[Senate Hearing 111-304]
[From the U.S. Government Publishing Office]
S. Hrg. 111-304
PROVIDING CARE FOR RURAL VETERANS: COMMUNITY-BASED OUTPATIENT CLINICS
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED ELEVENTH CONGRESS
FIRST SESSION
__________
AUGUST 26, 2009
__________
Printed for the use of the Committee on Veterans' Affairs
Available via the World Wide Web: http://www.access.gpo.gov/congress/
senate
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Washington, DC 20402-0001
COMMITTEE ON VETERANS' AFFAIRS
Daniel K. Akaka, Hawaii, Chairman
John D. Rockefeller IV, West Richard Burr, North Carolina,
Virginia Ranking Member
Patty Murray, Washington Lindsey O. Graham, South Carolina
Bernard Sanders, (I) Vermont Johnny Isakson, Georgia
Sherrod Brown, Ohio Roger F. Wicker, Mississippi
Jim Webb, Virginia Mike Johanns, Nebraska
Jon Tester, Montana
Mark Begich, Alaska
Roland W. Burris, Illinois
Arlen Specter, Pennsylvania
William E. Brew, Staff Director
Lupe Wissel, Republican Staff Director
C O N T E N T S
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August 26, 2009
SENATORS
Page
Isakson, Hon. Johnny, U.S. Senator from Georgia.................. 1
WITNESSES
Williams, Joseph, Deputy Under Secretary for Health, Operations
and Management, Veterans Health Administration, U.S. Department
of Veterans Affairs; accompanied by Lawrence Biro, Network
Director, Veterans Integrated Service Network 7; and Rebecca
Wiley, Director, Charlie Norwood VA Medical Center............. 3
Prepared statement........................................... 6
Cook, Tom, Assistant Commissioner, Field Operations and Claims,
Georgia Department of Veterans Services........................ 14
Prepared statement........................................... 15
Nordeoff, Cort, Southeast Georgia District Commander, Disabled
American Veterans.............................................. 18
Prepared statement........................................... 19
Spears, Albert R., Quartermaster, Department of Georgia, Veterans
of Foreign Wars of the United States........................... 24
Prepared statement........................................... 26
APPENDIX
Southwest Atlanta Medical Center; brochure....................... 35
PROVIDING CARE FOR RURAL VETERANS: COMMUNITY-BASED OUTPATIENT CLINICS
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WEDNESDAY, AUGUST 26, 2009
U.S. Senate,
Committee on Veterans' Affairs,
Jesup, GA.
The Committee met, pursuant to notice, at 2:35 p.m., in C.
Paul Scott Polytechnical Center, Altamaha Technical College,
Jesup, Georgia, Hon. Johnny Isakson, presiding.
Present: Senator Isakson.
OPENING STATEMENT OF HON. JOHNNY ISAKSON,
U.S. SENATOR FROM GEORGIA
Senator Isakson. Good afternoon and welcome. I am U.S.
Senator Johnny Isakson and I am delighted to be here. I want to
thank the Technical College and their President for all their
cooperation and hospitality in allowing us to hold this hearing
today.
Before I get into my opening remarks, I want to say to all
our veterans that are in the audience today, first of all, on
behalf of all Georgians and all Americans, we thank you for
your service. One of the reasons that I asked to be on the
Veterans Committee when I was elected to the Senate was because
I wanted to do everything I could to see to it that the
promises made to our veterans were delivered, and everywhere we
could improve veterans services, we would do that. Community-
Based Outpatient Clinics are certainly one of those areas where
that is taking place, and that is the purpose of this hearing
today. Most importantly, on behalf of all the people of our
country and of this State, we want to thank you for your
service and your sacrifice for the United States of America.
On community-based outpatient clinics: 1922 is when the
first service to our veterans who came home took place, and it
was generally--it was always a patient-based hospital service.
And then in 1994, in Amarillo, Texas, a change took place and
VA converted to--they didn't convert from hospitals to
community-based clinics, but began opening community-based
clinics around the United States. Today, there are over 700
community-based clinics in the United States of America serving
our veterans.
A while back, there was a proposal made by the
administration and the Department of Veterans Affairs to open
two new clinics in this part of Georgia--one in Hinesville and
one in Glynn County--and that is substantially the purpose of
this meeting today.
Now, I am aware that both of those clinics have been
somewhat delayed--Hinesville for very obvious reasons. The
Veterans Administration decided after determining we needed an
expanded clinic here, and what was originally thought to be a
10,000 square-foot outpatient center is now planned to be, as I
understand it--and I will be corrected by our witnesses, I am
sure, if I am wrong on this--a 25,000 square-foot outpatient
facility, including mental health services.
As everyone knows, there is a tremendous challenge in the
Gulf War, the wars in Afghanistan and Iraq, for those returning
with PTSD or TBI. I have personally had the privilege of seeing
the marvelous work that the Augusta Uptown VA and the
Eisenhower Medical Center in Augusta have done to create a
seamless transition for our veterans going from DOD into
veterans health care, to see the many people who came out of
the war with TBI or PTSD who have been remediated, have been
treated, and are back in society--as we want everybody to
possibly be. So, the expansion of that clinic precipitated
somewhat of a delay.
Glynn County: I am not sure I know exactly why, and I am
sure part of the testimony will be to answer that, as well; but
we have a substantial and significant number of veterans in
this part of Georgia, in no small measure because of the
facilities at Kings Bay in Camden County and Fort Stewart in
Liberty County. We want to make sure that the services to our
veterans are complete, and that in terms of health care, it is
reachable or within the reach of every single veteran.
The change in 1994 at Amarillo reflected the change in both
injuries as well as the need for services, and it is now a lot
easier in Georgia for a veteran to get service at a clinic
rather than having to drive to either Dublin, Atlanta, or
Augusta, which are the location of the three hospitals. I want
to personally thank the Veterans Administration for the
outreach they have provided and for the investment they have
made in Georgia and the clinics we have been able to open since
I was elected to the U.S. Senate, for which I take no credit
except to be a part of. I thank the Veterans Administration for
having done that and for what they have done in it.
I want to introduce a couple of staff members who are with
me today. Lupe, raise your hand. Lupe is the brains of the
operation. I am just the front man. And Chris--Chris is the VA
staff person in my office. They will be here to assist me
today.
We have passed out three-by-five cards. After the testimony
and the questioning that I will give, if you will pass those
forward or give them to one of my people. Nancy Bobbit is here
in the back. She will collect them if you have a question, and
I will ask those questions of our panelists if we have time.
That will be in the off-the-record program after the testimony
of this field hearing today from panel one and from panel two.
With that said, let me invite our first panel to come
forward. Joe Williams, the Deputy Under Secretary for Health,
Operations, and Management.
Lawrence Biro--did I pronounce it right? I do it wrong
every time. I said it wrong when you were in Washington, I
know, and I apologize. It is only four letters. I ought to be
able to get that right. He is the Director of Veterans
Integrated Service Network.
Rebecca Wiley, Director of the Charlie Norwood VA medical
center. I have already bragged in my opening remarks about the
Charlie Norwood Center once, but I want to brag about them
again. They were featured on ``NBC Nightly News'' about 2
months ago because of the miraculous and marvelous work that
they are doing. And as long as I am able to serve in the U.S.
Senate, I am going to attempt to see to it that whenever we
have a DOD facility and a veterans facility in the same city,
that they can replicate what has been done in Augusta, Georgia.
It is truly a great service to our veterans and I congratulate
you on that.
I don't know what order you were told, but my mother raised
me that ladies were always first, so Rebecca? If you will, try
to keep your remarks to around 5 minutes; but if you go over,
that is fine. We will take your testimony first.
Ms. Wiley. Thank you, sir. I am going to defer to Mr.
Williams.
Senator Isakson. OK. I am sorry, Mr. Williams, but she is a
lot prettier than you are, so I wanted her to go first.
Mr. Williams. Yes, sir, and I am glad you recognize that.
[Laughter.]
Senator Isakson. I am old, but I am not that old.
Mr. Williams?
STATEMENT OF JOSEPH WILLIAMS, DEPUTY UNDER SECRETARY FOR
HEALTH, OPERATIONS AND MANAGEMENT, VETERANS HEALTH
ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS;
ACCOMPANIED BY LAWRENCE BIRO, NETWORK DIRECTOR, VETERANS
INTEGRATED SERVICE NETWORK 7, U.S. DEPARTMENT OF VETERANS
AFFAIRS; AND REBECCA WILEY, DIRECTOR, CHARLIE NORWOOD VA
MEDICAL CENTER
Mr. Williams. Mr. Chairman, thank you for the opportunity
to appear before you today to discuss the Department of
Veterans Affairs' health care and facility issues in Georgia.
I am accompanied today by Mr. Lawrence Biro, the Network
Director for the VA Southeast Network, VISN 7, and Ms. Rebecca
Wiley, the Director of Charlie Norwood (Augusta) VA Medical
Center.
Today, my testimony will address the process by which VA
determines where to build new Community-Based Outpatient
Clinics, how such clinics are built, and the services that they
provide. I will also discuss how VA provides care to veterans
in Georgia. Thanks for providing this opportunity to us to
address these important issues and for your continued support
of our veterans.
VA determines its health care and benefits infrastructure
requirements through a strategic planning process that is
closely linked to the Department's missions and goals. VA is
further committed to further improving the access to health
care for veterans, including veterans in rural areas, by
comprehensively evaluating demographics in the market,
determining clinical need for services in the area, and then
aligning capital investment strategies to meet the health care
needs of those veterans. VA carefully analyzes utilization
trends. We look at our veteran population and the enrolled
users to ensure that the appropriate mix of services is
available to meet the needs of our local veterans.
Over the last few decades, CBOCs have shown to be effective
in improving access to care for our veterans and assist us in
providing a high quality of care in a cost-effective manner.
The Veterans Health Administration plans to continue meeting
those comprehensive health care needs for veterans nationwide
by establishing new CBOCs, new outreach clinics, mobile clinics
utilizing state-of-the-art technology to bring care closer to
our veterans' home, and using resources within the communities
when clinically necessary. By the end of the fiscal year 2010,
VA plans to operate 833 CBOCs, and that will be 78 more than we
had active in 2008.
CBOCs are developed through a methodology that partners
Central Office with our VISNs. This allows the decisionmaking
with regard to CBOCs and the needs and the priorities to be
made in the context of future and local markets and those
market circumstances. The methodology evaluates the convergence
of geographic access as measured by drive-time guidelines for
primary care services and projected demand for primary care and
mental health services, as well. The methodology drives the
initial step in VHA's national CBOC deployment plan.
A comprehensive business plan is required to submit an
application, and several alternatives are reviewed within this
business plan and these alternatives include renovations of the
existing facility. It may include construction of a new
facility, procuring a lease for space, or contracting within
for community resources. These are all things that we look at
to address the health care gaps as we move the CBOC application
forward.
Once the analysis is completed and the access gaps are
identified, VISNs will determine if a CBOC will best meet the
needs of the veterans in that particular area. The VISN will
then submit a Business Plan to VA Central Office for review by
a panel of experts. The review considers much of the following
criteria: the quality and need of the proposal; the location in
the market not meeting VA access guidelines; they will look at
the quantity of users and enrollees, and market penetration.
There will be considerations for unique things, included in the
proposal: how their proposal improves access for minority
veterans; how it overcomes geographic barriers; or reaches out
to the medically underserved areas. Cost effectiveness and the
impact on waiting times is also looked at as part of that
review criteria.
VA uses both a VA personnel management model and a
contracting model when we consider staffing our CBOCs. The VA
personnel management model ensures direct accountability of
staff to VA managers, direct coordination of care and services
with other VA programs. It delivers more efficient records
management in a VA-staffed CBOC. It ensures DOD and VA
collaboration at a higher degree, and education and teaching
opportunities that we can all leverage and benefit from.
The contracting operations management model is used
generally in areas where the veteran population is small, and
we see some of those particularly in some of the smaller rural
areas. The contract operation model must meet VA's quality and
patient safety standards, and is cost effective because it
allows VA to take advantage of existing community resources
where the numbers are small.
Georgia is supported by two VISNs, the VA Southeast
Network, which is the VISN 7, and the VA Sunshine Health Care
Network, which is Network 8. Although the latter extends into
the Southeastern portion of the State, VISN 7 provides services
to veterans in South Carolina, Georgia, and Alabama. There are
an estimated 1.46 million veterans living within the boundaries
of VISN 7 in fiscal year 2008, and 457,000 veterans are
enrolled in that health care system.
VISN 7 includes eight VA medical centers or health care
systems based in Augusta, Georgia; Atlanta, Georgia; Dublin,
Charleston, South Carolina; Columbia, South Carolina;
Birmingham, Alabama; Tuscaloosa; and the Central Alabama
Veterans Health Care System, which have locations in Montgomery
and Tuskegee.
In fiscal year 2008, the network provided services to about
328,000 veterans out of the 457,000 enrolled. There were about
3.56 million outpatient visits and a total of 30,335 hospital
inpatient discharges. The cumulative full-time employee level
for this network was 12,678, and the operating budget was over
$2.1 billion.
Six of our VA medical centers or health care systems have
robust research programs and each has been fully accredited by
the Association of Accreditation for Human Research Protection
Programs. These facilities also have their own research
compliance officer. Some highlights of the research being done
in VISN 7 include Rehabilitation Research Center of Excellence
in Atlanta and Geriatric Research Education and Clinical
Centers in Atlanta and Birmingham.
Specialty services are also available at a number of our
facilities. For example, both Augusta and Birmingham offer
blind rehabilitation services. Augusta is home to a spinal cord
injury unit program. Central Alabama, Tuscaloosa, Atlanta, and
Birmingham offer residential rehabilitation treatment programs.
Augusta, Central Alabama, and Dublin provide domiciliary
support, and all VA medical centers in VISN 7 have women's
veterans programs.
Access to care is a priority in VISN 7. Between fiscal year
2009 and fiscal year 2010, we are opening four new CBOCs in
Georgia alone to support that.
Georgia is a home to three VA medical centers, Augusta,
Atlanta, and Dublin. The Atlanta facility employs 2,500 full-
time employees and served more than 65,000 unique patients in
fiscal year 2008. More than 3,500 of those who served in
Operation Enduring Freedom and Operation Iraqi Freedom were
served by this facility. Augusta employs more than 2,100 people
and serves more than 38,000 uniques and provided care to 2,400
OEF/OIF veterans in 2008. Dublin, which has been designated as
a rural access facility, employs approximately 850 full-time
employees and serves approximately 28,500 veterans. This
includes over 1,600 OEF/OIF veterans or patients in 2008. The
three facilities provide approximately 660,000, 360,000,
190,000 outpatient visits, respectively.
There are currently 15 active CBOCs and primary care
clinics in Georgia and four more are scheduled to open by the
end of 2010. The Committee has expressed interest in two
specific CBOC projects, Brunswick and Hinesville. The Brunswick
CBOC is currently in the lease advertisement process for clinic
space. VA will evaluate the offers received, which will include
site selection. Proposals were due by July 31, and VA is in the
process now of reviewing those responses. VA currently expects
to open the clinic sometime in February 2010.
Regarding the Hinesville market area, VA has a space plan
under review by VA Real Property Service that will likely
require approval by the Secretary. VA currently estimates the
Hinesville CBOC to be activated around October 2011.
In summary, with the support of the Senate Committee on
Veterans' Affairs and the Georgia Congressional delegation, VA
is meeting the health care needs of veterans in the area.
Again, Mr. Chairman, we want to thank you for the
opportunity to testify today at the hearing. My colleagues and
I are available to address any questions that you may have for
us.
[The prepared statement of Mr. Williams follows:]
Prepared Statement of Joseph Williams, RN, BSN, MPM, Acting Deputy
Under Secretary for Health for Operations and Management, Veterans
Health Administration, U.S. Department of Veterans Affairs
Mr. Chairman and Members of the Committee, thank you for the
opportunity to appear before you today to discuss Department of
Veterans Affairs (VA) health care and facility issues in Georgia. I am
accompanied today by Mr. Lawrence Biro, Network Director, VA Southeast
Network (Veterans Integrated Service Network [VISN] 7) and Ms. Rebecca
Wiley, Director of the Charlie Norwood (Augusta) VA Medical Center
(VAMC).
Today, my testimony will address the process by which VA determines
where to build new community-based outpatient clinics (CBOC), how such
clinics are built, and the services they provide. It will also discuss
how VA provides care to Veterans in Georgia. Thank you for providing
this opportunity to address these important issues and for your
continued support of America's Veterans.
community-based outpatient clinic selection process
VA determines its health care and benefits infrastructure
requirements through a strategic planning process that is closely
linked to the Department's mission and goals. VA is committed to
further improving access to health care for Veterans, including
Veterans in rural areas, by comprehensively evaluating demographics in
a given market, determining the clinical need for services in the area,
and then aligning capital investment strategies to meet the health care
needs of Veterans in the area. VA carefully analyzes utilization
trends, Veteran Population (VetPop) data, and enrolled users to ensure
that the appropriate mix of services is available to meet the needs of
local Veterans. Over the last decade, CBOCs have shown to be effective
in improving access to care for Veterans and providing high-quality
care in a cost-effective manner. The Veterans Health Administration
(VHA) plans to continue meeting the comprehensive health care needs of
Veterans nationwide, by establishing new CBOCs, outreach clinics,
mobile clinics, utilizing state-of-the-art technology to bring care
closer to the Veteran's home, and using community resources when
clinically necessary. By the end of fiscal year (FY) 2010, VA plans to
operate 833 CBOCs, 78 more than were active in FY 2008.
CBOCs are developed through a methodology that partners VA's
Central Office and VISN staff. This allows decisions regarding CBOC
needs and priorities to be made in the context of current and future
local market circumstances. The methodology evaluates the convergence
of geographic access as measured by drive-time guidelines for primary
care services and projected demand for primary care and mental
services. The methodology drives the initial step in VHA's national
CBOC deployment plan. Comprehensive business case applications are
submitted that provide several alternatives (including renovation of an
existing facility, construction of a new facility, procuring a lease,
or contracting with community resources) to address any health care
gaps.
Once the analysis is completed and access gaps are identified,
VISNs will determine if a CBOC will best meet the needs of Veterans in
the area. The VISN will submit a Business Plan for the CBOC to VA's
Central Office for review by a panel of experts. This review considers
the following criteria:
Quality and need of the proposal
Location in a market not meeting VA Access Guidelines
Quantity of users and enrollees
Market penetration
Unique considerations, including whether the proposal
improves access for minority Veterans, overcomes geographic barriers,
or reaches out to medically underserved areas
Cost effectiveness and
Impact on waiting times
VA uses both the VA personnel management model and contracting
operation management model to staff CBOCs. The VA personnel management
model ensures direct accountability of staff to VA managers, direct
coordination of care and services with other VA programs, delivers
efficient records management compliance, DOD and VA collaboration, and
education and teaching opportunities. The contract operations
management model is used generally in areas where the Veteran
population is small, particularly in rural areas. The contract
operation model must meet VA's quality and patient safety standards and
is cost effective because it allows VA to take advantage of existing
community services.
visn support in georgia
Georgia is supported by two VISNs: VA Southeast Network (VISN 7)
and VA Sunshine Healthcare Network (VISN 8), although the latter
extends only into the southeastern portion of the state. VISN 7
provides services to Veterans in South Carolina, Georgia and Alabama.
There were an estimated 1.46 million Veterans living within the
boundaries of VISN 7 in FY 2008, and 457,349 Veterans were enrolled in
VA for health care.
VISN 7 includes eight VA medical centers or health care systems
based in Augusta, GA; Atlanta, GA; Dublin, GA; Charleston, SC;
Columbia, SC; Birmingham, AL; Tuscaloosa, AL; and the Central Alabama
Veterans Health Care System (locations in Montgomery, AL and Tuskegee,
AL). In FY 2008, the Network provided services to about 328,000 out of
more than 457,000 enrolled Veterans. There were about 3.56 million
outpatient visits and 30,335 hospital inpatient discharges. The
cumulative full-time employee level was 12,678, and the operating
budget was about $2.1 billion.
Six of our VAMCs or health care systems have robust research
programs, and each has been fully accredited by the Association for the
Accreditation of Human Research Protection Programs (AAHRPP). These
facilities also have their own research compliance officer. Some
highlights of the research being done in VISN 7 include a VA
Rehabilitation Research Center of Excellence in Atlanta and Geriatric
Research Education and Clinical Centers in Atlanta and Birmingham.
Specialty services are available at a number of our facilities. For
example, both Augusta and Birmingham offer Blind Rehabilitation
Services; Augusta is home to a Spinal Cord Injury (SCI) program;
Central Alabama, Tuscaloosa, Atlanta and Birmingham offer Residential
Rehabilitation Treatment Programs; Augusta, Central Alabama and Dublin
provide domiciliary support; and all VA medical centers in VISN 7 have
women Veterans' programs. Access to care is a priority in VISN 7, and
between FY 2009 and FY 2010, we are opening four new CBOCs in Georgia
alone.
georgia health care facilities
Georgia is home to three VA medical centers: Augusta, Atlanta, and
Dublin. The Atlanta facility employs approximately 2,500 full-time
employees and served more than 65,000 unique patients in FY 2008, more
than 3,500 of whom served in Operation Enduring Freedom or Operation
Iraqi Freedom (OEF/OIF). Augusta employs more than 2,100 people, serves
more than 38,000 unique patients, and provided care to 2,400 OEF/OIF
Veterans in FY 2008. Dublin, which has been designated a rural access
facility, employs approximately 850 full-time employees and served
approximately 28,500 Veterans (including over 1,600 from OEF/OIF) in FY
2008. The three facilities provided approximately 660,000, 360,000, and
190,000 outpatient visits respectively.
There are currently 15 active CBOCs and primary care clinics in
Georgia, and four more are scheduled to open by the end of FY 2010. The
Committee has expressed interest in two specific CBOC projects:
Brunswick and Hinesville. The Brunswick CBOC is currently in the lease
advertisement process for clinic space. VA will evaluate offers
received which will include site selection. Proposals were due by July
31, 2009, and VA is reviewing these responses. VA currently expects to
open the clinic in February 2010.
Regarding the Hinesville market area, VA has a space plan under
review by VA Real Property Service that will likely require approval by
the Secretary. VA currently estimates the Hinesville CBOC will be
activated in October 2011.
conclusion
In summary, with the support of the Senate Committee on Veterans'
Affairs and the Georgia Congressional delegation, VA is meeting the
health care needs of Veterans in the area. Again, Mr. Chairman, thank
you for the opportunity to testify at this hearing. My colleagues and I
are available to address any questions you may have for us.
Senator Isakson. Well, thank you very much, Mr. Williams. I
appreciate your testimony, and I want to make note, by the end
of this year, we will have 78 more clinics--833--is that right?
Mr. Williams. Yes, sir.
Senator Isakson. That is an outstanding condition.
With regard to Brunswick, my understanding is there was an
RFP put out for that clinic. It came in. You all made a
decision, then you decided to reopen it and you are just now in
the process of making a final decision on a site, is that
correct?
Mr. Williams. Yes, sir. I will defer to Mr. Biro for
comments.
Mr. Biro. Yes, that is right. There was a technical flaw in
the bidding process that we had to resolicit the bid. We got
back several offers and we plan to move ahead on that right
now.
Senator Isakson. Will this be a leased facility?
Mr. Biro. The building itself, yes, will be a leased
facility.
Senator Isakson. With regard to Hinesville, I think the
testimony of Mr. Williams said probably the fall or October
2011 would be the target date. Is that meetable? Is that target
meetable?
Mr. Biro. That is a very conservative date. The problem
there is the belief that there isn't a suitable building in the
Hinesville area, at least with our real estate people right
now. We just rode over from Charleston and we kind of feel
that, looking a little harder, we may find a building that
would be appropriate for a veterans clinic. We are also
thinking of starting maybe--doing some outreach there a little
bit earlier, as early as we can. But right now, the 2011 date,
based on the size of the lease, requires many more approvals.
Senator Isakson. I would like to ask you to consider doing
something in Hinesville, if you don't mind. As you probably are
aware, the Secretary of the Army recently pulled back on a
previous commitment to move a brigade combat team to Fort
Stewart. The community has made a significant investment in
additional facilities in anticipation of the brigade combat
team coming. I don't know if any of those facilities would be
appropriate for a veterans clinic, but I think there is an
obligation on behalf of the country, because of pulling that
commitment, to do everything they can to make that community
whole.
So, I would like to personally ask if you would make sure
that you reach out to the banks and the development community
who have put in over $400 million in investments in the
Hinesville-Fort Stewart area in anticipation of that combat
team coming, which is now not coming. If there was a building
that was suitable and the VA could lease it for that purpose,
it would be a win-win proposition for the VA and certainly help
that community that is going to struggle because of the pull-
out of that commitment by Secretary Gates. So, if you would
promise me you would make that consideration, I would very much
appreciate it.
Mr. Biro. Yes, I will. I will make contact immediately and
do the market survey there.
Senator Isakson. Mr. Williams, did I understand correctly
that in Regions 7 and 8, there are 1.4 million veterans, or in
just Region 7? Do you remember?
Mr. Biro. Can I answer that? That is just VISN 7.
Senator Isakson. Just VISN 7. And 457,000 are enrolled in
care?
Mr. Biro. That is enrolled, yes.
Senator Isakson. And you treated--what was the number you
actually treated?
Mr. Biro. Roughly over 300,000. I think it is 324,000. But
it is over 300,000.
Senator Isakson. Mr. Biro, you are responsible for the
Atlanta hospital, are you not?
Mr. Biro. Yes.
Senator Isakson. OK. This hearing is not about the Atlanta
hospital, but I think I have an obligation to ask a question
about it, too, particularly on behalf of our veterans. The
hospital is going through a renovation and an expansion, which
I was proud to help procure the money for. But the Clairmont
Road facility and the need for construction has significantly
restricted parking for veterans going for services. I want to
thank the hospital publicly for the efforts they have made in
terms of shuttles and other things, but are we making some
improvement in accessibility, to your knowledge, for those
veterans that go there for services?
Mr. Biro. The remote parking--we are making progress with
that. We ran into one little glitch about how we can transport
people, but we are making progress. We do have on the plans,
which would not be real immediate, a parking structure in the
front of that building where the parking lot is, which would
then alleviate the parking problems. So we are working on it in
as many ways that we can.
Besides being the Network Director, I am a veteran and I do
get my services at Atlanta. I frequently joke that if I saw
that parking problem, I would drive by. I have a spot, so I can
park. But yes, that is an issue I am very sensitive of.
Senator Isakson. I appreciate that. I don't want to
interrupt my questions, but would the Mayor of Hinesville who
just arrived stand up? Didn't I see him come in back there? I
want the record to reflect that I have already asked for the VA
to consider utilizing the existing facilities that Hinesville
has prepared that were in anticipation of the brigade combat
team for its lease operation be considered for its veterans
clinic, Mr. Mayor. So, I wanted to let you know we have already
looked out for you. Thank you, sir, and thank you for what you
do, Mayor.
Ms. Wiley, I always brag about what you all do there. It is
nothing short of remarkable. How is the progress coming with
the seamless transition, and how is the rate of cures in terms
of TBI progressing?
Ms. Wiley. Well, thank you, Senator, for your continued
support of our program. We are very proud of it, too. At this
time, we continue to have a very strong relationship with the
DOD, and this year already we have treated approximately the
same number of active duty soldiers through our rehab and TBI
program that we treated for the total year last year. So we
continue to see a very strong relationship.
We have also initiated another program through our
domiciliary--our TRRP program--and that was a pilot program
this last year. We have had tremendous success with treatment
of patients with specific TBI-related diagnoses who did not
need hospital-level care, but needed domiciliary type of care.
I believe that our results to date have been approximately a 35
percent return to duty rate for those soldiers. So, it is our
aim for the coming year to continue to explore ways to work
with the DOD, not only at Fort Gordon, but expand that a bit in
the Southeast to offer that service for other soldiers.
Senator Isakson. If I am not mistaken, not only is the
return rate now at 35 percent and improving, but a lot of those
people are returning actually to the theater of operations in
Afghanistan or Iraq. Is that not correct?
Ms. Wiley. That is correct, sir. I am just not sure of the
35 percent--how many of those return to the theater.
Senator Isakson. Well, it is a great credit to Augusta.
When I had the field hearing at Augusta, I guess it has been 2
years ago now--it may have been last year--I met a Sergeant
Harris as I was touring the facility, and if you remember, she
turned the corner. She had been hit with an IED her second day
in Iraq and had suffered from TBI. She came back, was assigned
to veterans and dismissed from the military. You all turned her
around at the clinic and she was reenlisting and was going back
to Iraq, which is a great testimony to what you are doing there
at the Augusta center.
At the Augusta facility, there was an incident with regard
to either endoscopy or colonoscopy in terms of equipment and
sterilization. Has that been addressed?
Ms. Wiley. Absolutely, sir. Our situation regarding
reusable medical equipment had to do with endoscopies, which is
the device that is used to go down the nose or the throat.
Since that time, we have instituted a complete revision of all
of our standard operating procedures, all of our processes for
reusable medical equipment, and we have been surveyed
externally and internally numerous times in the last 2 months
and have had 100 percent results from those surveys.
Senator Isakson. Mr. Williams, on that subject, has that
incident resulted in a change within the system to ensure a
redundancy in terms of sterilization?
Mr. Williams. Yes, sir. The changes that Ms. Wiley spoke to
are not only changes that are happening at the Augusta
facility, but they are happening across the country. Our
network directors and medical center directors all took
aggressive actions to move forward to assess where they were
with regards to standard operating procedures and outcomes. We
deployed managers, leaders, teams across the country to assess
all of our facilities.
From that, and I am sure you are aware that a recent review
by the IG teams that went out indicated that we had substantial
compliance with the standards. Not only did we demonstrate that
we had addressed those issues that had been identified, that we
had actually moved beyond and were learning new things and
taking opportunities to make even more efficiencies occur, such
as limiting the number of places where we perform these
procedures, standardizing our standard operating procedures at
medical centers, readdressing our training and education.
So, yes, sir, we have looked at this from a systems
standpoint and we are demonstrating that type of improvement in
compliance across the country.
Senator Isakson. Thank you for that answer.
In your testimony, when you talked about where you place--
the criteria you go by to place an outpatient clinic, you
mentioned quality, access guidelines, market penetration, and
the medically underserved.
Mr. Williams. Yes, sir.
Senator Isakson. And when I heard you talk about the
medically underserved, I heard you mention that the
preponderance of your contract providers were in medically
underserved clinics. Is that correct? Did I hear you say that,
or was I not----
Mr. Williams. I don't recall.
Senator Isakson. Well, let me ask the question another way
and maybe Mr. Biro would want to answer it. Of our 800, or soon
to be 833 outpatient clinics, how many of the providers are
staff VA providers and how many of them are contract providers?
Mr. Williams. I don't have that specific information, but
we can provide that for you.
Mr. Biro. We will have to take it for the record.
Senator Isakson. Do you have just a ballpark guess?
Mr. Biro. I think only about two out of the ones in
Georgia----
Senator Isakson. Are contract?
Mr. Biro [continuing]. Are contract, yes.
Senator Isakson. OK. Thank you very much.
I am going to ask the question I have been handed, but I
don't know if I understand the question or not. What is the
potential for VA/DOD collaboration at the Hinesville clinic?
Mr. Biro. It is great. We are already working with Fort
Stewart. We have people there already as liaison. We are
already doing the discharge or exit physicals there. We will
certainly talk to the Commander of the hospital there on how we
can cooperate.
Senator Isakson. Well, let me ask you this question with
regard to Uptown VA in Augusta and Eisenhower. The closest
hospital, I guess, to Hinesville would be Dublin?
Mr. Biro. That is right. The Hinesville facility is going
to be run by the Charleston VA.
Senator Isakson. By Charleston? Is it----
Mr. Biro. Right, Charleston, South Carolina.
Senator Isakson. I know proximity is essential to what you
all have done in Augusta, Ms. Wiley, but is it possible to
adopt some of the seamless transition procedures they have done
in Augusta in this new Hinesville facility with Charleston?
Mr. Biro. Yes. Yes. Like I said, we are doing the
separation physicals now; at least we are coordinating them and
we are in the process of doing even more. So, we will make sure
that that continues to work.
Senator Isakson. I think Secretary Shinseki has been very
impressed with what has happened there and I think the results
bear out that this is an important thing to cover.
Two questions. Ms. Wiley, let me ask you this question. You
have been at Augusta long enough to make a determination since
the Warrior Transition Centers were upgraded, the beginning of
the upgrade here was about, I guess, 18 months ago. Are the
Warrior Transition Centers helping in terms of the condition of
the veterans who come out of DOD and into VA health care? Is
that a loaded question?
Ms. Wiley. Yes, it is, sir.
Senator Isakson. OK.
Ms. Wiley. What I can tell you----
Senator Isakson. Well, give me a loaded answer.
Ms. Wiley. What I can tell you that I observe is maybe not
an answer that could be applicable to everyplace else, because
in Augusta, we have such a close relationship with the Warrior
Transition Unit and the VA. We have a lot of interconnectedness
that occurs that is unique to our situation, and because of
that, the positive working relationship that we have--because
of the active duty unit--also translates to a very positive
working relationship as we are transitioning soldiers back into
veteran status.
Senator Isakson. Second question. With regard to the
Transition Centers. I was struck, when I went through the
center at Fort Stewart last year, by the number of women that
were going through the Warrior Transition Center; and unlike
TBI and PTSD, many of their problems were orthopedic, in
particular because of the weight of the equipment that many of
them were carrying on the battlefield. Was that a correct
observation, number 1, on my part? And number 2, what are we
doing to address that in terms of their care?
Ms. Wiley. Well, again, I could tell you what we are doing
in Augusta as soldiers become veterans. We have established a
women's clinic that opened in April----
Senator Isakson. Great.
Ms. Wiley [continuing]. Specifically to address women's
needs, and we have a gynecologist and a practitioner who is
devoted to the women's clinic. We also have a relationship with
Eisenhower regarding mammography services and work
collaboratively with them on all of our women's needs.
Senator Isakson. Was I correct in my observation about
orthopedic problems, or is it more of other types?
Ms. Wiley. I can't tell you that for sure, but I will find
that out for you.
Senator Isakson. I wish you would, because when I was with
the people at Fort Stewart, that specifically was the question
I asked. It appeared to me there were a disproportionate number
of women in the center versus the ratio in the service and I
asked the question, why? And the immediate answer was, because
of the orthopedic difficulties from weights and things like
that. So, check into that for me and let me know.
With regard to the underserved and rural care, we now have
11 community-based clinics now, right? No, that is wrong. We
have 15 going on 19 in Georgia, is that correct?
Mr. Biro. Yes.
Senator Isakson. Can you tell me, Mr. Biro, about how that
affects accessibility for the average veteran? I mean, we are
in a technical college in Georgia and we like to say that we
have a technical education center within 45 minutes of every
student that wants technical education. Are we getting to a
point that our veterans have reasonably quick access to
outpatient clinics if they don't go to the hospital?
Mr. Biro. We are getting there. We are working on this. We
have this formula, as Mr. Williams had pointed out, that there
be no more than a particular length of commuting time. It is
about 30, 60, or 90 minutes, depending upon saturation. So, we
have a map and we are turning that map green by--the map is
gray, and as we put new clinics in, it turns green, showing
that the clinics are close enough. Are we finished? No, but we
are making progress. We are making a lot of progress.
Senator Isakson. Thirty to 90 minutes is great progress
compared to three hospitals and no clinics, which was the case
just a few years ago. So, I commend you on what you are doing
and continuing to do.
I am going to summarize--unless somebody behind me reminds
me of something I forgot to ask--by talking about a couple of
things I had mentioned earlier. One, we thank you very much for
the emphasis on Glynn County and Brunswick and the emphasis on
Hinesville. I think both of the answers were that the opening
of Brunswick in 2010 and the opening of Hinesville in late 2011
are conservative estimates, which means it might happen sooner
and we certainly hope that takes place.
But also with regard to Hinesville, I want to repeat what I
said earlier. I sincerely hope the administration will consider
looking at those facilities that have been built in preparation
for the brigade combat team which has now been withdrawn, to
see if one of those facilities will match with the VA's use,
which would be a win-win, I think, for the VA and the Army. It
would certainly be a win for Liberty County and the city of
Hinesville.
Senator Isakson. OK. Mr. Williams, I have been asked to ask
you a question which you know the answer to. The new Health
Care Center Facility Program--do you know what that is?
Mr. Williams. Pardon me, sir----
Senator Isakson. The new Health Care Facility Program? HCC?
I am not an acronym guy. I apologize.
Mr. Williams. Yes, sir.
Senator Isakson. Tell me how that is going to work.
Mr. Williams. Well, the concept of a health care center is
one of the components of our continuum of care that we provide
to our veterans. If you look from our mobile clinics to an
outreach clinic to a CBOC, we are able to increase the number
of services we provide based upon the needs in those particular
areas and based upon the resources that are available and are
able to be provided.
The HCC kind of fits in between a medical center with
inpatient beds and an independent clinic. It is a large
outpatient operation with--it typically would have some
special--a lot of specialty care, ambulatory surgery, high-end
diagnostic capabilities. It typically will not have an
inpatient bed section, and you will see some of these can be as
large as from 300,000 to 500,000 square feet, depending on
need. But again, what distinguishes it from others is that it
is typically much larger than a CBOC and sometimes larger than
an independent clinic, but does not fit a full medical center
profile. Typically, it doesn't have inpatient beds.
Senator Isakson. Well, let me thank all three of you for
your testimony and for your service to our veterans. I will
excuse you, and I am going to call our second panel up. Thank
you very much.
Mr. Williams. Thank you, sir.
Senator Isakson. Mr. Williams, will you be able to stay
until the second panel is complete? Thank you very much.
Our second panel is Mr. Tom Cook, the Assistant
Commissioner of the Georgia Department of Veterans Services; Al
Spears, the Quartermaster, Georgia Veterans of Foreign Wars;
and Cort Nordeoff, the Southeast Georgia District Commander for
Disabled American Veterans.
I think each one of you are prepared to give testimony, is
that correct?
Mr. Spears. Yes, sir.
Senator Isakson. Yes. Good. I want to say to Mr. Tom Cook,
I want you to deliver my best wishes to Pete Wheeler.
Mr. Cook. Certainly.
Senator Isakson. Georgia is proud of all of its veterans,
but it is particularly proud--we have had the best Commissioner
of Veterans Affairs any State could possibly have. He is older
than dirt and he has been around, and his entire life he has
dedicated to the veterans of Georgia. I just want you to
personally extend him my thanks. I worked with him for years
when I was in the Georgia Legislature, as I have worked with
you, and I think you all do a fantastic, tremendous job. And
please tell him I said so.
Mr. Cook. I certainly will. Yes, sir.
Senator Isakson. If it is all right with you, we will go
with Mr. Cook first for his testimony, then to Mr. Nordeoff,
and then Mr. Spears. Is that all right? Mr. Cook?
STATEMENT OF TOM COOK, ASSISTANT COMMISSIONER, FIELD OPERATIONS
AND CLAIMS, GEORGIA DEPARTMENT OF VETERANS SERVICES
Mr. Cook. Thank you, Mr. Chairman and distinguished guests.
It is an honor for me to be here, and thank you for inviting
our Department to testify this afternoon. Commissioner Wheeler
sends his personal regrets for not being able to be here due to
his wife's serious health problems. It is my privilege to
testify on his behalf; and Senator Isakson, Commissioner
Wheeler wants you to know that he values your friendship and
that he appreciates the interest of your Committee regarding
veterans having top-notch and accessible health care available
throughout all of Georgia.
As requested, we will limit our oral testimony to 5
minutes. We submitted our complete written testimony to you. We
believe that our testimony reflects the feelings of the
majority of veterans who are being treated in the VA clinics.
The feedback we received has been overwhelmingly positive
and veterans are very pleased with the quality of care they are
receiving. They speak highly of the screening done by the
nurses. They state that the physicians are very dedicated to
their jobs, very thorough in their examinations, that they
listen carefully to what they say. Veterans seem very impressed
with the increasing availability of clinics and they are
delighted that they no longer have to make the long drive to
Atlanta, Dublin, Augusta, or Northern Florida for their routine
appointments. They state that their appointments are scheduled
in a timely manner and that they are seen promptly once they
arrive. On a very positive note, we received many favorable
comments regarding mental health treatment.
Co-location of State veterans service offices within the
clinics facilitates one-stop shopping for our veterans health
care and benefits concerns. We are presently co-located in the
Athens, Savannah, St. Mary's, and Valdosta clinics and we would
like for future plans to include space for our Department's
representatives, as well, if possible. We currently have, as
has been said, 15 clinics open in Georgia.
Within the past year, new clinics have opened in St.
Mary's, Perry, and Stockbridge, and within the next few months
we would hope they would be open in Newnan, certainly, then
Brunswick as soon as possible. We eagerly await also the
opening of clinics within the next months or so in Hinesville,
Statesboro, Blairsville, Carrollton, and Milledgeville.
Additionally, we understand that VA is planning to open a
clinic in Waycross. These clinics are centrally and
strategically located throughout Georgia and it is absolutely
critical that all of them open as planned for our veterans to
have the accessible outpatient health care they deserve.
We are disappointed that the contract for the Brunswick
clinic had to be rebid due to complaints for contractors, and
our understanding is that the estimates are that the clinic
will open later this fall or down the road, as soon as we can.
Although the delay is inconvenient for the veterans in the
area, it does not seem to us to be excessive, at least not yet.
We believe that VA is doing everything they can to open the
clinic as soon as possible.
Although the focus of this hearing is on clinics, we
believe that it is imperative that we emphasize the need for
another VA hospital on the Southwest side of Atlanta. The
Atlanta VA Hospital has too many patients and too few parking
spaces. As Commissioner Wheeler would so eloquently state, the
situation is much like trying to put a size 12 foot inside a
size 6 shoe. We believe the answer to this problem is the
Southwest Atlanta Medical Center, which is available on the
Southwest side of Atlanta right now, and we understand that a
request is at the VA Central Office. We request the support of
your Committee, sir, in getting this important request approved
by the VA as soon as possible. We have provided pictures of
that hospital so you can see how nice it is and how much
parking is available there. I have some extra copies with me,
as well.
Thanks again for allowing us to testify. I will be happy to
answer any questions you might have now or later, and may God
bless the important service you provide and may God bless the
United States of America. Thank you, sir.
[The prepared statement of Mr. Cook follows:]
Prepared Statement of Tom Cook, Assistant Commissioner, Field
Operations and Claims, Georgia Department of Veterans Service
Mr. Chairman and Members of the Committee: Thank you for the
opportunity to present the views of Commissioner Wheeler and Georgia
Department of Veterans Service regarding veterans' perceptions of
Community Based Outpatient Clinics in Georgia. Commissioner Wheeler
sends his personal regrets in not being able to testify due to
circumstances surrounding his wife's health. He wants you to know that
he values the friendship and support of Senator Isakson; and he
appreciates the interest and concern of the Senate Committee on
Veterans' Affairs regarding veterans having top notch and accessible
health care available in the rural areas of Georgia, as well as in the
more densely populated metropolitan areas of the state.
quality of care
Once we were notified of this hearing, we solicited comments from
veterans and our department's field office representatives throughout
Georgia to prepare for the hearing. Although time did not allow for
investigation of complaints or confirmation of compliments, we believe
that our testimony reflects the feelings of the majority of veterans
who are being treated at our Community Based Outpatient Clinics
(CBOC's).
The overwhelming response has been that veterans are extremely
pleased with the outstanding quality of care they receive in the
CBOC's. The reputation of the CBOC's among our veterans is
exceptionally good. Veterans generally report being treated with
courtesy and respect by a great staff. They speak highly of the
screening done by the nurses. They state that the physicians are very
dedicated to their jobs, that they are very thorough in their
examinations, and that they listen carefully to what they say.
Veterans report that they believe the quality of care has improved
at the Albany CBOC since the change from a private contract with Phoebe
to a VA run clinic. We believe this is a significant lesson learned in
providing top notch VA health care for CBOC's throughout the United
States.
In some instances, veterans believe that personnel behind the sign
in window are overly strict in the enforcement of ``the line'' to stand
behind when another veteran is already at the window. This is
particularly true when veterans come to the clinic for the first time.
They may not know about ``the line'' and inadvertently cross over it.
In some cases, veterans describe being made to feel like a ``criminal''
and being somewhat rudely ``ordered'' to get behind the line.
Similarly, they state that in some cases the security guards are called
out to ensure that they get behind ``the line.'' Certainly, if a
veteran is unruly, then calling security is appropriate. However,
calling security seems premature for innocent violations of policy
regarding ``the line'' when no disruptive behavior is involved.
We know that the Privacy Act and HIPPA requirements impose a high
level of sensitivity regarding access to veterans' personal
information. We fully support protecting the privacy and identity of
our veterans. Perhaps some personnel are just being overly zealous in
the enforcement of those requirements.
This is really the only area where we have received specific
complaints regarding discourteous treatment. We do not intend to
chastise the VA by raising this issue because we really believe that
the overall courtesy and treatment of our veterans at the CBOC's is
exceptionally good. We raise the issue simply because we suspect it is
one that merits being given some attention across the VA health care
system in clinics and in medical centers.
We think this could be addressed by having more prominent signs
posted at the clinics regarding the policy and by including written
notice of the policy in correspondence that goes to the veterans. We
also think that training could be given to ensure that veterans who
``cross the line'' are treated in a courteous manner.
An additional observation along the same line of thought is that
some veterans are frustrated by the protective glass window at some of
the clinics. They report feeling like they are ``in prison talking
through a bullet proof glass.'' So, perhaps the tension between the
need for adequate security and the need for a ``warm'' reception needs
to be evaluated.
availability of services
The feedback we have received from veterans indicates that they are
very impressed with the steadily increasing availability and
accessibility of outpatient treatment that is being offered through the
CBOC's in Georgia. Many veterans are delighted that they no longer have
to make the long drive to Atlanta, Dublin, Augusta, or Northern Florida
for routine appointments in a VA Medical Center.
In most cases, veterans seem pleased that their appointments are
scheduled in a timely manner. Once they arrive for their appointments,
they report being seen promptly. In fact, some veterans report that
they believe the CBOC's are much better organized and run than the VA
medical centers.
However, due to the steadily increasing number of veterans in need
of treatment throughout Georgia, some of the CBOC's (for example,
Oakwood) have already reached capacity and are no longer accepting new
patients. Other clinics (for example, Columbus) are reported to be too
small for the number of veterans served. Some clinics (for example,
Valdosta) are reported to be in need of another Medical Team because of
the size of the provider's panels.
These concerns highlight the need for VA to expand the size and
staffing of existing clinics while opening additional clinics
throughout Georgia. We are pleased with the progress that has been made
thus far, but we are very cognizant of the fact that we cannot remain
stagnant. We must continue to expand in order to provide the level of
service to our veterans that they deserve.
We have received some complaints regarding the availability of
specific treatment for women veterans. Some in Smyrna state that they
are being referred to non-VA providers. Some women veterans have
complained that pap smears and mammograms are not routinely provided in
clinics.
We have received many favorable comments regarding mental health
treatment. PTSD therapy has been overwhelming popular and has received
many accolades. The only drawback is the length of time for the
appointments due to the popularity.
We received a number of complaints regarding being able to ``get
through'' or ``leave messages'' on the telephone systems. Similarly,
some say that their messages are not answered and that their calls are
not returned. Also, we have been informed that the number for the Perry
Clinic is not listed anywhere. Consequently, our local office receives
about 10 calls per day from veterans wanting the number for the
clinic.
We are told that the Athens Clinic does not show up on GPS or
MapQuest. Consequently, some veterans drive ``all over creation''
trying to find the clinic. Perhaps sending veterans a strip map would
be helpful.
Co-location of State Veterans Service Offices within the CBOC's
enhances the level of services available for the veterans and
facilitates one stop shopping for their health care and benefit
concerns and entitlements. We are presently co-located in the Athens,
Savannah, St. Mary's and Valdosta clinics. We would like for future
plans to include space for our department's representatives as well. We
believe this is particularly important for Brunswick, Statesboro,
Blairsville, Carrollton and Waycross. We also would like for
consideration of co-location to be given during planning for expansion
of any of the other clinics, especially Newnan and
Stockbridge.
placement of clinics
We currently have 13 CBOC's and two additional Outpatient Clinics
open in Georgia. We are aware of plans to open eight additional CBOC's
within the next couple of years. Within the past year, new CBOC's have
opened in St. Mary's, Perry and Stockbridge. VA will open the Newnan
CBOC in September of this year.
We eagerly await the opening of CBOC's in Brunswick, Hinesville and
Statesboro. VA has assured us that these clinics will open within the
next year. The addition of these clinics will greatly increase
accessibility for veterans in Southeast Georgia. Similarly, VA has
assured us that CBOC's will open in Blairsville, Carrollton and
Milledgeville, which will greatly improve accessibility in other areas
of Georgia. We also understand that the CBOC in Carrollton will be a
Mega, or Super, Clinic with up to 45K square feet of space and a number
of specialty clinics, and that it will open within the next year.
Additionally, we understand that VA is planning to open a CBOC in
Waycross. This location fills a great gap in distance for the veterans
of Southeast Georgia. It is vital that a clinic open in Waycross as
soon as possible.
These clinics are centrally and strategically located throughout
Georgia. It is critical that all of them open as planned for our
veterans to have the accessible outpatient health care they deserve.
We also emphasize that Georgia is the largest state east of the
Mississippi River in land area. That fact, coupled with the steadily
increasing veteran population in Georgia, highlights the need for
additional clinics to be planned in the near future for other areas of
the state. We suggest Canton, Dalton, Tifton, LaGrange, Griffin, and
Hazlehurst for consideration.
rebidding of brunswick contract
We are interested in getting a CBOC in Brunswick as soon as
possible. In that regard, we are disappointed that the contract had to
be rebid due to complaints from contractors. Our understanding is that
the latest estimates project that the clinic will be open by late
September or early October 2009. We have been told that the nursing
staff has already been hired and that they are going through
orientation training. We have been informed that the physicians are
currently going through the credentialing process, and that the
remainder of the administrative staff position will be posted soon.
Although the delay is inconvenient for the veterans in the area, it
does not seem to us to be excessive. We believe that VA is doing
everything they can to open the clinic as soon as possible.
va hospital on west side of atlanta
Although the focus of this hearing is on CBOC's, we believe that it
is imperative that we emphasize the need for another VA Medical Center
on the West or Southwest side of Atlanta. The Atlanta VA Medical Center
located in Decatur is faced with a continually growing number of
patients and with a steadily increasing parking problem.
On a daily basis, veterans contend with long lines of vehicles
extending to the highway waiting for their turn to park at the Atlanta
VA Medical Center. Many veterans have to wait long periods of time
before they are able to go to their appointment. Once they get inside
the hospital, they are faced with additional delays due to the ever
increasing number of patients being treated at the hospital.
Even if we could solve the parking problem today, the patient care
problem would still exist. In fact, the number of patients will
continue to increase due to the referrals that are made from the
increasing number of CBOC's in the Atlanta area, as well as due to the
treatment of increasing numbers of OIF/OEF veterans. The parking
problem outside the hospital and the patient care problem inside the
hospital combined are like trying to put a size twelve foot inside a
size six shoe.
We need another VA hospital in Atlanta in order to provide timely
and quality health care for the steadily increasing number of patients.
We believe the answer to this problem is the Southwest Atlanta Medical
Center, which is available on the southwest side of Atlanta right now.
We are attaching information and photographs of this hospital for your
perusal. This facility has more than adequate parking and is ready made
for patient care. Once approved, VA will just need to negotiate the
lease agreement and staff the hospital.
We understand that a request for another hospital is at the VA
Central Office for a decision by Secretary Shinseki. We request the
active support of the Senate Committee on Veterans' Affairs in getting
this important request for an additional hospital in Atlanta approved
by the VA as soon as possible.
Senator Isakson. Well, Tom, thank you very much. In your
reference to Brunswick, I would say the numbers the VA
committed, I think by mid-2010 in Brunswick, not the end of
this year, but certainly within that reasonable period of time.
I appreciate that very much.
Also, for all of you, your previously submitted printed
testimony will, by unanimous consent, be published in the
record, so it will be accepted from all of you.
Mr. Nordeoff?
STATEMENT OF CORT NORDEOFF, SOUTHEAST GEORGIA DISTRICT
COMMANDER, DISABLED AMERICAN VETERANS
Mr. Nordeoff. Senator Isakson, I am honored and privileged
to appear before you today. As the Southeast District Commander
of the Disabled American Veterans, I appear here today on
behalf of the State Commander of Georgia, Freddie Swint, and
the 54,526 fellow disabled veterans in the Southeast District
of Georgia.
Our National Office in Washington, DC, submitted a written
statement for this hearing today. I ask that the statement be
made a part of the record of this hearing.
Senator Isakson. Without objection.
Mr. Nordeoff. At this time, sir, I would like to thank you
and the Department of Veterans Affairs for all the positive
steps that each of you have taken to provide for increased
medical health for the veterans of the State of Georgia.
Due to the overwhelming numbers of Disabled American
Veterans who reside in the districts, the need for a VA clinic
is of utmost importance. For the State of Georgia, we have 133
community-based clinics, with only two on the East Coast. One
clinic is located in the Northeast of the district, while the
other one is located in the Southeast of the district.
While the Hinesville clinic would help serve the 15,425
disabled veterans who reside in the five surrounding counties,
which could lessen the number of veterans who are currently
being seen at the Savannah, Georgia, clinic, and that is not
counting the 25,672 disabled veterans that are located in
Chatham County. This could cut down on travel times for the
veterans from 1-2 hours to approximately 30-40 minutes anywhere
within the district.
Hinesville is the home of the Third Infantry Division,
which is currently discharging soldiers on a daily basis, which
adds to the percentage of 7,620 disabled veterans who reside in
Liberty County and Hinesville. Also, with a clinic in
Brunswick, we could help serve those 7,480 disabled veterans
who reside in the three surrounding counties, which could
lessen the number of veterans that are currently being seen in
Kingsland, Georgia, clinic, which is not counting the 5,949
disabled veterans who reside in Camden
County.
With the number of disabled veterans that are now in the
district, the Disabled American Veterans just recently
purchased a van for the Southeast District to provide
transportation for disabled veterans so they will be able to
make their appointments or any other medical treatment that the
VA orders.
Thank you, sir. This concludes my testimony. On behalf of
the Disabled American Veterans, I would be pleased to answer
any questions from you or from the other members.
[The prepared statement of Mr. Nordeoff follows:]
Prepared Statement of Cort Nordeoff, Southeast Georgia District
Commander, Disabled American Veterans
Senator Isakson and Members of the Committee: Thank you for
inviting the Disabled American Veterans (DAV) to testify at this
oversight hearing of the Committee to evaluate Georgia veterans'
perceptions of Veterans' Affairs (VA) community-based outpatient
clinics in terms of their quality of care, availability of services,
and the placements of clinics in Georgia. Also the Committee
specifically asked that I address the recent contract that was rebid
for the community based outpatient clinic in Brunswick, GA. We value
the opportunity to discuss our views. Rural health is an issue of
significant importance to many DAV members in Georgia and veterans in
general.
Approximately 3.2 million, or 41 percent, of veterans enrolled for
VA health care throughout the country are classified by VA as rural or
highly rural. Also, 44 percent of current active duty military
servicemembers, who will be tomorrow's veterans, list rural communities
as their homes of record. In the State of Georgia, rural Georgians have
a proud tradition of military service dating all the way back to the
American Revolution. VA estimates that 773,000 veterans live in
Georgia, of which almost 23,000 are proud members of the DAV. In
Georgia, VA meets veterans' health care needs with major medical
centers in Atlanta, Augusta and Dublin. VA operates fourteen community-
based outpatient clinics, in Albany; Athens; Columbus; Decatur; East
Point; Lawrenceville; Macon; NE Georgia/Oakwood; Perry; Rome; Savannah;
Smyrna; Stockbridge; and, Valdosta. VA plans to establish additional
clinics based on unmet need. As a general rule, DAV is very pleased
with the VA commitment to rural health care access in the State of
Georgia. Nevertheless, research shows that when compared with their
urban and suburban counterparts, veterans who live in rural settings in
general have worse health-related quality-of-life scores; are poorer
and have higher disease burdens; worse health outcomes; and are less
likely to have alternative health coverage. Such findings anticipate
greater health care demands and thus greater health care costs from
rural veteran populations.
Over the past several years, through authorizing legislation and
additional appropriations, Congress has attempted to address unmet
health care needs of veterans who make their homes in rural and remote
areas. With nearly half of those currently serving in the military
residing from rural, remote and frontier areas, access to VA health
care and other veterans services for them is perhaps VA's biggest
challenge. We recognize that rural health is a difficult national
health care issue and is not isolated to VA's environment. We also
appreciate that many service-connected disabled veterans living in
rural areas face multiple challenges in accessing VA health care
services, or even private services under VA contract or fee basis.
Shortage of health care providers, long travel distances, weather
conditions, geographical and financial barriers all negatively impact
access to care and care coordination for many rural veterans, both the
service-connected and nonservice-connected alike.
Section 212 of Public Law 109-461 authorized VA to establish the
Veterans Health Administration (VHA) Office of Rural Health (ORH). We
deeply appreciate the due diligence of this Committee and Congress as a
whole in exerting strong support for rural veterans by enacting this
public law.
As required by the Act, the function of the ORH is to coordinate
policy efforts across VHA to promote improved health care for rural
veterans; conduct, coordinate, promote and disseminate research related
to issues affecting veterans living in rural areas; designate in each
Veterans Integrated Service Network (VISN) rural consultants who are
responsible for consulting on and coordinating the discharge of ORH
programs and activities in their respective VISNs for veterans who
reside in rural areas; and, to carry out other duties as directed by
the Under Secretary for Health. In the Act, VA also was required to do
an assessment of its fee-basis health care program for rural veterans
to identify mechanisms for expanding the program and the feasibility
and advisability of implementing such mechanisms. There were also a
number of reports to Congress required including submission of a plan
to improve access and quality of care for enrolled veterans in rural
areas; measures for meeting the long term care and mental health needs
of veterans residing in rural areas; and, a report on the status of
identified and opened community-based outpatient clinics (CBOCs) and
access points from the May 2004 decision document associated with the
Capital Asset Realignment for Enhanced Services (CARES) plan. Finally,
the Act required VA to conduct an extensive outreach program to
identify and provide information about VA health care services to
veterans of Operations Iraqi and Enduring Freedom (OIF/OEF) who live in
rural communities for the purpose of enrolling these veterans into the
VA health care system prior to the expiration of their statutory
eligibility period (generally, five years following the date of
military discharge or completion of deployments).
In addition to establishing the ORH, in 2008, VA created a 13-
member VA Rural Health Advisory Committee to advise the Secretary on
issues affecting rural veterans. This panel includes physicians from
rural areas, disabled veterans, and experts from government, academia
and the non-profit sectors. We applaud former VA Secretary Peake for
having responded to our recommendation in the Fiscal Year (FY) 2009
Independent Budget (IB) to use VA's authority to form such a committee.
We hold high expectations that the Rural Veterans Advisory Committee
will be a strong voice of support for many of the ideas we have
expressed in previous testimony before Congress, and joined by our
colleagues from AMVETS, Paralyzed Veterans of America, and the Veterans
of Foreign Wars of the United States, in the IB.
We are pleased and would like to congratulate VA on its progress to
date in establishing the necessary framework to begin to improve
services for rural veterans. It appears that ORH is reaching across the
Department to coordinate and support programs aimed at increasing
access for veterans in rural and highly rural communities. We note;
however, that the ORH has an ambitious agenda but only a minimal staff
and limited resources. The ORH is still a relatively new function
within VA Central Office and it is only at the threshold of tangible
effectiveness, with many challenges remaining. Given the lofty goals of
Congress for rural health improvements, we are concerned about the
organizational placement of ORH within the VHA Office of Policy and
Planning rather than being closer to the operational arm of the VA
system. Having to traverse the multiple layers of VHA's bureaucratic
structure could frustrate, delay or even prevent initiatives
established by this office. We believe rural veterans' interests would
be better served if the ORH were elevated to a more appropriate
management level in VA Central Office, with staff augmentation
commensurate with its stated goals and plans.
We understand that VA has developed a number of strategies to
improve access to health care services for veterans living in rural and
remote areas. To begin, VA appointed rural care designees in all its
VISNs to serve as points of contact in liaison with ORH. While we
appreciate that VHA designated the liaison positions within the VISNs,
we expressed concern that they serve these purposes only on a part-time
basis. We are pleased that VA is conducting a pilot program in eight
VISNs to determine if the rural coordinator function should be a part-
time or a full-time position.
VA reported that its approach to improving services in rural areas
includes leveraging existing resources in communities nationwide to
raise VA's presence through outreach clinics, fee-basis, contracting,
and use of mobile clinics. Additionally, VA testified it is actively
addressing the shortage of health care providers through recruitment
and retention efforts; and harnessing tele-health and other
technologies to reduce barriers to care. Also, in September 2008, VA
announced plans to establish new rural outreach clinics in Houston
County, Georgia, Juneau County, Alaska, and Wasco County, Oregon. VA
plans to open six additional outreach clinics by August 2009 in:
Winnemucca, NV; Yreka, CA; Utuado, PR; LaGrange, TX; Montezuma Creek,
UT; and Manistique, MI.
VA also reported that it has conducted other forms of outreach and
developed relationships with the Department of Health and Human
Services (HHS) (including the Office of Rural Health Policy and the
Indian Health Service), and other agencies and academic institutions
committed to serving rural areas to further assess and develop
potential strategic partnerships. Likewise, VA testified it is working
to address the needs of veterans from OIF/OEF by coordinating services
with the HHS' Health Resources and Services Administration community
health centers, and that these initiatives include a training
partnership, technical assistance to community health centers and a
seamless referral process from community health centers to VA sources
of specialized care.
In August 2008, VA announced the establishment of three ``Rural
Health Resource Centers'' for the purpose of improving understanding of
rural veterans' health issues; identifying their disparities in health
care; formulating practices or programs to enhance the delivery of
care; and, developing special practices and products for implementation
VA system-wide. According to VA, the Rural Health Resource Centers will
serve as satellite offices of ORH. The centers are sited in VA medical
centers in White River Junction, Vermont; Iowa City, Iowa; and, Salt
Lake City, Utah.
Given that 44 percent of newly returning veterans from OEF/OIF live
in rural areas, the IB veterans service organizations believe that
these veterans, too, should have access to specialized services offered
by VA's Readjustment Counseling Service, through its Vet Centers. In
that regard, we are pleased to acknowledge that VA is rolling out a
fleet of 50 mobile Vet Centers this year to provide access to returning
veterans and outreach at demobilization sites on military bases, and at
National Guard and Reserve units nationally.
The issue of rural health is an extremely complex one and we agree
with VA that there is not a ``one-size-fits-all'' solution to this
problem. To make real improvements in access to the quality and
coordination of care for rural veterans, we believe that Congress must
provide continued oversight, and VA must be given sufficient resources
to meet its many missions, including improvements in rural health care.
In regard to funding for rural health, in 2008 VA allocated almost
$22 million to VISNs to improve services for rural veterans. This
funding is part of a two-year program and would focus on projects
including new technology, recruitment and retention, and close
cooperation with other organizations at the Federal, state and local
levels. These funds were used to sustain current programs, establish
pilot programs and establish new outpatient clinics. VA distributed
resources according to the fraction of enrolled veterans living in
rural areas within each VISN. It is DAV's understanding that VISNs with
less than three percent of their patients in rural areas, received
$250,000, those with between three and six percent received $1 million,
and those with six percent or more received $1.5 million.
The ORH has testified VA allocated another $24 million to sustain
these programs and projects into 2009, including the Rural Health
Resource Centers, mobile clinics, outreach clinics, VISN rural
consultants, mental health and long-term care projects, and rural home-
based primary care, and has convened a workgroup of VISN and Central
Office program offices to plan for the allocation of the remaining
funds. In February 2009, ORH distributed guidance to VISNs and program
offices concerning allocation of the remaining funds to enhance rural
health care programs.
Concurrently, Public Law 110-329, the Consolidated Security,
Disaster Assistance, and Continuing Appropriations Act, 2009, approved
on September 30, 2008, included $250 million for VA to establish and
implement a new rural health outreach and delivery initiative. Congress
intended these funds to build upon the work of the ORH by enabling VA
to expand initiatives such as telemedicine and mobile clinics, and to
open new clinics in underserved and rural areas. Notably, the bill also
included $200 million for additional fee-basis services.
Health workforce shortages and recruitment and retention of health
care personnel, are also a key challenge to rural veterans' access to
VA care and to the quality of that care. The Institute of Medicine of
the National Academy of Sciences report ``Quality through
Collaboration: The Future of Rural Health'' (2004) recommended that the
Federal Government initiate a renewed, vigorous, and comprehensive
effort to enhance the supply of health care professionals working in
rural areas. To this end, VA's deep and long-term commitment to health
professions education seems to be an appropriate foundation for
improving these situations in rural VA facilities as well as in the
private sector. VA's unique relationships with health professions
schools should be put to work in aiding rural VA facilities with their
human resources needs, and in particular for physicians, nurses,
technicians, technologists and other direct providers of care. The VHA
Office of Academic Affiliations, in conjunction with ORH, should
develop a specific initiative aimed at taking advantage of VA's
affiliations to meet clinical staffing needs in rural VA locations.
While VA maintains it is moving in this general direction with its
pilot program in a traveling nurse corps; VA's pilot program in
establishing a ``nursing academy,'' initially in four sites and
expanding eventually to twelve; its well-founded Education Debt
Reduction Program and Employee Incentive Scholarship Program; and, its
reformed physician pay system as authorized by Public Law 108-445, none
of these programs was established as a rural health initiative, so it
is difficult for DAV to envision how they would lend themselves to
specifically solving VA's rural human resources problems. We do not see
them as specific initiatives aimed at taking advantage of VA's
affiliations to meet clinical staffing needs in rural VA locations.
The DAV has a national resolution from its membership, Resolution
No. 247, reaffirmed at our National Convention in Denver, CO, August
22-25, 2009, fully supporting the rights of rural veterans to be served
by VA, but insisting that Congress provide sufficient resources for VA
to improve health care services for veterans living in rural and remote
areas. We thank VA and this Committee for supporting specific-purpose
funding for rural care without jeopardizing other VA health care
programs, consistent with our adopted resolution. Furthermore, we
appreciate the Committee's interest in conducting this oversight
hearing to learn more from VA about the local situation here in
Georgia. Such information serves everyone's interest in ascertaining
how rural veterans receive care at VA's expense that otherwise might
not have received care were it not for the new resources made available
for rural veterans, as well as gathering data on how their health
outcomes have been affected as a measure of the quality of care.
VA's previous studies of rural needs, identified the need for 156
priority CBOCs and a number of other new sites of care nationwide,
recently including some here in Georgia. A March 30, 2007, report
submitted to Congress indicates 12 CBOCs had been opened, 12 were
targeted for opening in FY 2007, and five would open in FY 2008. In
June 2008, VA announced plans to activate 44 additional CBOCs in 21
states during FY 2009. As of the end of the second quarter of FY 2009,
VA reported 768 clinics in operation, 392 of which are in urban
settings, 337 in rural areas, and 38 in highly rural locations. VA
directly staffs 540 clinics, and the remainder of these CBOCs are
managed by contractors. Of the CBOCs VA operates, 353 are doing real-
time video conferencing (predominantly tele-mental health), while 130
CBOCs are transmitting tele-retinal imaging for evaluation by
specialists in VA medical centers. Services such as these greatly
enhance patient care, extend specialties into rural and highly rural
locations, and drastically cut down on long-distance travel by
veterans. In addition, VA is expanding its capability to serve rural
veterans by establishing rural outreach clinics. Currently, 12 VA
outreach clinics are operational, and more are planned. These are major
investments by VA, and we appreciate both VA and Congress for
supporting this level of extension of VA services into more and more
communities.
While we applaud the VHA for improving veterans' access to quality
care and its intention to spread primary and limited specialty care
access for veterans to more areas, enabling additional veterans access
to a convenient VA primary care resource, DAV urges that the business
plan guiding these decisions generally first emphasize the option of
VA-operated and staffed facilities. When geographic or financial
conditions warrant (e.g., highly rural, scarceness, remoteness, etc.),
we do not oppose the award of contracts for CBOC operations or leased
facilities, but we do not support the general notion that VA should
rely heavily or primarily on contract CBOC providers to provide care to
rural veterans.
We understand and appreciate those advocates on this Committee and
in Congress in general who have been successful in enacting authority
for VA to increase health care contracting in rural areas through a new
multi-VISN pilot program enacted in Public Law 110-387. However, in
light of the escalating costs of health care in the private sector, to
its credit, VA has done a remarkable job of holding down costs by
effectively managing in-house health programs and services for
veterans. While some service-connected and nonservice-connected
veterans might seek care in the private sector as a matter of personal
convenience, doing so may well cause them to lose the safeguards built
into the VA system by its patient safety program, prevention measures,
evidence-based treatments, national formulary, electronic health
record, and bar code medication administration (BCMA), among other
protections. These unique VA features culminate in the highest quality
care available, public or private. Loss of these safeguards, ones that
are generally not available in private sector systems or among
individual practitioners or group practices (especially in rural
areas), would equate to diminished oversight and coordination of care,
lack of continuity of care, and ultimately may result in lower quality
of care for those who need quality the most.
For these reasons, we urge Congress and VA's ORH to closely monitor
and oversee the development of the new rural pilot demonstration
project from Public Law 110-387, especially to protect against any
erosion or diminution of VA's specialized medical programs, and to
ensure participating rural and highly rural veterans receive health
care quality that is comparable to that available within the VA's
health care system. We are pleased that the ORH reported it is
coordinating with the Office of Mental Health Services, to implement
this pilot program. We ask VA, in implementing this demonstration
project, to develop a series of tailored programs to provide VA-
coordinated rural care (or VA-coordinated care through local, state or
other Federal agencies, as VA has previously claimed it would be doing)
in the selected group of rural VISNs, and to provide reports to the
Committees on Veterans' Affairs, of the results of those efforts,
including relative costs, quality, satisfaction, degree of access
improvements and other appropriate variables, compared to similar
measurements of a like group of rural veterans who remain in VA health
care. To the greatest extent practicable, VA should coordinate these
demonstrations and pilots with interested health professions academic
affiliates. We recommend the principles outlined in the Contract Care
Coordination section of the FY 2010 IB be used to guide VA's approaches
in this demonstration, and that it be closely monitored by VA's Rural
Veterans Advisory Committee, with results reported regularly to
Congress.
We also recommend that VA be required to provide more thorough
reporting to this Committee, to enable meaningful oversight of the use
of the funds provided, and the implementation of the authorizing
legislation that serves as a foundation for this work. We urge the
Committee to consider legislation strengthening recurring reporting on
VA rural health as a general matter. We are concerned that funds
Congress provided to VA to address shortages of access in rural areas
will simply be dropped into the VA ``Veterans Equitable Resource
Allocation'' (VERA) system, absent means of measuring whether these new
funds will be obligated in furtherance of Congress's intent--to enhance
care for rural and highly rural veterans, with an emphasis on outreach
to the newest generation of war veterans who served in the National
Guard, and hail from rural areas, including our State. Reports to
Congress should include standardized and meaningful measures of how VA
rural health care capacity or ``virtual capacity'' has changed; VA
should provide recorded workload changes on a quarterly or semi-annual
basis, and disclose other trends on whether the rural health care
initiatives and funds allocated for them are achieving their designed
purposes.
In closing, DAV believes that VA is working in good faith to
address its shortcomings in rural areas, but VA clearly still faces
major challenges and hurdles. In the long term, its methods and plans
may offer rural and highly rural veterans better opportunities to
obtain quality care to meet their specialized health care needs.
However, we caution about the trend toward privatization, vouchering
and contracting out VA health care for rural veterans on a broad scale.
As VA's ORH develops its policies and initiatives, DAV cannot stress
enough the importance of communication and collaboration between this
office, other VA program offices, field facilities, and other Federal,
state and local organizations, to reach out and provide VA benefits and
services to veterans residing in rural and highly rural areas. As noted
above, we are concerned that the current staffing level assigned to ORH
will be insufficient to effectively carry out its mission. Moreover,
DAV believes ORH's position in VHA's organizational structure may
hamper its ability to properly implement, guide and oversee VA's rural
health care initiative. Also, Congress should monitor VA's funding
allocation to ensure that rural health needs do not interfere with
other VA medical obligations. Finally, we are hopeful that with
continued oversight from this Committee and, with these principles in
mind; rural veterans will be better served by VA in the future.
Senator Isakson, your invitation letter asked specific questions
regarding the local situation in rural Georgia, and in particular about
the status of the Brunswick community-based outpatient clinic, that I
would be pleased to discuss in my oral
remarks.
This concludes my formal statement submitted on behalf of DAV. I
would be happy to address questions from you or other Members of the
Committee.
Senator Isakson. Thank you very much, Mr. Nordeoff.
Mr. Spears?
STATEMENT OF ALBERT R. SPEARS, ADJUTANT/QUARTERMASTER,
DEPARTMENT OF GEORGIA, VETERANS OF FOREIGN WARS OF THE UNITED
STATES
Mr. Spears. Good afternoon, Senator and members of your
staff. First, if I can, I haven't heard anyone say anything,
but I would like to offer the condolences, prayers, and best
wishes for the family of Senator Kennedy, the lion of the
Senate. Senator Kennedy helped many on both sides of the aisle
in his many years and he was himself a veteran.
Thank you for inviting the Veterans of Foreign Wars of the
United States to share its views with you on this important
topic. As you know, I am Albert Spears, the State Adjutant/
Quartermaster of the Department of Georgia Veterans of Foreign
Wars.
The topic of the Community-Based Outpatient Clinics, CBOCs,
as you recognized, is both important and timely, but the topic
is not a stand-alone topic. There are significant issues that
affect the CBOCs and quality of care that they provide, the
range of services that they offer, and the placement of those
clinics. The idea is to place and staff CBOCs with Department
of Veterans Affairs employees in a reasonable proximity of the
homes of the veterans to be served. The CBOCs and the system
administering them must not only be located near the population
to be served, but also must provide the range of services
required not just today, but tomorrow and into the future.
I would like to sit here and tell you that everything is
great with the CBOCs. I want to tell you that the quality of
care is world class, the range of services is direct and as it
should be, and that a CBOC is currently located exactly across
Georgia, where it should be, but I cannot.
Currently in Georgia, our CBOCs are operated by VAMCs in
South Carolina, Florida, Alabama, as well as Georgia, and we
have people from Georgia going into Tennessee. We need some
sort of better coordination and may even need some sort of CBOC
command in Georgia. The point will not be lost on you that
these represent not only several different hospitals and
medical centers, but several different Veterans Integrated
Service Networks, or VISNs. Consistency of service is not a
strong point.
The CBOCs must meet the needs not only of the many elderly
veterans from World War II, Korea, and Vietnam, they must
increasingly meet the needs of the younger veteran of the
current conflicts of the First Gulf War, Operation Enduring
Freedom, and Operation Iraqi Freedom. Each must deal with the
medical issues of age-related diabetes, for example, and those
of Traumatic Brain Injury and traumatic amputation on the
battlefield.
We must also not ignore the needs of our female veterans.
While each of us realizes the current makeup of the all-
volunteer military, we must acknowledge and understand that
women are veterans, too. It is not just a slogan or a campaign
speech. Women have been a vital part of the Armed Forces since
the days when Molly Pitcher kept the guns firing at the Battle
of Monmouth to today's females being awarded the Silver Star
for gallantry in
action.
And to our enduring discredit, they have not always been
treated with honor, respect, and the dignity which they
deserve. Yet we have women veterans having their civilian
medical insurance being charged by the VA when they are being
treated at the VA for service-connected disabilities. This
continues still.
Regardless of the value of the CBOCs throughout Georgia, a
female veteran cannot obtain routine care that is required for
her as expected by her age group, and female veterans represent
about 25 percent of the veterans population needing care in
Georgia. Our female veterans express that the medical health
care providers within the VA system and contracted health care
providers frequently do not take them seriously. The providers
do not seem concerned about our female warriors' medical
problems and their association of various conditions from the
combat environment.
The VA simply must also deal with the issue of child care.
Pap smears, mammograms, pre- and post-menopausal care, and
sexual trauma care are practically nonexistent in the system
today, especially in the CBOC. This does not even consider the
other needs and other gynecological needs such as fertility
counseling that may be necessary. Since we have decided to make
so many of these young women into almost professional athletes
by the various services' physical and strength training, many
of our female warriors have not had normal menstrual cycles in
years.
There are various programs established for and targeting
female veterans, but most require travel to centers and
programs that simply cannot be considered reasonable,
especially for our younger female veterans that are frequently
single parents.
One point that I pray is not missed and does not fall on
deaf ears is that a female veteran that files a claim for
service connection as a victim of military sexual trauma while
in the service, whether it was last week or 60 years ago,
should be considered presumptive if she is suffering the mental
effects of that trauma. She should not be further traumatized
and revictimized by having to prove service connection when
every cog in the system in which she was operating told her to
take it and forget it happened when it happened.
Remember that the movie ``The General's Daughter'' was, in
essence, a true story of rape in the military and that was what
we call the modern military. We must all remember the scandals
over the years of the drill sergeants and their trainees, the
scandals of the rapes, and the institutional cover-ups at
various service academies. Presumption of service connection is
a must-do. It cannot wait and it must be done now, by
legislation, if necessary.
Again, I realize that the CBOC cannot do everything, but we
are not serving any of our Post Traumatic Stress victims
properly at the CBOC, nor are we doing a very good job at the
VAMCs. The staff of each is trying hard, and I want to stress
this. The staff of each is trying hard to accommodate the need,
but it simply is not being met. The suicide rate demonstrates
that fact.
Our female warriors should be placed in PTSD group
counseling sessions with other female veterans. This can be as
simple as mental health visiting and establishing a group
within the women's clinic each month.
For the topic at hand, the Brunswick CBOC, I found no one
that discussed any dissatisfaction with that facility except
the time that it is taking to get it online.
With noted exceptions regarding female veterans, the CBOCs
are providing outstanding services and an adequate range of
services. Many clinics have waiting times for appointments and
procedures that are excessive.
We must also remember that with the reduction of medical
staffs in rural America, much of the previous access to medical
care that may have been available in an area has been
diminished drastically. I have noticed as I have driven through
the State of Georgia numerous offices of health care providers
that have been closed, as well as clinics and hospitals. There
may be an opportunity to lease or purchase some of these
facilities for CBOCs in needed areas, as an example, in McRae
in Telfair County. That hospital was closed within the last
year. Such efforts may be beneficial to attract medical-related
businesses to the area, such as pharmacies and drug stores.
Prime irritants within the CBOCs, and the entire VA health
care system are--and I am just about finished, if you would
bear with me--telephone numbers. There never seems to be a
direct telephone number to anybody. I can call your office
direct, and even if you are not on the floor, I can talk to
you. Unfortunately though, I can't call Larry Biro, by way of a
direct line. I have got to go through three switchboards and
two patient advocates in order to get there.
Appointment wait times--some CBOCs have a very short
waiting time, such as Stockbridge, and others have a
significantly longer waiting time, such as Smyrna. Endless
``round-robin'' telephone systems--no one minds a truly
responsive telephone menu system, but too many of them are
endless loops within the VA system.
In closing, I must reiterate the treatment of our female
veterans. Our women warriors served this Nation in the true
spirit of Palace Athena and they need to receive the health
care treatment to which they are entitled. Only one clinic at
the VAMC Atlanta treats these great warriors. The purchase of
the Southwest Atlanta Medical Center is available now. Purchase
of that facility and conversion to a VA medical center could
facilitate the expansion of health care services across the
board so desperately needed now by freeing up space in Decatur
or making it available at Southwest Atlanta Medical.
Thank you for inviting me here today, and I welcome any
questions.
[The prepared statement of Mr. Spears follows:]
Prepared Statement of Albert R. Spears, State Adjutant/Quartermaster,
Department of Georgia Veterans of Foreign Wars of the United States
Good Afternoon, Senator Isakson and members of this Field Hearing
of the Senate Veterans' Affairs Committee. Thank you for inviting the
Veterans of Foreign Wars of the United States to share its views with
you on this important topic. As you will recall, I am Albert Spears,
the State Adjutant/Quartermaster of the Department of Georgia Veterans
of Foreign Wars of the U.S.
The topic of Community-Based Outpatient Clinics (CBOCs) as you
recognize is both important and timely and I will address it directly--
its strengths and its shortcomings. But the topic is not a stand-alone
topic. There are significant issues that affect the CBOCs and the
quality of care that they provide, the range of services that they
offer, and the placement of those clinics.
The ideal is to place and staff with Department of Veterans Affairs
employees, CBOCs in a reasonable proximity of the homes of the veterans
to be served. The CBOCs and the system administering them not only must
be located near the population to be served but also must provide the
range of services required not just today, but tomorrow and in to the
future.
I would like to sit here and tell you that everything is great with
the CBOCs. I want to tell you that the quality of care is world class,
that the range of services is direct and as it should be, and that a
CBOC is currently located exactly where it should be. Alas, I cannot.
Currently in Georgia, our CBOCs are operated by VAMCs in South
Carolina, Florida, Alabama, Tennessee, as well as Georgia. We need some
sort of better coordination and may even need a ``CBOC Command'' in
Georgia. The point will not be lost on you that these represent not
only several different hospitals/medical centers but also several
different Veterans Integrated Service Networks (VISN). Consistency of
services is not a strong point.
The CBOCs must meet the needs not only of the many elderly veterans
of World War II, Korea, and Vietnam; they must also meet increasingly
the needs of the younger veteran of the current conflicts of the first
Gulf War, Operation Enduring Freedom, and Operation Iraqi Freedom. Each
must deal with the medical issues of age related diabetes (as an
example) and those of Traumatic Brain Injury and traumatic amputation
from the battlefield. We also must not ignore the needs of our female
veterans. While each of us realizes the current make-up of the All
Volunteer Military, we must acknowledge and understand that women are
veterans too!
Women are veterans too is not just a slogan or campaign speech.
Women have been a vital part of the Armed Forces since the days of
Molly Pitcher keeping the field guns firing at the Battle of Monmouth
to today's females being awarded the Silver Star for gallantry in
action. And to our enduring discredit, they have not always been
treated with honor, respect, and dignity that they deserve. Yet, we
have women veterans having their civilian medical insurance being
charged by the VA when treated at the VA for established service-
connected disabilities.
Regardless of the value of the CBOCs throughout Georgia, a female
veteran cannot obtain routine care that is required for her as expected
by her age group and female veterans represent about 25 percent of the
veteran population needing care in Georgia.
Our female veterans express that the medical healthcare providers
within the VA System and contracted health care providers do not take
them seriously. The providers do not seem as concerned about our female
warriors' medical problems and the association of various conditions
with combat and the combat environment.
The VA simply must deal with the issue of child-care. The
Department of Defense is working toward providing child-care while
warriors are receiving medical treatment; the VA has to consider this
as well. We have so many patients that need treatment--not all of whom
are female nor even young--that are single parents and have no place to
leave a child when going to the VA for treatment. This certainly
requires a review.
Pap smears, mammograms, pre/post menopausal care, sexual trauma
care are practically non-existent in the system today. This does not
even begin to consider other needs and other gynecological needs such
as fertility counseling that may be necessary after we have made so
many young women almost professional athletes by the various services'
physical and strength training that many of our female warriors have
not had normal menstrual cycles in years. There are several programs
established for and targeting our female veterans but most require
travel to centers and programs that simply cannot be considered
reasonable especially for our younger female veterans that are
frequently single parents.
One point that I pray is not missed and does not fall of deaf
ears--a female veteran that files a claim for service connection as a
victim of sexual trauma while in the service whether or not it was last
week or 60 years ago should be considered ``presumptive'' when she is
suffering the mental effects of that trauma. She should not be further
traumatized and re-victimized by having to prove service connection
that every cog in the system told her she should just ``. . . take it
and forget it happened . . .'' when it happened. Remember that the
movie ``The General's Daughter'' was in essence a true story of rape in
the military and it was what we call the modern military. We all
remember the scandals over the various years of the drill sergeants and
their trainees and the scandals of the rapes and institutional cover-
ups at the various service academies. Presumption of service connection
is a must do; it cannot wait and must be done now, by legislation if
necessary.
Again, I realize that the CBOC cannot do everything but we are not
serving any of our real Post Traumatic Stress victims properly at the
CBOC nor are we doing a very good job at the Veterans Administration
Medical Centers (VAMC). The staff of each is trying hard to accommodate
the need but it is not being met. The suicide rate simply demonstrates
that fact. Our female warriors should be placed in PTSD group
counseling sessions with other female veterans. This can be as simple
as mental health visiting and establishing a ``group'' in the Women's
Clinic once each month.
For the topic at hand, the Brunswick CBOC--I found no one that
discussed treatment specifically at that clinic either good or bad. As
I alluded to earlier in my testimony, the VFW prefers that all clinics
be staffed with professionals employed by the Department of Veterans
Affairs. We realize that may not always be possible and some may have
to be staffed by contract. The difficulty with contracting is that
regardless of the requirements that are or should be built into the
contract as performance standards, the perception is that contract
personnel are less receptive to the needs of veterans especially
elderly ones. It seems to get lost to the contractor that the old man
who is moving so slowly on the walker, has hearing aids in both ears,
wears coke bottle thick glasses, and talks too loud in the waiting room
was the same young man who charged a machine gun nest 65 years ago on
an island in the Pacific saving the lives of countless Marines.
With the noted exceptions regarding female veterans, the CBOCs are
providing outstanding services and an adequate range of services. At
many clinics the appointment waiting times (and procedures) are
excessive.
We must also remember that with the reduction of medical staffs in
rural America, much of the previous access to medical care that may
have been available in an area has been diminished drastically. I have
noticed as I have driven the State of Georgia, numerous offices of
healthcare providers that have closed as well as clinics and county
hospitals. There may be an opportunity to lease or purchase some of
these facilities for CBOCs in needed areas. Such efforts might also be
beneficial to attracting medical related businesses to the area as well
such as pharmacies and drug stores.
Prime irritants regarding the CBOCs but also apply to the entire VA
Health Care System are:
a. Telephone Numbers--there never seems to be a published
direct telephone number to a clinic or a number at which a
patient can talk to a human being. I can (and do) pick up the
telephone and call your office, the Chief of Staff of the
Army's Office, the Secretary of Veterans Affairs Office, but I
cannot call the Office of the Director of VAMC-Atlanta's Office
or even the direct line to the Stockbridge CBOC.
b. Appointment Wait Times--While some CBOCs have a very short
wait time, others have significant wait times even when the
appointment is needed solely for a referral for a serious
condition.
c. Endless ``round robin'' telephone systems--No one truly
minds telephone menu systems that sort and a route to ultimate
solutions. Too many of those in the VA Health Care System
result in having to leave a message to await a call back at
some date in the future. Too frequently that call never comes.
Appointments, prescription refills, specialty referral
requests, and even calls to the patient advocate are too
frequently on such systems.
In closing, I must return to treatment of our female veterans. Our
women warriors served this Nation in the true spirit of Pallas Athena
and they needed to receive the healthcare treatment they are entitled.
Only one clinic at the VAMC-Atlanta treats these great warriors. The
purchase of the Southwest Atlanta Medical Center in Atlanta is
available now. Purchase of that facility and conversion to a VA Medical
Center could facilitate the expansion of healthcare services so
desperately required now by freeing space at Decatur or making it
available at Southwest Atlanta Medical.
Thank you for inviting me here today.
Senator Isakson. Well, thank you, Mr. Spears.
First of all, Mr. Nordeoff, if I made my notes correctly on
your testimony, there are 54,526 disabled veterans in
Southeastern Georgia?
Mr. Nordeoff. Yes, sir.
Senator Isakson. And you made note of the extensive burden
on the Savannah facility now. So, I want to ask you this
question. With the opening of a Hinesville facility in 2011 and
the Brunswick facility in 2010, will that--do you think that
meets the needs of those 54,000 and reduce the extended waiting
time periods?
Mr. Nordeoff. Yes, sir, I believe it is going to help a
lot. Because right now, that would end up giving Hinesville and
the local area 15,000 people going there. Savannah would have
25,000. So it would influx a whole bunch of----
Senator Isakson. Savannah would have 25,000 after the
opening of Hinesville?
Mr. Nordeoff. Yes, sir.
Senator Isakson. OK.
Mr. Nordeoff. Yes, sir. They have got 25,672 as we speak.
Senator Isakson. OK.
Mr. Nordeoff. Plus there are 15,000 from the surrounding
areas in Hinesville, Georgia.
Senator Isakson. Some of those 25,000 that are using
Savannah now would probably transition to Hinesville, would
they not?
Mr. Nordeoff. Yes, sir, I would imagine.
Senator Isakson. So, it would relieve some of Savannah's
pressure by opening Hinesville.
Mr. Nordeoff. Yes, sir. Yes, sir.
Senator Isakson. What about the positive effect of
Brunswick? Have you quantified that?
Mr. Nordeoff. Yes, sir. Yes, sir. Brunswick, just where
Kingsland is, sir, Camden County, they are doing 5,949 veterans
as we speak. Now, from the three surrounding counties, there
are 7,408 disabled veterans. So, with a Brunswick clinic and
the three surrounding areas, they would end up taking 7,480 off
of Kingsland, where Kingsland is running 5,949, sir.
Senator Isakson. So the timely opening of Brunswick and
Hinesville will make a dramatic improvement in the
accessibility for veterans in this region?
Mr. Nordeoff. Yes, sir. The Brunswick clinic wouldn't have
to be as big as the Hinesville clinic. The Hinesville clinic
has got to be something to maintain, you know, for PTSD and
everything like that.
Senator Isakson. Well, let the record reflect that is
precisely why we are having this hearing today, so that is
exactly the intent we plan for.
Mr. Spears, on your statement with regard to the
presumption of service connection in terms of sexual harassment
or abuse, you are referring that presumption to the VA's
responsibility to treat, not to the conviction of a
perpetrator, is that correct?
Mr. Spears. Yes, sir. I am not speaking of any prosecution
or anything. I am talking about if a psychiatrist has found
that this person has, indeed, suffered that trauma and so
forth, it should be considered service-connected, period. I am
not talking about prosecution or anything of that nature.
Senator Isakson. I just want to make sure the record was
correct on that.
Mr. Spears. Yes, sir. Absolutely.
Senator Isakson. Also, I do appreciate your emphasis on
women. As you know, in the earlier panel, I made reference to
the trauma which a number of women are going through in our
Warrior Transition Centers because of the uniqueness of some of
the injuries that they are affected with, orthopedically and
other ways, so I appreciate your raising that again.
I will say, in my interaction with the VA hospitals and
facilities, I think that is of note to them now. Not that they
were not looking at it before, but I think the intensity of the
number of unique health-related circumstances is causing a
bigger focus on our women veterans. We appreciate their service
and I appreciate your bringing that up.
Mr. Spears. Yes, sir. Thank you. I also noted that after I
filed my testimony with your office and with the Senate
Veterans' Affairs Committee, that Secretary Shinseki has come
forward and modified some of the requirements on PTSD.
Senator Isakson. Thank you for that. I have one other
question for you, if I can.
Mr. Spears. Yes, sir.
Senator Isakson. From your discussions with veterans, have
you been able to see a difference in patient satisfaction
between VA-staffed clinics and contract clinics?
Mr. Spears. Yes, sir. Quite honestly, and there is a
portion of it in my prepared remarks. The veteran himself--and
whether it is just a perception, but as you know, when you are
in there, perception is reality--that they are better treated
by VA employees. Many times it is because the VA employees
themselves are veterans, as Mr. Biro mentioned. He is a
veteran. They feel that they are better treated. You don't
really get across, necessarily, to a contractor that the old
guy wearing two hearing aids and walking on a walker and
talking too loud in the waiting room is a guy who 65 years ago
charged a machine gun nest and saved countless Marines.
Senator Isakson. My comment on that would be, I think that
is an appropriate issue to raise; and I think as the VA
contracts for services, that recognition should be there so
that sensitivity becomes a part of the contract. I don't think
the care of the physicians itself is substandard, but I think
maybe the lack of sensitivity to the veteran may not be there
simply because, unfortunately, it is like the U.S. Senate.
There are only 27 of us, I think, that served, or 30, something
like that, and there is a disconnect in some cases. I think
possibly the VA could note in their contracts with the
providers to recognize who these men and women are and where
they have come from and what they have done to sacrifice for
our country.
Tom, did VA contact your office when it was apparent that
there would be delays in opening the Brunswick clinic? And how
would you rate the communication from the VA to your Department
in Georgia?
Mr. Cook. My hearing is--did you ask, did VA contact us----
Senator Isakson. Were you in contact when the delays of
Brunswick were encountered with the first re-do of the first
contract to go to a second offering? Were you made aware that
was happening so you could communicate it?
Mr. Cook. We were not made--to my knowledge, we were not
made aware, no, sir, not until the--when the issue was raised
by your office in conjunction with this hearing. That could be
as much part of us as them. But I do not believe that as far as
a delay in the contract or the rebidding process, that we were
made aware of it until the call came to prepare for this
hearing. We started asking questions at that point, as far as
what was going on with it and what the delay involved.
Senator Isakson. Well, the reason I asked the question is,
I understand the tremendous--I understand Mr. Spears' comments
about how many computers you have to talk to on the telephone
before you get to a person. I deal with that frustration
myself. Communication is a very important thing, and a lot of
frustration with services is more out of frustration with the
lack of information and communication than it is the actual
service. So I think there is a good lesson. You know that in
representing those you represent--either VFW, American Legion,
Disabled Veterans, whatever.
I think it should be well noted, one of the best things the
Georgia Department of Veterans Services has going for it is
Pete Wheeler--a one-man communications center--who makes sure
the veterans know that he knows what is on their minds. So your
comments there are well noted.
Mr. Cook. The other part that I believe you asked, in terms
of our communication level with the VA, I think it is very
good. When we ask, we will certainly get an answer; and there
is no problem there. I think, likely with the contract rebid
issue and perhaps some other things that we don't get in on, it
is more so the flurry of activity of what we are in on. The
issues that we are dealing with and working with and so many
things are going on at the same time, which if it doesn't get
raised to our attention by, say, a veteran in the field
somewhere or one of our offices, then we don't inquire whether
it should have been shared or whether there could be--I am sure
it could be improved.
Communication on all accounts and all levels likely can be
improved. But the Commissioner has a way of finding out and
knowing. Some times we just have so much going on particularly
right now with the budget issues and trying to fight for
survival for our programs--that what we do has likely got us
tunnel-visioned on some things that we should have been in on.
Senator Isakson. Mr. Biro, why don't you join us up at the
table. I am going to ask a question that might involve your
participating in the answer. In fact, I know it will, so that
is why I want you to join us.
Pete Wheeler, as represented by Tom Cook's testimony,
mentioned the second Atlanta VA hospital. You did a great job
of testifying as to the criteria that you go through in terms
of determining outpatient clinics. Can you share with me and
with the audience what criteria you go through in terms of the
establishment of a new residential hospital facility?
Mr. Biro. It is very similar to the one we talked about for
Community-Based Outpatient Clinics. It is based on data. It is
an actuarial model of utilization that the Department runs for
us and projects the demands for many, many services--I am
saying 40 or 50 services--over a period of time based on the
veteran population, using a model that takes private
utilization, takes VA utilization, Medicare, and does a very
complex analysis of that.
Senator Isakson. Do you know if any analysis is being done
given the Atlanta region now?
Mr. Biro. Yes, it has been. It is finished. What the data
shows is a tremendous growth in outpatient needs of several
hundred thousand square feet of additional clinical space for
outpatient facilities; need for residential rehabilitation for
mental health patients; and what you are asking about. The
acute care shows about 10 to 12 more beds, which are----
Senator Isakson. For acute care?
Mr. Biro. For acute care.
Senator Isakson. So you need more clinical--the study
indicates more clinical services, but not that much in actual
bed services or residential services?
Mr. Biro. Inpatient acute care.
Senator Isakson. And that service is based on what the
Clairmont facility will be when the renovations are finished
there?
Mr. Biro. Yes, sir. That is correct.
Senator Isakson. OK. Will the Department normally, based on
the study they run, make the request, or do you wait for the
State through their Representatives or Senators to make the
request for that consideration?
Mr. Biro. We work off that data. As Mr. Williams pointed
out, we work off that data. It is constantly updated. The
appropriation is based on that data. Everything is based on
that database. So we follow the plan--Senators and
Representatives can ask for an exception--but we follow the
plan. The Department follows the plan.
Senator Isakson. Well, my observation to the results that
you mentioned is that one of the reasons the outpatient clinics
are so successful--and I think you can tell by the nods of
heads every time something like that has been said by our
veterans--is that the nature of care is changing dramatically
from in-bed care to outpatient care. I go to Walter Reed quite
frequently to visit with our amputees and with our men and
women who sacrificed, and it is remarkable--the technology that
VA is applying and how those veterans are coming out of those
facilities. Their needs are more for outpatient services once
they come out than they are for inpatient residential service.
So, I guess what you are saying is that 12 beds residential is
not a huge number compared to the number we already have, but
there is a shortfall of the clinical services that we need to
look at.
Mr. Biro. Yes, that is right.
Senator Isakson. All right. If that is the case--I am not
being presumptive here and I don't want to be presumptive here,
but I think Mr. Spears made reference to the same type of
thing--does that beg the question that the need is a clinic, an
outpatient clinic specifically for those PTSD, TBI, and other
related mental health services?
Mr. Biro. Yeah. We will proceed to get enough space. As you
have already brought up, we have an application in for a health
care center, which Mr. Williams talked about. We will also
proceed along a parallel line to lease several hundred thousand
square feet of clinic space in the Atlanta area. So we are
moving on the plan.
Senator Isakson. So the health care center might be one of
the solutions to that problem?
Mr. Biro. Right.
Senator Isakson. OK. Tom, have you got any comments on
those questions? I wanted Pete to make sure you knew I asked
all of them.
Mr. Cook. I believe certainly the Commissioner supports as
many clinics and rehab facilities as we can open and any
expansion of health care in any realm. I think the point that
needs to be emphasized along with the bed space is the
specialty care appointments issue. With the growth of the
clinics and expansion of the clinics, particularly in the
Atlanta area, the referrals to the medical center for specialty
care appointments is growing, or at least that is our
position--correct me if I am wrong. And if that is the case,
that it is not just simply a bed issue--even though Position B
would have made the hospital on the Southwest side of Atlanta--
but the specialty care referrals, as well, is where we have a
problem right now inside the Atlanta Medical Center--with the
specialty care.
Senator Isakson. Well, my observation at Clairmont, I was
overwhelmingly impressed with the specialty services available
at Clairmont--particularly blindness, specialty services like
that. I would presume, Mr. Biro, that those types of services
could be accommodated in a clinical setting; because if I
remember correctly, when I visited the Blind and Low-Vision
Center at Clairmont, it was an outpatient part of the hospital
itself, if I am not mistaken.
Mr. Biro. Right, and I may have not been real specific.
What we are saying is we are planning for not only primary care
but all specialties, or the core set of specialties. So, we
will have space to cover that. That requires what is happening
in almost every VA is that the primary care is moving out of
the main building and more specialty care is going there. But
we are also going down the route of having more specialty care
in the Community-Based Outpatient Clinics or remotely. So, we
are moving along that way. We would take care of all needs.
Senator Isakson. Well, I want to thank you. I learned a
lot, and I appreciate your candor. I appreciate, Tom, your
raising that question, because we have received, what,
hundreds, Chris, of calls regarding Clairmont--mostly over the
parking right now and that inconvenience--but also about the
growing demand and need, particularly because of the number of
Gulf War and Iraqi Freedom and Enduring Freedom veterans who
are coming back to the metropolitan Atlanta region.
Mr. Spears, my staff reminded me you were making comments
with regard to the women's issue. S. 252 is expected to clear
when we return. This has the pilot program for therapy in a
retreat setting. It has a status report on implementation of
having a Women's Veterans Coordinator in every health facility,
day care for women, and things like that. So, the Committee is
moving forward on those provisions and I am sorry I didn't
mention that early during your comments.
Mr. Spears. Yes, Senator, and those coordinators are doing
an outstanding job, by the way. Much of what I got was from
some of those coordinators.
Senator Isakson. Thank you for that.
I will tell you what. Let me see, Mr. Williams, if you
could pull a chair up, and let our VA lady from Augusta come up
and take this chair at the end. I am going to gavel the
official hearing closed so we can then respond to some
questions that have been presented to me from the audience.
I would also note--Lupe, I think this is correct--I will
ask unanimous consent that the record remain open for 10 days
for any additional testimony you would like to submit with
regard to questions I asked or any things that came up during
the course of the hearing.
But now, for the purpose of Q&A, I will gavel this part of
the hearing closed.
[Whereupon, at 3:50 p.m., the Committee was adjourned.]
A P P E N D I X
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