‘They blew my trust’

Veterans say more staff, specialists needed at Dayton VA.

Darrell Rodin wishes he could just take his veterans card to any hospital for care. Since he can’t, the Navy veteran from Xenia chooses to pay his medical bills rather than rely on the Dayton VA Medical Center.

“They blew my trust,” said Rodin, one of the veterans tested for hepatitis after it was discovered that a dentist there used unsterilized equipment and didn’t properly change gloves during procedures.

Rodin, who has other complaints about his care, is one of the dozens of veterans who called the I-Team when concerns about long waits at the Phoenix VA Medical Center flared into a national scandal and ignited calls for reform. Veterans shared their ideas about how to improve the VA, including boosting the budget, allowing veterans more access outside the VA, hiring more doctors and firing under-performing employees.

The I-Team took these concerns to VA officials, policy experts and federal lawmakers who had differing views on what reforms are needed to restore the trust of veterans like Rodin.

Some changes are already in the works. A joint U.S. Senate-House conference committee is working to iron out the differences between reform measures passed by the House and Senate. Issues on the table include making it easier for veterans to get care outside of the VA if they can’t get treated in a certain time frame, as well as increasing VA funding and authorizing an independent investigation of wait times.

Recommendations are expected before Congress in August, but there is no long-term funding plan. Expanded access to care outside the VA could come with a price tag of more than $50 billion a year, Congressional Budget Office estimates show.

‘Generous’ budgets

The budget for the VA, which has had to deal with an influx of wounded Iraq and Afghanistan veterans, has increased dramatically in recent years.

An I-Team analysis of VA expenditures since 2002 found the VA’s budget for health care and general operating expenses — excluding other kinds of VA benefits — has more than doubled, rising from $24.9 billion in 2002 to $62.9 billion in 2013.

“Our budgets are very generous,” said Glenn Costie, director of the Dayton VA Medical Center.

In Ohio, expenditures during that same time period more than quadrupled — from $854 million to $4.4 billion. Total nationwide spending for all VA programs was $142.8 billion last year.

VA patient loads have increased even as the nation’s veteran population had declined. From 25.5 million in 2002, the number of American veterans dropped to 21.9 million in 2013. Yet the number of patients using the VA increased by more than a million nationally during that time, reaching 5.7 million. In Ohio, the patient load grew from 165,018 to 223,944.

Meanwhile, per-patient costs soared, nearly quadrupling from roughly $5,000 to nearly $20,000.

VA officials say there are several reasons for the skyrocketing costs. For one, veterans are returning from Iraq and Afghanistan with combat wounds previous generations wouldn’t have survived, requiring complex and expensive treatment.

The VA also faces the “unfinished business” of previous wars — new diseases linked to Agent Orange exposure and Gulf War illness, as well as PTSD treatment from all wars.

“More troops are surviving combat today,” said Nicole Alberico, a VA spokeswoman. “After nearly 12 years of combat, their injuries are serious and their issues are complex. Complex issues and injuries often equate to longer-term care.”

‘We’re going to take care of you’

U.S. Sen. Sherrod Brown, D-Ohio, who sits on the Senate-House conference committee, said the financial cost of dealing with the current scandal is necessary to keep the nation’s health care promise to veterans.

“If we’re going to send people to war the way that Congress and the president did a decade ago, we damn well better take care of them and it’s going to cost money to do it,” he said. “If you served this country, we’re going to take care of you when you get back.”

Meanwhile, U.S. House Speaker John Boehner, R-West Chester Twp., has appointed eight House Republicans to work on the conference committee.

“All of the stories we’ve heard, and continue to hear, from veterans about things like the VA backlog and delays in care that have occurred — these are all symptoms of a systemic problem that exists at the VA,” Boehner said in a statement.

Solutions debated

Throwing money at the problem won’t fix the VA, argue critics like Joseph Antos, a health care and retirement policy scholar at the conservative American Enterprise Institute. He advocates for a full review of the VA’s mission and budget in health care.

“Real reform would re-evaluate whether we really need the Veterans Administration to provide medical services in government-owned facilities with government-owned practitioners, in a very inefficient way,” Antos said.

“This is really just putting more money into a system that doesn’t work.”

Terri Tanielan, senior research analyst at the RAND Corporation, noted the VA has evolved from a network of inpatient care facilities for veterans with service-connected injuries, to an integrated health care system providing primary and specialty care — increasingly with age-related issues — to veterans and their family members.

“I think we need rigorous studies to look at the design of the system, to really assess the best ways to meet the needs of the veteran population, especially as the demographics of the veteran population will change in coming years,” she said.

While the idea of privatizing the VA appeals to some conservatives — most notably, Boehner — the concept faces resounding opposition from veterans groups.

Last month, 20 of the nation’s largest veterans organizations issued a joint letter to Congress cautioning that any reform should protect and preserve the VA system.

“While developing final legislation designed to expand access to care outside the VA, Congress must never lose sight of the continuing need to increase VA’s internal capacity to provide specialized care to veterans who rely heavily or entirely on the VA system,” the letter says.

‘It’s hurt me physically’

Army veteran Timothy Hammond of Dayton said he went to a private clinic in Huber Heights in January after he concluded the Dayton VA was putting off his colonoscopy. The eventual procedure found four precancerous polyps, he said.

Going outside the VA can be an expensive decision for veterans like Hammond.

“It’s hurt me financially,” the second-generation Army veteran said. “It’s hurt me physically, and I get very angry because my dad was in for 26 and 1/2 years.”

The VA currently allows people to get care elsewhere if they need treatment the hospital can’t provide. Dayton VA officials say they spend about $30 million a year on outside care.

Recent administrative changes ensure that veterans who have waited more than 60 days for certain appointments are sent elsewhere. Dayton VA officials say they don’t have a big problem with wait times — the Dayton VA fared better than the national average on wait times in a recent audit — and just 16 veterans have been sent outside the VA due to the recent change.

Costie said the primary concern with increasing usage of non-VA facilities is making sure patient medical records are properly tracked.

“That requires a paper record to be brought into our system,” he said. “We have to scan that into the medical record and those are all opportunities for error that we don’t want to contribute to. So whenever possible I’d like to see our veterans getting care inside our Dayton VA.”

No easy fix

The need to hire more doctors came up repeatedly in conversations with veterans, but it may not be an easy fix.

Costie, who will soon leave to temporarily take the helm of the troubled Phoenix VA, said the Dayton VA has seven openings for physicians he can’t fill.

“I have the money to pay for their salaries. We can move them here. We have all the resources we need,” he said. “It really is just there’s a national shortage right now for primary care providers.”

Attracting doctors in specialty care disciplines — like oncologists, cardiologists and neurosurgeons — is particularly difficult for the VA, said Tom Hardy, chief of staff for Dayton VA Medical Center.

“I spent 10 years in the private sector before I came to the VA, and from a salary standpoint the VA can’t compete in specialty care,” said Hardy, a veteran and former vice president of medical affairs for Kettering Health Network.

“The salary scale in the VA is about a half to two-thirds of what a physician could make on the outside.”

Travis Singleton, senior vice president of the health care staffing firm Merritt Hawkins, said the VA has unique challenges that exacerbate the national physician shortage all hospitals face.

“It’s a very crowded and competitive marketplace, and when you’re in that market you can’t afford to have any other strikes against you,” he said. “At this point, it’s sort of like turning the Titanic, there’s too many things to change.”

Government red tape makes the hiring and contracting process cumbersome, according to Hawkins. And the wage gap — the difference between private sector and VA pay — has grown to between $20,000 and $150,000 a year depending on the job market, he said.

“That gap is as big as we’ve ever seen and that’s getting too big to overlook, even for someone who wants to give back,” he said.

U.S. Rep. Brad Wenstrup, R-Cincinnati, believes that in addition to new doctors, the VA needs to use the ones it has more efficiently.

“They’re stuck doing paperwork and data entry instead of seeing more patients,” said Wenstrup, a private practice physician and member of the House Committee of Veterans Affairs. “VA doctors see less than half the number of patients on any given day than their counterparts in the private sector for similar procedures.”

More changes sought

Army veteran Arthur Hill said he received good care from the Dayton VA for years before a botched prostate operation in 2007 prompted him to go on a VA “health care strike.”

“To get me back they would have to — not just for me — they would have to be better off with all veterans,” he said.

Steven Heckman, a service-disabled Marine Corps veteran who served in the early 1990s, said doctors at the Dayton VA initially missed a lung diagnosis that may require a lung transplant.

“They need a bigger facility, a lot more doctors, a lot more nurses,” he said.

Last week President Barack Obama nominated former Procter & Gamble president and CEO Robert McDonald as VA secretary, replacing the ousted Eric Shinseki.

But U.S. Sen. Rob Portman, R-Ohio, said more changes are needed.

“It is also critical that the new secretary have the necessary tools to effect change and enforce accountability, including the ability to hire and fire top VA personnel,” Portman said.

Costie acknowledged some of the problems, saying evidence from some VA hospitals that administrators were juking the numbers to improve wait times on paper speaks to the giant task at hand.

“There seemed to be an over-emphasis in meeting a particular measure, not how’s the overall quality and safety of your total organization,” he said.

‘What keeps me up at night’

Darrell Rodin served four years on active duty and two years in the Navy reserves.

Although he earned his right to VA care, he thinks of it only as “catastrophic insurance” in case a major disaster comes along.

He paid for his own gall bladder surgery three to four years ago because he didn’t think the VA was acting fast enough. The self-employed handyman also claims the VA misdiagnosed a scabies infection.

“For a time there, it seemed like veterans were an easy pick and easy ones to write off,” he said.

Stories like these concern Costie, who hopes the echoing criticisms of the VA system haven’t eroded veterans’ trust irreparably.

“What keeps me up at night is whether or not veterans are scared about coming to the Dayton VA,” he said. “I just want veterans to know that in the 16-county area we serve, that they should be able to come to the Dayton VA and they’re going to get the highest quality and safest care possible.”

It’s clear many veterans still appreciate the VA’s care. Heckman, the Marine Corps veteran, said he doesn’t file complaints because he has “one of the best nurses out there.”

“I never felt right, because that’s my primary care, my only caregiver,” he said of the Dayton VA. “It’s free and they’re just over-slammed.”

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