VA health care crisis hits home for veterans in Fayetteville

By DREW BROOKS AND PAIGE RENTZ | The Fayetteville Observer, N.C. | Published: June 22, 2014

Mike Schultz holds his glasses away from his face and squints.

Doctors have told him his eyesight is getting worse, but Schultz, a Marine veteran who served from 1969 to 1971, can only take their word for it.

"Fuzzy is fuzzy," he said. "Without the glasses, I can't even see the hand in front of my face."

It was November when Schultz first tried to schedule an appointment to see a VA eye doctor. He said he is still waiting.

"They say, 'We'll see what we can do,'" Schultz said. "They say, 'We're taking care of it.'"

Earlier this year, Schultz gave in and paid to see a doctor outside the Veterans Affairs health system.

That doctor told him he would need cataract surgery on both eyes but declined to do it because he said the VA has a poor reimbursement record.

"I'm frustrated," Schultz said. "I'm just hoping I can get it done."

Scores of other local veterans have reported long waits, delays in care and other problems with the Department of Veterans Affairs medical system in the past two weeks. An audit says the Fayetteville VA has some of the longest wait times for appointments in the country. And that is in comparison with a scandal-plagued national system with wait times so long Congress is pushing through legislation to allow veterans to get care elsewhere.

The Senate and House have both passed bills with overwhelming support that would provide funding for VA patients stuck waiting for appointments to be seen by doctors outside the system.

According to the latest audit, new patients at the Fayetteville VA Medical Center are waiting more than 91 days on average for a primary care appointment, more than 63 days for a specialist and more than 28 days for a mental health appointment.

Existing patients have much shorter waits but still wait longer than the national average: more than 29 days for primary care, more than nine for a specialist and more than three days for a mental health appointment.

Rising costs

The VA already spends about $44 billion each year on health care for veterans. The Congressional Budget Office estimates the new legislation could double that price tag for at least the next two years.

House and Senate negotiators are working to reconcile their bills, with the goal of getting legislation approved by July 4.

Rep. David Price, a Chapel Hill Democrat whose district includes part of Fayetteville, said even at about $50 billion a year, passage is a safe bet.

"I don't know of very many items in the budget that have a unifying effect as strong as veterans care does," Price said. "That's not to say it's easy to do. We're under intense budget pressures."

Sen. Kay Hagan, a Democrat from Greensboro, noted that the Senate bill would be funded from emergency appropriations.

"In my mind, if there was ever an emergency, veterans who have served our country potentially dying while waiting for health care certainly qualifies as an emergency."

The Senate bill is much broader than the House version, including provisions to add staff and expand treatment for sexual trauma.

"We've got to bring more people in; we've got to expand the times," Hagan said. "With a growing veteran population, you have to have more providers."

Hagan and Rep. Renee Ellmers, a Harnett County Republican, both called the current legislative efforts a step in the right direction but emphasized the need for continued oversight and analysis of the problems.

While there is broad support among both parties for the emergency legislation, visions of more permanent reform vary.

"Throughout this investigation into serious problems facing the VA system, we have learned that government-run health care is neither efficient nor effective," Ellmers said, stressing the need for greater patient choice. "While there are currently many alternatives to the problems infecting the VA, privatization should remain one of the most viable options in this conversation."

Price, however, said he wants to see the VA eventually be able to handle its full patient load.

Simply pouring money into the VA will not make that happen, nor will handing down new regulations, he said.

"It's not just new legislation," Price said. "It's going to be reform in the department and attention to funding that is required. It's not just about money, but it is surely partly about money."

Monthlong battle

The scandal at the VA has raged for months, peaking in May when Secretary Eric Shinseki stepped down from his post.

Before Shinseki's resignation, lawmakers and veterans service organizations took sides in a battle over VA care that was spurred on by reports that veterans died while waiting for care at the Phoenix VA and that staff had falsified wait-time data.

After the VA's access audit showed the long wait times in Fayetteville, acting VA Secretary Sloan Gibson visited the hospital here. National leaders from the American Legion also came to Fayetteville, where they hosted a town hall and a "crisis center" for veterans.

The crisis center had met with 787 veterans by the time officials left Friday, said Verna Jones, director of the American Legion's Veterans Affairs and Rehabilitation Division.

"These people are frustrated," Jones said. "Look and listen and please try to understand people are hurting. . The VA system certainly is a great system, but it's broken right now."

Local veterans have complained not only about long wait times but about a scheduling program with systemic problems, a carousel of medical providers and, in some instances, shoddy care.

Don Boyd, a retired first sergeant, said he nearly died because of misdiagnoses at the Fayetteville VA in 2011.

No one at the hospital could figure out what was wrong with him, he said, and many doctors and nurses seemed too busy to put much effort into his care.

A doctor outside the VA system discovered the problem when he realized Boyd was missing his gall bladder, despite never having the organ removed.

"I was rotting on the inside," he said. "They scraped out two-and-a-half pounds of gangrene. I was in bad shape."

Jerry Leazer said he has been treated at the VA for years and has seen a steady decline in medical care and customer service.

Leazer, a Marine veteran who fought in Vietnam, said his physician left the VA about a year ago and he has been unable to get a clinic appointment since.

He said he had been forced to visit the VA emergency room several times in the past few weeks for treatment.

"I am a heart patient, diabetic, have gout, CHF, hypertension, severe hemorrhoids, and a whole laundry list of problems, none of which are being addressed adequately," he said.

Local VA officials - while pledging to improve - said that many of their current problems can be traced to rapid growth in the number of patients.

Some veterans are not buying the excuses.

"We appreciate everything that you've got to do, but it shouldn't have gotten to the point where people are dying waiting in the hospital," one veteran told Fayetteville VA Director Elizabeth Goolsby at Monday's town hall meeting. The veteran said he filled out paperwork in February and was still waiting for a doctor's appointment.

Goolsby took issue with any insinuation that she or her staff are not doing their best with what they have.

"Forty-nine percent of my staff are veterans," she said. "This is truly veterans taking care of veterans. We take that responsibility very seriously."

Goolsby and her staff oversee a 21-county region that spans southeastern North Carolina and a small part of South Carolina.

Last year, the patient population in that region grew 7.2 percent, she said, well above the VA average of 1 percent during the same time period.

"Nobody planned for 13 years of war," she said at that meeting.

In 2002, the 21 counties in the Fayetteville region had more than 180,000 veterans, according to VA data. Of those veterans, 35,552 sought care at the Fayetteville VA Medical Center, which includes several outpatient clinics. Their care cost more than $144 million.

By 2013, the same region had added 16,000 veterans and the Fayetteville VA system had an additional 20,000 patients on its rolls, according to VA data. Their care now costs more than $395 million a year.

The growth is taxing current VA facilities, Goolsby said at the town hall meeting. She was not available to respond to the Observer's questions last week, her staff said.

Fayetteville and Jacksonville, with their large military bases, have been hit hardest by the growth.

The Fayetteville VA Medical Center was built in the 1940s and has needed several upgrades in recent years. The grounds are crowded with a number of temporary buildings. Parking is insufficient.

"It's a beautiful old building, but health care has changed quite a bit since 1940," Goolsby said.

Jacksonville has a clinic that is also too small for the patient population. A replacement clinic set to open there next year will be triple the size, officials said.

Meanwhile, a new VA health care center is taking shape on Raeford Road in west Fayetteville and is set to open in spring 2016.

Goolsby and other VA officials are quick to point out those projects, and a new clinic in Sanford, but Goolsby acknowledged that the construction will not address the short term.

"The problem is the here and now," she said at the town hall meeting.

For that, Goolsby said officials are finishing deals to lease more space. Within the next 60 to 90 days, the Fayetteville VA will add 10,000 square feet of additional space, Goolsby said. Jacksonville will add 5,000 square feet. That additional space will allow the VA to reach more veterans, she said, by giving more space to doctors, nurses and therapists.

"Is there a delay right now? Yes, there is," Goolsby said. "But not because of a lack of providers. . I have no place to put them."

The legislation moving through Congress is also designed to lighten the load on VA medical facilities.

Both the House and Senate versions of the bill would encourage veterans who have had long waits to seek care outside the VA system. It is an option that VA patients have had in the past, but it has been discouraged.

Fayetteville veterans said many local outside medical providers decline to treat VA patients because of long waits for payment. And VA officials have said they prefer providing care inside the VA system to control costs.

The VA Mid-Atlantic Health Care Network, the Fayetteville VA's higher headquarters, said a reduction in out-of-system care saved $24 million in 2011.

"Our goal is to minimize the number of procedures or treatments that are conducted in the community," according to the network's website.

Local providers

Now, though, with Congress apparently poised to encourage out-of-system care while the VA sorts out its problems, local medical providers are looking to see some kind of influx of VA patients.

"We're ready," said Mike Nagowski, CEO of Cape Fear Valley Health System in Fayetteville.

"We will extend hours; we will work weekends," he said. "We want to make sure the veterans are taken care of. Whether it's office hours, urgent care, specialty offices - whatever's necessary."

Nagowski said he does not expect to see a surge in new patients coming from the VA but does expect growth.

New patients from the VA would not necessarily mean big changes for Cape Fear Valley, which already provides emergency department and specialty services for VA patients.

The two organizations already have some agreements in place on compensation for care, and Nagowski said he does not expect the hospital system will have to do much reworking of those.

"The relationship is strong," Nagowski said. "It's been a long-term relationship for us. We treasure it. We're going to be here for them."

Robeson County-based Southeastern Health has also worked with veterans in the area for years, said CEO Joann Anderson. She said her health system has capacity available to accept veterans in its clinic network, acute care facility and other services.

Robert W. Seligson, CEO of the North Carolina Medical Society, expects the effect of the action in Congress to vary from community to community.

"Obviously, it will probably put a little bit of strain on them," he said of private facilities in the Fayetteville VA's coverage area. But even if there is a bit of a private-sector squeeze, Seligson said patients in this area are close enough to the Raleigh-Durham-Chapel Hill area, which has a larger health care base, to be able to get appointments quickly.

Seligson said the society supports allowing VA patients to go into the private sector to get the care they need.

"Will there be problems? Sure," Seligson said. "Anytime you change a system, there will be administrative issues. . but if we can get some immediate relief, we'll help get the word on how they can treat these people and get reimbursed."

The two versions of VA legislation have different wording on reimbursement rates for VA patients getting care out of the system, but they are likely to be at least as high as Medicare payments. One question health care officials have is how long it will take the government to pay them.

Julie Henry, director of communications for the N.C. Hospital Association, said many of the association's non-VA hospitals treating VA patients have long waits for payment.

"We are currently working with hospitals and the federal government to work out payment arrangements for accounts that are outstanding past a year," she said.

Cape Fear Valley is among the hospitals that have experienced delays in payments from the VA.

"We have developed a relationship with some of the VA payment staff, and they have been working with us," said Janet Conway, Cape Fear Valley's director of marketing. The VA's new electronic claims system, Conway said, "is causing us further delays in payment as they fine-tune their new process."

Southeastern's Anderson said she knows of no outstanding accounts for treatment of VA patients in her system.

Other initiatives

While legislation moves through Congress, national and local VA leaders are working to address what they can with their resources.

Last week, the VA announced it would move forward in efforts to replace its outdated scheduling system.

Gibson directed all VA medical center and health care system directors to conduct monthly reviews of scheduling practices.

"Our top priority is getting veterans off of wait lists and into clinics," Gibson said. "We need our folks in the facilities to work directly with staff, answer all questions, and ensure our veterans receive the timely care they have earned."

In Fayetteville, the VA received an extra $7.4 million to help pay for overtime and other costs associated with expanded hours and increased contracts with private providers.

Goolsby will have led the VA for four years next month. Last week, she was put on the defensive when she attended the American Legion town hall meeting, surprising many veterans who did not expect a VA official to attend.

While some local veterans have defended the VA, many of the more vocal have blamed local officials for the long waits and other problems.

Goolsby faced several of those critics at the meeting. She responded to most complaints and handed out business cards for veterans to reach out to her.

Goolsby vowed to get better, often apologizing to veterans who reported poor care in Fayetteville.

The director has made a point of corresponding with some of her biggest critics over the past few years, and her desk is stacked high with remarks from patients and their families - good and bad.

The verbal blows that Goolsby took last week gave some veterans an added respect for the director.

"Man, I don't know you, but I'm going to give you a benefit of the doubt," Mike Davis, a retired chief warrant officer who served in Vietnam, told Goolsby.

"I may not agree with everything you say, and a lot of people in this room may not, either," a Marine veteran added. "But thanks for having the guts to come forth."

During the meeting, Goolsby heard a host of complaints.

Some veterans attacked the care itself, saying overstressed doctors and other providers have missed severe medical problems because they are overworked or booked so tightly that appointments last only about 15 minutes.

Troy Page, who retired from the Army in 2009, said, "It's the system. The system is broken."

Page said the Fayetteville VA is repeatedly replacing doctors who move on, wasting the time of patients who lose appointments or have to repeat procedures.

"I've never seen the same guy twice," said Willie Pickens, a retired chief warrant officer five.

Pickens said he has had no problems getting VA appointments. Instead, he said, it seems he is "getting all of them."

On more than one occasion, he said, he has been informed of appointments that were actually for other patients. On one such visit, he learned that he was to be fitted for dentures, despite having all his teeth.

Another veteran said he received a letter informing him that an appointment had been scheduled - two weeks after his appointment date.

Others said they have visited out-of-system emergency rooms to receive care. There, they had to contend with long waits, then had to deal with calls from bill collectors because the VA failed to pay for the care.

Even veterans who had scheduled appointments had complaints. They talked about hours-long waits and confusion in VA offices, last-minute cancellations and wrong information about where they would be seen.

In some cases, confusion led to missed visits. Then they had to wait six months or more for a replacement appointment.

Several complaints centered on lack of access to specialists in Fayetteville.

Goolsby told the veterans that she wants that to improve.

"My goal is to be able to have more of the specialties here so that our veterans don't have to go to Durham, to (Winston-Salem, to other places," Goolsby said.

Several veterans specifically mentioned hearing care as a problem.

"I just want my hearing checked," said one veteran who said he first tried to get an appointment in March.

That veteran said he is scheduled to see a doctor in July.

"Why do you have to wait three months?" he asked.

The medical center has added a trailer for audiology and hired two more audiologists.

"It doesn't look pretty or wonderful, but it's functional," Goolsby said.

The Fayetteville VA also does not do heart surgery or joint replacements, instead sending patients to other VA medical centers in North Carolina or Virginia.

Officials said some specialties will be added when space is available, likely after the west Fayetteville health center is built.

The VA is unlikely to get relief from its growing population anytime soon.

With the war in Iraq over and the war in Afghanistan winding down, the Army and other services are downsizing because of budget pressures and to address a force restructuring.

Retired Col. Mark Lowe, who once commanded the 1st Special Warfare Training Group at Fort Bragg, said a wave of new veterans who may need VA care is on its way.

And unlike past generations of soldiers, the majority of these troops - particularly those from Fort Bragg - are combat veterans with associated wounds and problems.

"A lot of my soldiers are getting out and asking how to get through the hurdles," he said.




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