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THE VA WAITING ROOM IS FULL -- OF FRUSTRATION --

The Portland VA is expanding its surgical ward to increase

capacity by 50 percent. But, will it be enough?

 

 

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Story below:

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VA waiting room full -- of frustration

Health care - The Portland medical center is expanding its surgical ward to increase capacity by 50 percent

MARK LARABEE
The Oregonian

The first weekend in June, Steve Gay was working in his backyard auto shop when he felt pain in his lower abdomen.

The 57-year-old veteran and former nurse knew immediately he had a hernia. The following week, a nurse practitioner at the U.S. Veterans Affairs clinic in Northeast Portland confirmed Gay's self-diagnosis and told him he needed surgery.

Then he waited an agonizing two months for a consultation with a surgeon at the Veterans Affairs Medical Center in Portland and another month before getting the operation.

Gay's experience epitomizes the frustration military veterans in Portland often feel as they wait months for routine, but necessary, surgical procedures. A slow but steady increase in requests for such care has exacerbated the problem.

In an effort to reverse the trend, the VA Medical Center is in the midst of an $8 million expansion of its surgical ward that, when completed in January, will increase capacity by 50 percent.

The agency's policy states that patients, including those in need of a surgical consultation, should be seen within 30 days of their request. In Portland, hospital officials are well aware they aren't meeting the mandate even though it's a top priority, said Bernie Deazley, executive assistant to the hospital's chief of staff.

While veterans with urgent needs or emergencies are seen immediately, the wait for those needing elective surgeries in Portland is often up to five months, Deazley said.

Veterans who need non-urgent procedures, such as Gay, are seen according to a complicated priority schedule. Those with higher eligibility ratings -- primarily based on the extent their ailments are connected to military service -- jump to the head of the line. So do new veterans of the Iraq and Afghanistan wars.

"We're trying to align the pipe so the diameter is the same the whole way through, so it doesn't get jammed up," Deazley said.

A nationwide problem

The long-wait problem is not unique to Portland. Nationwide, the Department of Veterans Affairs is struggling to reduce waiting times for its patients.

An audit released Sept. 10 by the VA's office of inspector general found that the system's hospitals met the 30-day target 75 percent of the time. That finding contradicts former VA Secretary Jim Nicholson and other agency officials, who have repeatedly said the agency meets the target 95 percent of the time. In June, Nicholson said the discrepancy was due to "semantics" in how the number was calculated.

But the auditors found the VA's number was inflated, citing widespread discrepancies in the way appointments were being made. It also found that appointment schedulers were not following established procedures, making it look as if actual appointment dates were the ones requested by the patient when they were not.

The Portland VA Medical Center reached capacity in its existing eight operating rooms by 2002, said Dr. Ralph Ortman, operating room manager. That year, there were 4,662 surgery cases. By last year, there were 5,015.

Planners began working on expanding surgical services to meet the growing need.

Surgeries have undergone a shift during the past decade nationwide, with more procedures being done on an outpatient basis. Currently, the Portland VA Medical Center does about 55 percent of surgeries that way, versus 45 percent a decade ago.

The new surgery ward on the hospital's fourth floor is designed to handle the outpatient trend. It will include four operating rooms and centralized waiting and patient processing areas.

A preoperative center will be used to make sure a patient is medically ready to undergo surgery. And a postoperative center will give specialists a place to watch over the patients as they recover. The redesigned spaces also will house labs that can do on-site skin cancer evaluations and immediate treatment.

Waits won't disappear

Deazley said the new center will significantly reduce waiting times but won't eliminate them. "We don't want to build for peak demand," he said. "That would be a crazy use of our resources."

The medical center sometimes sends patients to outside clinics or hospitals for surgical procedures, though that pressure release valve is used rarely -- 170 times last year, or about 3 percent of the time.

The hospital employs the equivalent of 20 full-time surgeons and will hire six more to meet the increased demand. Deazley said the VA hospital has amenities that will help attract specialists in a competitive market.

Deazley cites competitive salaries and Veterans Affairs' teaching and research relationship with Oregon Health & Science University as the biggest draws. The medical center also has a $30 million annual research budget and protects researchers' time in the lab.

The hospital also plans to hire 29 registered nurses and four nursing support staff. Deazley said the hospital recently was recognized by the American Nurses Credentialing Center for nursing excellence, which gives it a recruiting edge despite a nationwide nursing shortfall.

"We're able, in part, to expand because we feel confident in our ability to hire," Deazley said.

Gay, a Milwaukie resident, repaired F-4 fighters as a U.S. Air Force mechanic in Thailand in 1970. His job often took him to nearby Vietnam, when jets from his squadron needed immediate repairs.

He volunteered for the military during an unpopular war and said he feels as though VA health care was part of the bargain he made with the government. Still, he's only used the system for the past year.

While waiting for his surgery, he kept going to his job as a BMW mechanic despite increasing pain. While the nurse practitioner prescribed pain pills and anti-inflammatory drugs during his first appointment, a surgery date was elusive.

Eventually he was told by letter that he would have surgery July 31. But as his pain increased, he said he tried to get the date moved up. He said he made repeated calls to a patient advocate and to the hospital director's office, but nothing changed.

Gay said he received another letter telling him the July 31 appointment was only a consultation with a surgeon, not a surgery date.

"I'm normally a pretty patient guy," he said. "You just get the runaround. You're always waiting."

On July 31, the consulting surgeon confirmed Gay needed the operation. He also was told it could be another two months before he would get it. Eventually, Gay was referred to a private physician, and his hernia was repaired Aug. 30.

Gay said he is recuperating just fine, but he has another wait on his hands. He has been on a list since January for a knee replacement.

Mark Larabee: 503-294-7664;
 marklarabee@news.oregonian.com

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Larry Scott  --