[Congressional Record (Bound Edition), Volume 147 (2001), Part 10]
[Senate]
[Pages 14043-14044]
[From the U.S. Government Publishing Office, www.gpo.gov]



               ACCESS TO VA HEALTH CARE IN WEST VIRGINIA

  Mr. ROCKEFELLER. Madam President, as chairman of the Committee on 
Veterans' Affairs, I want to share with my colleagues some of the 
concerns voiced by veterans at a recent field hearing in my state of 
West Virginia.
  On July 16, the Committee held a hearing in Huntington, West 
Virginia, to examine the challenges facing veterans from rural areas 
who receive health care through the Department of Veterans Affairs. The 
Committee held its last West Virginia field hearing on access to rural 
VA health care in 1993.

[[Page 14044]]

Since then, profound changes in VA's health care delivery--a rapid 
increase in community clinics, eligibility reform that opened the 
system to more veterans, and the reorganization of VA into 22 service 
networks--have affected how veterans access basic and specialized 
medical care.
  The challenges that face VA in providing the best health care 
possible to our Nation's veterans are often magnified in rural areas, 
where veterans and VA caregivers must stretch already limited resources 
over long distances. West Virginia contends with a unique situation: 
each of our four VA medical centers belongs to a different VA service 
network. While this partitioning creates problems for West Virginians, 
it also offers the Committee the opportunity to study in microcosm the 
problems facing veterans throughout the VA health care system.
  Regrettably, many of the problems discussed at the 1993 field hearing 
remain with us: the struggles with an inadequate budget, long waiting 
times for care, too few VA personnel to provide specialized care, 
insufficient long-term care services, and transportation problems for 
veterans traveling to or between VA medical centers. And, with the 
aging of the veterans population and continued absence of meaningful 
prescription drug coverage under Medicare, veterans' concerns about 
access to, and copayments for, prescription drugs grow even more 
pressing.
  It will not be easy to solve these problems; after the President's 
recent tax cut, there is simply not enough money available--either in 
the President's budget or the Budget Resolution adopted by the 
Congress--for veterans' health care. That said, we must do our best to 
improve access to rural health care with the resources that we have.
  On July 16, West Virginia veterans talked to me about the obstacles 
they face just to get an appointment at a VA health care facility, and 
then in getting to that appointment for care. Veterans report to the 
State Veterans Coalition that they regularly wait months for an 
appointment for basic VA medical care--or even longer for a first 
visit. After veterans have finally seen a doctor for a first exam, they 
may wait weeks or months longer for a referral to needed specialty 
care.
  For veterans in rural areas, referrals frequently require a transfer 
to distant VA medical centers. After hours of driving, veterans may sit 
for many more hours in a waiting room, without meals or a safe place to 
rest. A shocking number of veterans disabled by spinal cord injuries 
neglect basic medical checkups to avoid travel. One West Virginia 
veteran described making more than 30 round trips to the VA hospital at 
Richmond for tests based on a single referral; and his story, 
unfortunately, is not unique. This is not only inconvenient for the 
veteran, but a waste of VA resources.
  VA must focus on coordination and management of care between 
facilities--both to provide the best health care and to consider the 
practical needs of veterans. For veterans who must drive long distances 
or depend on van services, appointments could be scheduled to 
accommodate their traveling times. VA could coordinate tests to 
compress them into the shortest time span possible, with lodging 
arranged when an overnight stay is required. Veterans who served this 
country should not be expected to sleep in waiting room chairs and to 
go hungry when simple attention to details can prevent excessive 
traveling and long waits. At the very least, VA should have a 
systemwide plan for communicating how transfers work, and what 
resources are available, to veterans and their families.
  Although it is impossible to expect that every veteran in the 
Nation's vast rural areas can access every health care service close to 
home, it is essential that--should they require care at distant VA or 
private facilities--their transfers happen as simply and efficiently as 
possible. VA's network and hospital directors must eliminate barriers 
to coordinating and managing care between medical centers or between 
networks. I will continue to work with VA to find better ways to 
communicate with veterans and to make transfers as seamless as 
possible.
  The Millennium Act, which VA has been shamefully slow to implement, 
will provide veterans with access to noninstitutional long-term care 
services. As I heard from the son of a World War II ex-prisoner of war, 
now being cared for at home at his family's expense, aging veterans 
suffering from PTSD need caregivers who understand the legacies of war-
time experiences. The Committee will continue to oversee VA's efforts 
to bring long-term care services--both nursing beds and 
noninstitutional services--to the veterans who need it.
  I have advocated the opening of community-based outpatient clinics, 
which bring basic primary health care closer to the veteran. These 
outpatient clinics are enormously important to veterans in rural areas, 
and I will continue to urge VA to make these clinics the best they can 
possibly be--without sacrificing the specialized programs at which VA 
has excelled.
  We have to count more than just the number of clinics and hospitals 
when we talk about access to health care--we must consider waiting 
times for an appointment. Many of the delays in appointments, 
referrals, and transfers that veterans experience stem from inadequate 
staffing, especially the increasingly critical shortage of skilled 
nurses. I have recently introduced legislation to improve VA's ability 
to recruit and retain nurses, whose skills are essential to providing 
high quality health care in a timely fashion.
  Finally, I would like to take this opportunity to acknowledge the 
efforts of the many volunteers who help bring rural veterans closer to 
health care. Disabled American Veterans (DAV) operates a nationwide 
Transportation Network that helps sick and disabled veterans reach VA 
medical facilities for care. Since its inception, DAV volunteers in 
West Virginia have dedicated more than 700,000 hours of time to driving 
veterans to medical appointments, often in vans donated by DAV to the 
VA. Nationally, DAV Hospital Service Coordinators operate 185 such 
programs, where 8,000 volunteers donated almost 2 million hours last 
year alone. Although this program does not replace VA's obligation to 
bring services close to the veteran where possible and to smooth 
transfers between medical centers, this service is certainly 
indispensable to disabled veterans who must reach a VA medical center 
for necessary medical care.
  Mr. President, in closing, I look forward to working with VA and my 
colleagues in the Senate to find the best ways to extend health care 
more efficiently--and effectively--to veterans in our Nation's rural 
areas. We owe our veterans nothing less.

                          ____________________