We should make it easier for them to be able to access health care," Rep. Mike Michaud, D-Maine, who chairs the House subcommittee that oversees veterans' health care, said in an interview.

For veterans who have a hard time getting to and from Togus, 6,000 free van rides are provided each year by volunteers from Disabled American Veterans. But because multiple people ride in the same van, veterans who take advantage of the service often have to wait for hours before and after their appointments.

The U.S. Department of Veterans Affairs has been addressing the problems with access to health care in Maine by expanding its use of video-based hook-ups to patients in remote areas and by opening medical offices in more Maine communities.

Currently, the VA has satellite clinics in Bangor, Calais, Caribou, Rumford, Saco and Lincoln. Another is expected to open next year in the Lewiston-Auburn area.

In 2003, a VA commission recommended opening additional clinics in Dover-Foxcroft, Farmington, Houlton and South Paris, but those proposed clinics have yet to get funding. Michaud is critical of Veterans Affairs officials for not implementing the recommendations more quickly, but the VA notes that it's opened 320 rural outpatient clinics nationwide in the last 12 years.

Among Maine veterans, stories about the geographic barriers to Veterans Affairs health care are commonplace.

Daniels, who suffers from both sleep apnea and bipolar disorder, said he prefers getting treatment from a private health-care service that's located closer to home.

He described suffering a nervous breakdown last November when he traveled to a VA sleep clinic in Boston.

"It was just a hard time," Daniels said.

Mike Bassett of Denmark said he has paid a tangible price for the three-hour round trip to Togus.

Bassett, 58, recently experienced great pain in his stomach, but he felt he could not make the drive to Togus' emergency room. Instead he went to Bridgton Hospital, just 20 minutes away.

Now he is stuck with a $400 hospital bill because the VA has determined that the condition was not life-threatening, he said.

George DiPaolo Sr. of Buxton said that he has largely stopped going to the VA hospital, instead relying on Maine Medical Center in Portland for health care related to high blood pressure and a heart defect.

DiPaolo, 74, said he used to dread the nearly four-hour round trip to Togus and back.

"It makes me dizzy and upsets my stomach," he said.

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Being a veteran doesn't guarantee VA health care

Eligibility is based on several factors, including income, date of combat and type of injury.

By JOSIE HUANG
Staff Writer

Being a veteran doesn't guarantee you health care from the Department of Veterans Affairs.

Rather, the VA considers a wide range of factors -- including income, disability and date of combat -- to determine eligibility, and whether services should be free or require co-payments.

Korean War veteran Albert Bishop learned this firsthand. At first, he said, the VA rejected his application because his household income -- about $613 in monthly Social Security benefits and his wife's nearly $30,000-a-year income -- was too high. Also, he had no injury related to his service in the Army.

After his wife was laid off last year, Bishop, a retired carpenter, re-applied. He was accepted about eight months ago, and is now saving hundreds of dollars each month on medications for bronchitis and osteoporosis. He plans to be fitted with new hearing aids next month.

"I think the service is fine once you're in the system," said Bishop, who is 72.

In the mid-1990s, the Department of Veterans Affairs expanded eligibility for health care, according to Jack Sims, the former director of Togus, before his retirement last month.

But in 2003, faced with a backlog of about 200,000 veterans nationally who were waiting an average of six months before receiving their first treatment at a Veterans Affairs health-care facility, the agency decided to cut off enrollment to veterans with higher incomes and no service-related medical conditions.

Veterans Affairs uses national and local wealth and income thresholds to determine eligibility. Take a veteran in the Lewiston-Auburn area, for example. Based on current standards, either a net worth of more than $80,000 or an income exceeding $30,450 a year would disqualify the veteran from receiving VA health care.

Those veterans who are currently eligible are categorized into seven different "priority" groups which differ in the benefits provided. Veterans in the highest priority group have the most serious service-related injuries and illnesses, while those in the lowest priority group do not have service-connected maladies, but their incomes fall below the limits.

The VA says that excluding higher-income individuals has allowed it to schedule appointments more quickly. Bishop, though, said he had to wait nearly three months for his first doctor's visit.

Special enrollment exceptions are being made for recent combat veterans even if they do not have a service-connected condition. For two years, the VA will provide free care to veterans with combat service after Nov. 11, 1998. When the two years are up, the veterans might still be eligible for care, depending on wealth, income and disability.

Togus spokesman Jim Doherty said that the VA is making more of an effort to reach out to eligible veterans than ever before. When combat veterans return stateside, they are met by friends and family, as well as a VA representative to help them sign up for health care.

"Fifteen years ago, getting out of the service meant you get your discharge papers and left," Doherty said. "Now they have briefings and transitional assistance programs."

 

APPLYING FOR BENEFITS

QUESTIONS AND ANSWERS about applying to receive health benefits from the Department of Veteran Affairs.

Q: How do I apply?

A: You need to fill out the VA Form 10-10EZ. You can obtain the form at any VA health care facility, by logging onto www.va.gov/1010EZ.htm  or by calling the VA's Health Benefits Service Center, toll-free at (877) 222-VETS (8387), Monday through Friday between 7 a.m. and 8 p.m.

Q: How do I know if I am eligible?

A: Eligibility depends on a number of factors, including income, level of disability and combat experience. Veterans are placed into eight categories, which vary in the breadth of benefits received. Veterans who were not disabled during their military service and have incomes exceeding the established limits are placed in the lowest priority group, and they are not currently eligible to receive VA health care.

Q: I recently served in combat. Do I qualify for free care?

A: Yes, at least for two years. After you return from combat service, you will receive free health care, including medication. At the end of two years, the VA will reassess your status to determine whether you continue to qualify for care, and if so, whether you will have to make co-payments.

Source: U.S. Department of Veteran Affairs

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Larry Scott  --