[Joint House and Senate Hearing, 110 Congress]
[From the U.S. Government Publishing Office]
S. Hrg. 110-146
SENATE-HOUSE JOINT FIELD HEARING ON ISSUES FACING VETERANS IN THE RURAL
AREAS OF APPALACHIA
=======================================================================
JOINT HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
AND THE
COMMITTEE ON VETERANS' AFFAIRS
HOUSE OF REPRESENTATIVES
ONE HUNDRED TENTH CONGRESS
FIRST SESSION
__________
MAY 29, 2007
__________
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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SENATE COMMITTEE ON VETERANS' AFFAIRS
Daniel K. Akaka, Hawaii, Chairman
John D. Rockefeller IV, West Larry E. Craig, Idaho, Ranking
Virginia Member
Patty Murray, Washington Arlen Specter, Pennsylvania
Barack Obama, Illinois Richard M. Burr, North Carolina
Bernard Sanders, (I) Vermont Johnny Isakson, Georgia
Sherrod Brown, Ohio Lindsey O. Graham, South Carolina
Jim Webb, Virginia Kay Bailey Hutchison, Texas
Jon Tester, Montana John Ensign, Nevada
William E. Brew, Staff Director
Lupe Wissel, Republican Staff Director
HOUSE COMMITTEE ON VETERANS' AFFAIRS
Bob Filner, California, Chairman
Corrine Brown, Florida Steve Buyer, Indiana, Ranking
Vic Snyder, Arkansas Member
Michael Michaud, Maine Cliff Stearns, Florida
Stephanie Herseth Sandlin, South Jerry Moran, Kansas
Dakota Richard Baker, Louisiana
Harry E. Mitchell, Arizona Henry Brown, South Carolina
John J. Hall, New York Jeff Miller, Florida
Phil Hare, Illinois John Boozman, Arkansas
Michael F. Doyle, Pennsylvania Ginny Brown-Waite, Florida
Shelley Berkley, Nevada Michael R. Turner, Ohio
John T. Salazar, Colorado Brian Bilbray, California
Ciro Rodriguez, Texas Doug Lamborn, Colorado
Joe Donnelly, Indiana Gus M. Bilirakis, Florida
Jerry McNerney, California Vern Buchanan, Florida
Zachary T. Space, Ohio
Timothy J. Walz, Minnesota
Malcom Shorter, Staff Director
Jim Lariviere, Republican Staff Director
C O N T E N T S
----------
May 29, 2007
SENATORS
Page
Brown, Hon. Sherrod, U.S. Senator from Ohio...................... 1
Space, Hon. Zachary, House Representative from Ohio.............. 3
WITNESSES
Anderson, Frank, Government Relations Director, Buckeye Chapter,
Paralyzed Veterans of America.................................. 5
Prepared statement........................................... 8
Moore, Larry D., Legislative Chairman, Department of Ohio,
Veterans of Foreign Wars of the United States.................. 12
Prepared statement........................................... 14
Ondick, George, Executive Director, Department of Ohio, AMVETS... 16
Prepared statement........................................... 18
Bertschy, Robert H., Vice Commander, Department of Ohio, Disabled
American Veterans.............................................. 22
Prepared statement........................................... 24
Burke, Thomas R., President, Buckeye State Council, Vietnam
Veterans of America............................................ 26
Prepared statement........................................... 28
Lanthorn, Donald R., Service Director, Department of Ohio, The
American Legion................................................ 30
Prepared statement........................................... 32
Carson, Terry M., Chief Executive Officer, Harrison Community
Hospital....................................................... 39
Prepared statement........................................... 41
Cross, Gerald M., M.D., FAAFP, Acting Principal Deputy Under
Secretary for Health, Department of Veterans Affairs........... 42
Prepared statement........................................... 44
SENATE-HOUSE JOINT FIELD HEARING ON ISSUES FACING VETERANS IN THE RURAL
AREAS OF APPALACHIA
----------
TUESDAY, MAY 29, 2007
U.S. Congress,
Joint Committee on Veterans' Affairs,
Washington, DC.
The Committees met, pursuant to notice, at 10 a.m., in
Founders Hall Auditorium, Kent State University-Tuscarawas, 330
University Drive, NE., New Philadelphia, Ohio, Hon. Sherrod
Brown (Member of the Senate Committee on Veterans' Affairs) and
Zachary Space (Member of the House Committee on Veterans'
Affairs) presiding.
Present: Senator Brown and Representative Space.
OPENING STATEMENT OF HON. SHERROD BROWN,
U.S. SENATOR FROM OHIO
Senator Brown. I'm Senator Sherrod Brown, joining with
Congressman Zach Space, many representatives of the veterans
community, and others here this morning, and I so appreciate
your all being here.
I would begin the day first by asking for a moment of
silence for the 3,400 Americans who have died in the Iraq-
Afghanistan, and the literally tens of thousands of Americans
who have been injured, if we can start with a moment of
silence. Thank you. I especially thank the veterans in the
audience who are here, the veterans who will testify, the
veterans' advocates who are with us. Every one of these veteran
advocates have already--I believe every single one has been to
see me in Washington. I assume many of them have been to see
Congressman Space with his position on the Veterans' Committee.
We know the importance of all of that.
I thank Gregg Andrews, the Dean of Tuscarawas Branch of
Kent State University, thank him and his staff for allowing us
to be here. I want to, again, especially thank those that have
come from all over the state to testify today.
It's fitting, of course, that we're holding this hearing
the day after Memorial Day, a date to honor our Nation's fallen
men and women in uniform. We're focusing on improving services
for our Nation's veterans, so we may honor them, as well. We
have a full slate of issues, and a very ambitious agenda, so
I'll keep my remarks brief.
The purpose of the field hearing is to hear from veterans
in Ohio so that we can make better decisions in Washington that
affect our Nation's veterans. This is an official hearing. We
have people from the Veterans' Committee in Washington. This is
the first of its kind. To our knowledge, it's the first time
the House and Senate Veterans' Committee have ever done a joint
hearing outside of Washington, and we chose to do it in the
heartland of sort of East Central Ohio, so that particularly
veterans facing the unique problems that veterans do in rural
Ohio, and rural parts of this country can be heard.
We know that the Veterans' Administration, a public system,
not a privatized one. We know that the VA gives the best
healthcare in the country, and in the world, when it's funded
properly. We also know the President's budget fell about $4
billion short in funding what veterans' organizations have
asked that we fund.
The good news is that the Congress, now the House and the
Senate, are working under a recently passed budget that very
closely mirrors the request of the Independent Budget. The
Independent Budget was put together by all the veterans service
organizations consulting with each other, and consulting with
the VA. And we have very closely followed the requests of that
budget.
While not everyone in this auditorium, of course, agrees on
the Wars in Iraq and Afghanistan, we all agree we need to do
everything we can to care and provide for our veterans, not
just this year or next year, but in the decades ahead, because
we know the immense costs. We're spending some $2.1 billion a
week on the War in Iraq. Some estimates have shown that
veterans' healthcare, because of the War in Iraq, will cost us
upwards of $600 billion in the years ahead. We need to prepare
for that now. It's not this year, next year. It's not even this
decade, next decade only. It is costs that we need to be
responsible for as elected officials, as veterans' advocates,
as citizens, and as veterans, we need to prepare for, perhaps,
as long as 50 years.
Ohio is home, as we know, to more than one million
veterans. These proud men and women and their families have
sacrificed, as we know, to serve our Nation. There are Ohioans
in this room who helped to defeat tyranny in World War II.
There are veterans in this room who served in the conflicts of
the cold war, enabling the United States to eventually defeat
totalitarianism, and we have a new group of veterans,
obviously, from the post-cold war era, from Bosnia, from
Afghanistan, and from two conflicts in Iraq and
Kuwait.
Some of Ohio's veterans include Presidents Grant and
Harrison, and Hayes and Garfield, and McKinley. Others, like
John Glenn and Neil Armstrong, and Clark Gable, and General
Sherman, and General Sheridan. Ohio is proud of our veterans
who were our soldiers in combat today, proud of our veterans
who are still living, proud of our veterans who are no longer
with us, who served this country. I look forward to hearing the
testimony today. We have a distinguished panel of witnesses.
Before we get started, I will run through how this will
work. First, Congressman Space will deliver his opening
remarks. Then we'll proceed to hear from each witness. I will
introduce three of the witnesses, he will introduce three.
We'll do the introduction, then the witnesses testify. Then
Congressman Space and I will take about five minutes to ask
questions, and then we'll proceed to the second panel.
I want to make a handful quickly of acknowledgments of
people that have been helpful. I mentioned Dean Andrews, Walter
Gritzan with Administrative and Business Services with Kent
State; Carla Barker, who is the Assistant to Dean Andrews; Kim
Lipsky, with the Senate on Veterans' Affairs, thank you, Kim;
Bill Cahill, also from Senate Veterans' Affairs Committee who's
in the back; Chris Austin from House Veterans' Affairs
Committee; Jean Wilson from my office. From Congressman Space's
office, Ken Engstrom, Cindy Cunningham, Mike Calevski, Barb
Lawrence, Shirley Farver; and from Congressman Wilson's office,
Dan Craig. Also, from my office are Doug Babcock, Beth Thames,
Nick Watt, Laura Pechaitis, and I believe that takes care of
everybody.
So it's my pleasure to, not introduce because he's your
Congressman, and in his first five months in Washington, he's
done an outstanding job of convincing us to do this, convincing
the Veterans' Committee in both Houses to do this first of its
kind in the country hearing. A lot of the credit for that goes
to Congressman Space, who has started so well, especially
advocating for this region. He just took me into Dean Andrews
office to advocate for something on this campus, so he doesn't
miss any opportunity to fight for his district.
Congressman Space.
STATEMENT OF HON. ZACHARY T. SPACE,
HOUSE REPRESENTATIVE FROM OHIO
Mr. Space. Thank you, Senator Brown, for the introduction,
and it is a real pleasure to be here with you today. Thank you
for your hard work, as well as that of your staff, and the
staff of the Senate Veterans' Affairs Committee in organizing
today's events. I would simply state, rather than reiterate,
just thank those same folks that you singled out, with the
addition of Jillian Carroll, who's behind me here on my staff
in Washington, DC.
This is a truly special occasion, and I think it's the
first of its kind, to my knowledge, anyway. We've managed to
bring together the House and the Senate Veterans' Affairs
Committees outside of Washington, DC, and we've done that here
in Ohio, and right here in New Philadelphia in the heart of
Ohio's 18th Congressional District. This is an indication, I
believe, of the importance of the topics that we're going to be
discussing today. And I am, indeed, delighted to be back here
in New Philadelphia, just a few miles from my hometown of
Dover.
A special thank you, again, to Kent State University for
allowing us to use these facilities. We very much appreciate
their hospitality. Specifically, I'd like to thank Dean Gregg
Andrews, Walt Gritzan, and Carla Barker, along with the rest of
the staff, and the Tuscarawas campus community for being so
accommodating and giving us the run of the place.
Kent State has a special place in my heart. This, without
question, serves as one of our most precious assets here in
Tuscarawas County. It has given many, literally thousands, of
young, bright, aspiring students the opportunity to further
their education. Some of those bright, aspiring students are
family members of mine, and we, in my family, certainly
appreciate the value that this regional campus brings to our
community.
It's also my privilege to be in the company of eight
distinguished witnesses today. I'm very much looking forward to
hearing your testimony, gentlemen, and I look forward to
engaging in a question and answer exchange, as well.
I'd like to take the opportunity to recognize the members
of my Veterans Advisory Board, many of whom are here today. I'm
indebted to these men and women for their commitment in
assisting me as I advocate for the needs of our Nation's
veterans, and I cannot think of a better way, to more
specifically advocate on behalf of Ohio's 18th District's
veterans than to ask some of Ohio 18 veterans where they stand.
I will rely upon the Vets Advisory Board that we created in the
coming weeks, and months, to give their informed opinions, as
they've already begun to do. I know I will continue to ask for
their input on other important issues, as well.
Can I ask those members of the Veterans Advisory Committee
that we've created to please stand, and be recognized. Thank
you, ladies and gentlemen. Can we have a round of applause for
them, please.
(Applause.)
Mr. Space. They have traveled here to New Philadelphia from
all parts of the 18th District, some taking more than 3 hours
to get here today, so they should be commended, and I'd like to
thank them for their work on behalf of our District's veterans.
Finally, I'd like to thank the audience for their
attendance today. I appreciate your interest in the issues
facing rural veterans, and I appreciate you taking the time out
of your day to join us here this morning. I hope we all find
this event to be a useful exchange of information, as well as a
productive forum for identifying specific problems that rural
veterans are facing, as well as crafting solutions. My personal
goal is to translate the ideas we hear today into legislative
fixes back in Washington.
A significant number of my constituents in Ohio's 18th
District are veterans, which is why I was eager to serve on
this Committee. A large number of our veterans live in rural
areas around the country. I repeated hear from these rural
veterans about the difficulties they have in accessing VA
services and care. Ohio 18 is lucky enough to have a VA Medical
Center in Chillicothe; however, that VAMC is about 159 miles
from where we sit today. The closest VAMC for folks here in New
Philadelphia is the Cleveland facility, and that's about 72
miles from where we sit. After that, the next closest facility
is in Pittsburgh. And we are lucky enough to have a CBOC here
in New Philadelphia, but, of course, those CBOCs do not have
the same capabilities as full-fledged hospitals.
I plan on working with the VA to expand their services here
in the 18th District. I know that will be a long, and very
difficult battle, but I think that what we'll hear today will
convince many that these steps are necessary to better serve
our rural veterans.
I'm also concerned that rural veterans are putting off
their doctors' visits because it is such a hassle to get to
their doctors. I'm afraid that by skipping check-ups thought to
be non-essential, veterans are suffering in the long-term by
not seeking preventative care. Often, it's too late when a
medical emergency occurs.
I know Mr. Carson can speak to the problems that non-VA
hospitals face when they open their doors to veterans, too. In
emergencies, our veterans need immediate care. They do not have
the luxury of traveling over an hour to a VA facility. Our
private hospitals have done their best to care for these
veterans in their times of need, but they've done so without
the assurance that they'll be reimbursed by the VA after-the-
fact. I look forward to discussing both this problem, and
solutions to it.
And, finally, I'm also concerned that as gas prices
continue to shoot through the roof, it's become increasingly
more difficult for rural veterans who, again, drive long
distances, to afford trips to the VA facilities. The current
mileage reimbursement rate of 11 cents per mile comes nowhere
near the $3.30 plus cost of gasoline per gallon. I believe this
must be addressed, as well.
Again, I'd like to thank you all for coming today, and I'd
like to turn it back over to Senator Brown to introduce our
first witness today on our first panel.
Senator Brown.
Senator Brown. Thank you, Congressman Space. Our first
witness will be Frank Anderson. Frank has been an advocate for
veterans as long as I can remember, comes to my office at least
once a year. I see him in Cleveland from time to time. He grew
up in Cleveland, joined the Armed Forces in 1976, was injured
in a training exercise, I believe at Fort Jackson, South
Carolina. He has advocated for paralyzed veterans ever since.
He and his wife, Joanna, wife of 34 years, have raised five
children. He's always been there as an advocate, and always
will be there as an advocate. We appreciate so much what he's
done for veterans, generally, and specifically for the
Paralyzed Veterans of America.
Mr. Anderson.
STATEMENT OF FRANK ANDERSON, GOVERNMENT RELATIONS DIRECTOR,
BUCKEYE CHAPTER, PARALYZED
VETERANS OF AMERICA
Mr. Anderson. Thank you, Mr. Chairman. Mr. Chairman,
Members of the Committee, on behalf of the Buckeye Chapter of
Paralyzed Veterans of America, I'd like to thank you for the
opportunity to testify before you today on issues facing
veterans who live here in Ohio, and surrounding states. The
challenges facing veterans here, particularly with regards to
healthcare, are not uniquely different to many of the other
areas of the country. However, if the VA can figure out the
best ways to address them here, they can certainly apply those
actions across the board.
Due to the broad areas of possibilities, I will limit my
comments to a few key areas that we believe require the
greatest focus, and that are of the utmost importance. My
comments will focus on the broader healthcare concern,
specifically for rural veterans. I will also address our
concerns about VA long-term care services, specifically for
Operation Enduring Freedom, and Operation Iraqi Freedom
veterans, as well as for veterans with spinal cord injuries or
dysfunction. Finally, I will comment on veterans' benefits
issues, particularly for members of the National Guard and
Reserves.
Given the attention that these Committees are faced on the
issues of access to healthcare for rural veterans, it is only
appropriate that this joint hearing be held in the state with
many veterans who live in rural areas. PVA recognizes that
there is no easy solution to meeting the needs of these
veterans who live in rural areas. These veterans were not
originally the target of population of men and women that the
VA expected to treat. However, the VA decision to expand to an
outpatient network through the
community-based outpatient clinics reflected the growing demand
on the VA systems from veterans outside of typical urban or
suburban settings.
However, PVA remains concerned that in addressing the
problems of access for these veterans, the long-term viability
of the VA healthcare system may be threatened.
PVA members rely on the direct services provided by the VA
healthcare facilities, recognizing the fact that they do not
always live close to the facilities. The services provided by
the VA, particularly specialized services like spinal cord
injury care, are unmatched in the private sector. If a larger
pool of veterans was sent into the private sector for
healthcare, the diversity of services and expertise in
different fields is placed in jeopardy.
Ultimately, PVA has a serious concern about any attempts to
give the VA additional leverage to broaden the contracting out
of healthcare services to veterans in geographically remote or
rural areas. If you review the early stages of PVA's Project
HERO, it is apparent that is a direction that some VA senior
leadership would like to go. PVA adamantly opposes any effort
to privatize the VA healthcare system, turning it into an
insurer of care, and not a provider of care. Privatization is
ultimately a means for the Federal Government to shift its
responsibility of caring for the men and women who serve.
PVA believes that any broader contracting out of healthcare
service would almost certainly lead to a diminution of
established quality, safety, and continuity of VA care. It is
important to know that VA's specialized healthcare programs
authorized by Congress, and designed expressly to meet the
needs of combat-wounded and ill veterans, such as the blind
rehabilitation centers, prosthetic and sensory aid programs,
readjustment counseling, polytrauma and spinal cord injury
centers, the centers for war-related illnesses, and the
National Center for Post-Traumatic Stress Disorder, as well as
several others, would be irreparably affected by the loss of
service-connected veterans to the private sector. The VA's
medical and prosthetic research program, designed to study and,
hopefully, overcome the ills of disease and injury consequent
to military service, would lose focus and purpose.
Additionally, Title 38, U.S. Code, Section 1706(b)(1), requires
VA to maintain the capacity of these specialized Medical
programs, and not let their capacity fall below that which
existed at the time when Public Law 104-262 was
enacted.
Furthermore, veterans who are sent out to a private sector
for care would lose many safeguards built into the VA system,
through its patient safety program, evidence-based medicine,
electronic medical records, and medication verification
program. These unique VA features culminate in the highest
quality care available, public or private. Loss of these
safeguards, that are generally not available in private sector
systems, would equate to diminished oversight and coordination
of care, and ultimately may result in lower quality of care for
those who deserve it most.
Current law limits VA in contracting for private healthcare
services to instances in which VA facilities are incapable of
providing necessary care to a veteran; when VA facilities are
geographically inaccessible to a veteran for necessary care;
when medical emergency prevents a veteran from receiving care
in a VA facility; to complete an episode of VA care; and for
certain specialty examinations to assist VA in adjudicating
disability claims. The VA could better meet the demands of
rural veterans through more judicious application of its fee-
for-service program.
We also believe that the VA could address the needs of
rural veteran through broad applications of the ``hub-and-
spoke'' principle. A veteran can get his or her basic care at a
community-based outpatient clinic (CBOC). However, if the
veteran requires more intensive care, or a special procedure,
he or she can be referred to a larger VA medical center. This
would ensure the veteran continues to get the best quality care
provided by the VA, thereby maintaining the viability of the
system.
Finally, we realize that it is an extremely difficult task
to establish a standard for when a veteran's home is considered
to be rural. Attempts to define ``geographically inaccessible''
have proven to be a very subjective effort. Access to VA
healthcare is subject not only to population density or
distance, but time, as well.
PVA believes that one possible way to address the concerns
of rural veterans is to correct the mileage reimbursement
inequity that currently exists. It is wholly unacceptable that
veterans have to live with the 11 cents per mile reimbursement
rate that the VA currently provides, when all federal employees
receive 48 cents per mile. In fact, PVA believes that some of
the difficulty in providing care to veterans in limited access
areas, particularly rural areas, might be eliminated with a
sensible reimbursement rate.
We believe that veterans will be less likely to complain
about access issues as a result of their geographic location if
they know that they would not have to put the majority of the
travel expense out of their own pocket. This is a change that
has been long overdue, and we urge the Committee and all of
Congress to take immediate action to correct this inequity.
In the end, we believe that in order for the VA to best
meet this need, adequate funding needs to be provided for VA
healthcare in a timely manner. As we previously stated, placing
the VA in the position it has dealt with for many years because
Congress continues to wrangle over federal budgets, does not
prepare the VA to properly meet demand, including demand in
rural areas.
In long-term care, one of the primary concerns for PVA and
its membership is access to long-term care services in the VA.
We have particular concerns about long-term care options for
veterans of the newest conflicts in Iraq and Afghanistan. PVA
believes that the age-appropriate VA non-institutional and
institutional long-term care programming for young OEF and OIF
veterans must be a priority for veterans and their committees.
New VA non-
institutional and institutional long-term care programs must
come on line, and existing programs must be re-engineered to
meet the various needs of a younger veterans population.
VA non-institutional long-term care program must be
required to assist the younger injured veterans with
catastrophic disabilities who need a wide range of support
services, such as personal attendant services, programs to
train attendants, peer support programs, assistive technology,
hospital-based home care teams that are trained to treat and
monitor specific disabilities, and transportation services.
These younger veterans need expedited access to VA benefits,
such as VA's Home Improvement/Structural Alteration Grant, and
VA's adaptive housing, and auto programs.
Senator Brown. Mr. Anderson, could you try to summarize
your testimony? You've gone beyond the time, but if you can
sort of summarize the end.
Mr. Anderson. Yes, sir.
Senator Brown. Thank you.
Mr. Anderson. We see that our veterans in rural areas do
need access to the system and long-term care, and operation of
VA so that they can address these needs, and our older
veterans. And we look forward to working with the VA and its
staff to make sure that our veterans are receiving timely and
quality care.
[The prepared statement of Mr. Anderson follows:]
Prepared Statement of Frank Anderson, Government Relations Director,
Buckeye Chapter, Paralyzed Veterans of America
Mr. Chairman and Members of the Committees, on behalf of the
Buckeye Chapter of Paralyzed Veterans of America (PVA) I would like to
thank you for the opportunity to testify before you today on the issues
facing veterans who live here in Ohio and surrounding states. The
challenges facing veterans here, particularly with regards to health
care, are not uniquely different to many other areas of the country.
However, if the VA can figure out the best way to address them here,
they can certainly apply those actions across the board.
Due to the broad array of possibilities, I will limit my comments
to a few key areas that we believe require the greatest focus and that
are of the utmost importance. My comments will focus on broader health
care concerns, specifically for rural veterans. I will also address our
concerns about VA long-term care services, specifically for Operation
Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans as
well as for veterans with spinal cord injury or dysfunction. Finally, I
will comment on veterans' benefits issues, particularly for members of
the National Guard and Reserves.
rural health care
Given the attention that these Committees have placed on the issue
of access to health care for rural veterans, it is only appropriate
that this joint hearing be held in a state with many veterans who live
in rural areas. PVA recognizes that there is no easy solution to
meeting the needs of veterans who live in rural areas. These veterans
were not originally the target population of men and women that the VA
expected to treat. However, the VA decision to expand to an outpatient
network through the community-based outpatient clinics reflected the
growing demand on the VA system from veterans outside of typical urban
or suburban settings.
However, PVA remains concerned that in addressing the problem of
access for these veterans, the long-term viability of the VA health
care system may be threatened. PVA members rely on the direct services
provided by VA health care facilities recognizing the fact that they do
not always live close to the facility. The services provided by VA,
particularly specialized services like spinal cord injury care, are
unmatched in the private sector. If a larger pool of veterans is sent
into the private sector for health care, the diversity of services and
expertise in different fields is placed in jeopardy.
Ultimately, PVA has serious concerns about any attempt to give the
VA additional leverage to broaden contracting out of health care
services to veterans in geographically remote or rural areas. If you
review the early stages of VA's Project HERO, it is apparent that this
is a direction that some VA senior leadership would like to go. PVA
adamantly opposes any effort to privatize the VA health care system,
turning it into an insurer of care and not a provider of care.
Privatization is ultimately a means for the Federal Government to shift
its responsibility of caring for the men and women who served.
PVA believes that any broader contracting out of health care
services would almost certainly lead to a diminution of established
quality, safety and continuity of VA care. It is important to note that
VA's specialized health care programs, authorized by Congress and
designed expressly to meet the needs of combat-wounded and ill
veterans, such as the blind rehabilitation centers, prosthetic and
sensory aid programs, readjustment counseling, polytrauma and spinal
cord injury centers, the centers for war-related illnesses, and the
national center for post-traumatic stress disorder, as well as several
others, would be irreparably affected by the loss of service-connected
veterans to the private sector. The VA's medical and prosthetic
research program, designed to study and hopefully overcome the ills of
disease and injury consequent to military service, would lose focus and
purpose. Additionally, Title 38, United States Code, section 1706(b)(1)
requires VA to maintain the capacity of these specialized medical
programs, and not let their capacity fall below that which existed at
the time when Public Law 104-262 was enacted.
Furthermore, veterans who are sent out to the private sector for
care would lose the many safeguards built into the VA system through
its patient safety program, evidence-based medicine, electronic medical
records and medication verification program. These unique VA features
culminate in the highest quality care available, public or private.
Loss of these safeguards, that are generally not available in private
sector systems, would equate to diminished oversight and coordination
of care, and ultimately may result in lower quality of care for those
who deserve it most.
Current law limits VA in contracting for private health care
services to instances in which VA facilities are incapable of providing
necessary care to a veteran; when VA facilities are geographically
inaccessible to a veteran for necessary care; when medical emergency
prevents a veteran from receiving care in a VA facility; to complete an
episode of VA care; and, for certain specialty examinations to assist
VA in adjudicating disability claims. The VA could better meet the
demands of rural veterans through more judicious application of its
fee-for-service program.
We also believe that the VA could address the needs of rural
veterans through broad application of the ``hub-and-spoke'' principle.
A veteran can get his or her basic care at a community-based outpatient
clinic (CBOC). However, if the veteran requires more intensive care or
a special procedure, he or she can then be referred to a larger VA
medical center. This would ensure that the veteran continues to get the
best quality care provided directly by the VA, thereby maintaining the
viability of the system.
Finally, we realize that it is an extremely difficult task to
establish a standard for when a veteran's home is considered to be
rural. Attempts to define ``geographically inaccessible'' have proven
to be a very subjective effort. Access to VA health care is subject not
only to population density or distance, but time as well.
PVA believes that one possible way to address the concerns of rural
veterans is to correct the mileage reimbursement inequity that
currently exists. It is wholly unacceptable that veterans have to live
with the 11 cents per mile reimbursement rate that the VA currently
provides when all Federal employees receive 48 cents per mile. In fact,
PVA believes that some of the difficulty in providing care to veterans
in limited access areas, particularly rural areas, might be eliminated
with a sensible reimbursement rate. We believe that veterans would be
less likely to complain about access issues as a result of their
geographic location if they know that they will not have to foot the
majority of the travel expense out of their own pocket. This is a
change that has been long overdue, and we urge the Committees and all
of Congress to take immediate action to correct this inequity.
In the end, we believe that in order for the VA to best meet this
demand, adequate funding needs to be provided for VA health care in a
timely manner. As we previously stated, placing the VA in the position
it has dealt with for many years because Congress continues to wrangle
over Federal budgets, does not prepare the VA to properly meet demand,
including demand in rural areas.
long term care
One of the primary concerns for PVA and its membership is access to
long-term care services in the VA. We have particular concerns about
the long-term care options for veterans of the newest conflicts in Iraq
and Afghanistan. PVA believes that age-appropriate VA non-institutional
and institutional long-term care programming for young OEF/OIF veterans
must be a priority for VA and these Committees. New VA non-
institutional and institutional long-term care programs must come on
line and existing programs must be re-engineered to meet the various
needs of a younger veteran population.
VA's non-institutional long-term care programs will be required to
assist younger injured veterans with catastrophic disabilities who need
a wide range of support services such as: personal attendant services,
programs to train attendants, peer support programs, assistive
technology, hospital-based home care teams that are trained to treat
and monitor specific disabilities, and transportation services. These
younger veterans need expedited access to VA benefits such as VA's Home
Improvement/Structural Alteration (HISA) grant, and VA's adaptive
housing and auto programs so they can leave institutional settings and
go home as soon as possible. PVA also believes that VA's long-term care
programs must be linked to VA's new polytrauma centers so that younger
veterans can receive injury specific annual medical evaluations and
continued access to specialized rehabilitation, if required, following
initial discharge.
VA's institutional nursing home care programs must change direction
as well. Nursing home services created to meet the needs of aging
veterans will not serve young veterans well. As pointed out in The
Independent Budget for FY 2008, VA's Geriatric and Extended Care staff
must make every effort to create an environment for young veterans that
recognizes they have different needs. Younger catastrophically injured
veterans must be surrounded by forward-thinking administrators and
staff that can adapt to youthful needs and interests. The entire
nursing home culture must be changed for these individuals, not just
modified. For example, therapy programs, living units, meals,
recreation programs, and policy must be changed to accommodate young
veterans entering the VA long-term care system.
PVA is also concerned that many veterans with spinal cord injury
and disease are not receiving the specialized long-term care they
require. VA has reported that over 900 veterans with SCI/D are
receiving long-term care outside of VA's four SCI/D designated long-
term care facilities. However, VA cannot report where these veterans
are located or if their need for specialized medical care is being
coordinated with area VA SCI/D centers.
Today's VA SCI/D long-term care capacity cannot meet current or
future demand for these specialized services. Waiting lists exist at
the four designated SCI/D facilities.
Currently, VA only operates 125 staffed long-term care (nursing
home) beds for veterans with SCI/D. These facilities are located at:
Brockton, Massachusetts (30 beds); Castle Point, New York (15 beds);
Hampton, Virginia (50 beds); and 30 beds at the Hines Residential Care
Facility in Chicago, Illinois. Geographic accessibility is a major
problem because none of these facilities are located west of the
Mississippi River. New designated VA SCI/D long-term care facilities
must be strategically located to achieve a national geographic balance
to long-term care to meet the needs of veterans with SCI/D that do not
live on the East coast of the United States.
VA's own Capital Asset Realignment for Enhanced Services (CARES)
data for SCI/D long-term care reveals a looming gap in long-term care
beds to meet future demand. VA data projects an SCI/D long-term care
bed gap of 705 beds in 2012 and a larger bed gap of 1,358 for the year
2022. VA's proposed CARES SCI/D long-term care projects would add
needed capacity (100 beds) but are very slow to come on line. CARES
proposes adding 30 SCI/D LTC beds at Tampa, Florida; 20 beds at
Cleveland, Ohio; 20 beds at Memphis, Tennessee; and 30 beds at Long
Beach, California. The CARES Tampa project is currently under
construction but is not scheduled to open for another 2 years and the
Cleveland project is currently in the design phase but remains years
from completion. The Buckeye Chapter is particularly pleased that the
Cleveland/Brecksville project is moving forward. This will prove to be
a critical facility for meeting the long-term, specialized care needs
of PVA members. Finally, the Memphis and Long Beach projects have not
even entered the planning stage at this time.
Methods for closing the VA SCI/D long-term care bed gap and
resolving the geographic access service issue are part of the same
problem for PVA. VA's Construction Budget for 2008 includes plans for
new 120 bed VA nursing homes to be located in Las Vegas, Nevada and at
the new medical center campus in Denver, Colorado. Also, VA has
announced construction planning of a new 140 bed nursing home care unit
in Des Moines, Iowa.
Mr. Chairman, PVA needs your support to ensure VA construction
planning dedicates a percentage of beds at each new VA nursing home
facility for veterans with SCI/D. PVA requests that Congress mandate
that VA provide for a 15 percent bed set-aside in each new VA nursing
home construction project to serve veterans with SCI/D and other
catastrophic disabilities. These facilities will require some special
architectural design improvements and trained staff to meet veteran
need. However, much of the design work has already been accomplished by
PVA and VA's Facility Management team. This Congressional action will
help reduce the SCI/D bed-gap and help meet the current and future
demand for long-term care. While a 15 percent bed allocation in new VA
nursing home construction plus the proposed CARES LTC projects do not
solve the looming bed gap problem in the short run it is a good first
step and these additions will improve VA's SCI/D long-term care
capacity in the western portion of the country.
Public Law 109-461 required VA to develop and publish a strategic
plan for long-term care. PVA congratulates Congress on understanding
the importance of this issue to ensure that America's catastrophically
disabled and aging veteran population is well cared for. During the
organization of VA's strategic long-term care plan PVA calls on VA and
Congress to pay careful attention to the institutional and non-
institutional long-term care needs of veterans with SCI/D and other
catastrophic disabilities. We request that PVA and other veterans
service organizations have an opportunity to provide input and assist
VA as it moves forward in the development of this important document.
In the past, and even today, many veterans with spinal cord injury
or disease and other catastrophic disabilities were shunned from
admittance to both VA and community nursing homes because of their high
acuity needs. PVA believes that catastrophic disability must never be
grounds to refuse admittance to VA or contract VA long-term care
services. PL 109-461 requires VA to include data on, ``the provision of
care for catastrophically disabled veterans; and the geographic
distribution of catastrophically disabled veterans.'' This information
is critical if VA's strategic plan is to adequately address the needs
of this population.
veterans benefits
PVA realizes that there is a desire to fix the problems with the
claims backlog in the Veterans Benefits Administration (VBA)
immediately. However, we must emphasize that there is no quick fix that
can be implemented to fix these problems. The backlog has become too
extensive to simply place some arbitrary requirement on VBA that will
not address the long-term situation.
We believe that the VA cannot continue to make changes in VBA, and
specifically the claims process, sporadically. We believe that the only
way the VA will ever get a handle on the claims process, the backlog,
and associated problems is to pick a specific date to make major
changes. It cannot implement change piecemeal.
We realize that fixing the discharge and subsequent claims process
is no easy task. However, we should not be shooting at individual
targets to attempt to fix the overall problem. It will take innovative
approaches focused on the broader system.
In the end, we believe that many of the problems in the Veterans
Benefits Administration are centered on proper training and
accountability. Without uniform training across all of VBA on the
standards established in regulations, problems will continue to arise
and the claims backlog will continue to grow. Furthermore, it is
absolutely essential that VBA personnel at all levels be held
accountable for their own actions and the actions of their
subordinates. Although we continue to advocate for adequate resources
and additional staff, these steps will not go far enough if training
and accountability are not a major component. Similarly, we recognize
that veterans service organizations have a commensurate obligation to
properly train and supervise their personnel.
Finally, despite efforts by VA to address all of the needs and
concerns of OEF/OIF veterans, another population of these men and women
still continue to receive lesser service than their active duty
counterparts--National Guard and Reserves. We have testified many times
in the past as to the importance of effective outreach, particularly
for the National Guard and Reserves. It is only appropriate that
National Guard and Reserve servicemembers be handled in the same way as
active duty servicemembers. The level of service being required of
these men and women in current operations more than justifies the need
to inform them of all of the health care and benefits services
available.
Mr. Chairman and Members of the Committees, the Buckeye Chapter
stands ready to assist you in any way to address the needs of veterans
here in Ohio and across America. It is vitally important that we work
together to ensure that the best improvements are made to benefit
veterans and their families.
Thank you again for the opportunity to testify. I would be happy to
answer any questions that you might have.
Senator Brown. Thank you. And understand, everyone's
written statement will be in the record in its entirety. These
statements will be used as we use Committee hearings in
Washington to move forward, as Congressman Space said, on
legislative efforts. One of the efforts you mentioned, Mr.
Anderson, on the mileage reimbursement should have been fixed a
long time ago. I am convinced it will be fixed in this
Congress. Senator Tester, and I, and others from Montana have
worked on legislation, and we will move forward on that, so
thank you for that.
Mr. Larry Moore is our next witness. Mr. Moore was in
active duty as a U.S. Navy CB in Vietnam from 1968 to 1970,
State Legislative Impact Chairman of the Veterans of Foreign
Wars, Department of Ohio. He's Director of the Richland County
Veterans Service Commission, and he spoke a couple of days ago
with my mother in Mansfield.
So, Mr. Moore, nice to have you with us. Thank you.
STATEMENT OF LARRY MOORE, STATE LEGISLATIVE
DIRECTOR, DEPARTMENT OF OHIO, VETERANS OF FOREIGN WARS OF THE
UNITED STATES
Mr. Moore. Well, thank you. Thank you, ladies and
gentlemen. Senator Brown, Representative Space, I am pleased to
be here before you today representing the 139,000 men and women
of the Veterans of Foreign Wars Department of Ohio, and our
Ladies
Auxiliary.
The first issue to be addressed today is access to the VA
healthcare system by veterans living in rural areas. Continuing
to expand VA community-based outreach clinics by either leasing
existing space, or new construction, should be one of the
priorities of the VA and Congress. The goal of these clinics is
to bring healthcare to a local level for our veterans, and
expanding these types of facilities in rural areas only makes
good sense.
The community-based outpatient clinics provide basic
healthcare needs, with an emphasis on preventative measures to
screen and test for such things as diabetes, heart conditions,
prostate cancer, and mental health conditions. The clinics
staff, registered nurses, and licensed social case workers, who
provide medical and mental healthcare covering an average of
six counties both in the clinic office, and at the veteran's
personal home.
Studies have shown that the VA healthcare is less costly
than that in the private sector. Expansion of these clinics
would potentially save the taxpayers millions of dollars, and
continue to bring medical treatments on a local level, rather
than the past practice of a regional VA medical center. If a
primary doctor feels a veteran needs to see a specialist, then
he will make an appointment at one of the VA medical centers;
however, this causes a problem for veterans living in rural
areas, because these centers can be hundreds of miles from his
home, with no public transportation available. This forces him
to either provide his own transportation, rely on a family
member or friend to transport him for his appointment.
The VA does provide gas mileage reimbursement to VA medical
facilities for appointments, but not at the present IRS rate of
48.5 cents per mile currently allowed to any businessman,
county, state, or federal employee. The VA allows only 11 cents
per mile. Most veterans I work with find this to be a complete
joke, and will not even bother filling out the paperwork for
the reimbursement. Not only do I agree this is a complete joke,
but I also feel it is a total insult to those who honorably
served this country.
I would ask Congress to investigate and find a solution
that allows that reflects today's high gasoline cost, not that
of 1960. The majority of the veterans must make multiple trips
to these regional VA medical centers. For example, on average,
it takes three trips for hearing aids, dental crowns, and
eyeglasses, and cancer treatments of radiation and chemotherapy
can take ten trips. To someone living in an already
economically depressed region, can you imagine the difficulty
and personal expense to the veteran and his family? Is this
what Congress meant in 1996 when legislation was passed,
stating that all honorably discharged veterans would be
eligible for VA healthcare as long as you can get there.
The VA Health Administration has developed a program to
provide more home care for patients. The program, which would
allow practitioners to manage more patients, is called Care
Coordination. This program would eliminate the need for
frequent visits by patients to VA medical facilities. Through
the Internet, telephone lines, and telemedicine units, such as
the glucometer devices, VHA medical professionals will remotely
observe patients with multiple chronic conditions, such as
mental health, diabetes, congestive heart failure, and spinal
cord injury.
One such device, called a Telebuddy, attaches to a
patient's phone jack. The patient responds to questions about
how he is feeling, and whether he took his medication. If there
is no problem, the device flashes green. If the patient does
not answer, the patient's case manager is notified. This is an
extremely useful tool to those VA staffers who make these house
calls, especially on the mental health side. These units are
programmed to ask targeted questions that could provide early
warning that the veteran's possible depression or PTSD
condition may be at a level dangerous to himself, or his
family.
Construction of new CBOCs, community-based outreach
clinics, cannot happen over night. And in the meantime, short-
term solutions need to be addressed. Some of those short-term
solutions presently being considered by Congress are the
following. House Resolution 92, the Veterans Timely Access to
Health Care Act.
HOUSE RESOLUTION 315, THE HEALTHY VETS ACT;
HOUSE RESOLUTION 339
The VFW strongly supports the intent of these types of
legislation. We do have some concerns, however, with the
potential for overuse of contracting care, but there are
certainly areas where its use is proper. Fee-basis care is more
expensive than that of the VA, and we believe that it would do
great harm to those veterans who elect to stay in the high-
quality VA healthcare system by taking away funding for the
system as a whole.
HOUSE RESOLUTION 1426
The VFW strongly opposes this legislation, which would
allow any veteran to elect to receive contracted care whenever
they choose. Although this legislation aims to expand the
coverage available to veterans, it would only dilute the
quality and quantity of the services provided to new and
existing veterans today, and in the future. That is
unacceptable.
DRAFT BILL, THE RURAL VETERANS HEALTH CARE ACT
The VFW supports this bill, which would make changes and
improvements to the availability of healthcare for rural area
veterans. With over 44 percent of the returning servicemembers
living in rural areas, the access problem they, and all
veterans, face are of increasing importance. This legislation
acknowledges that, and we are happy to support it.
Lastly, I would ask Congress to bear in mind the long-term
cost of care for those wounded servicemembers returning from
the War in Iraq. Head and limb injuries are signature wounds of
this war, because Iraqi insurgents have made the IED their
weapon of choice. Modern armor and rapid care mean that most of
the injured survive, but many live with traumatic brain
injuries and
amputations.
I would point out the hidden danger with respect to head
injuries. Between January 2003 and April of 2006, of the 692
traumatic brain injuries treated at Walter Reed Army Hospital,
nearly 90 percent had non-penetrating head injuries from the
sheer concussion of the blast from an IED. Returning combat
veterans may not know they suffer such a wound, and since this
type of injury isn't immediately apparent or visible to the
naked eye, medical personnel may miss the diagnosis if the
proper screening methods are not used.
Coupled with TBI-type injuries, there's Post Traumatic
Stress Disorder, better known as PTSD. Many servicemembers have
had multiple deployments to combat zones, and studies show
there is a 50 percent greater chance these combat veterans may
develop issues involving PTSD; and in most cases, these are
young men and women with serious service-connected disabilities
who will need expensive care for many years.
My hope is more emphasis will be put on screening for TBI,
depression, and PTSD. I do not wish to have another sobbing
mother in my office personally blaming herself for her 20-year-
old Marine reservist son's suicide, who just returned from a
tour in Iraq.
The VA system may not be perfect, but when adequately
funded in a timely manner by Congress, the ability to deliver
quality healthcare and reduce lengthy claims waiting periods
for service-connected disabilities could be achieved.
Senator Brown, Representative Space, this concludes the
VFW's testimony, and I would be happy to answer any questions
you may have. Thank you.
[The prepared statement of Mr. Moore follows:]
Prepared Statement of Larry D. Moore, Legislative Chairman, Department
of Ohio, Veterans of Foreign Wars of the United States
Senator Brown and Representative Space:
I am pleased to be here before you today representing the one
hundred and thirty-nine thousand men and women of the Veterans of
Foreign Wars Department of Ohio and our Ladies Auxiliary.
The first issue to be addressed today is access to the VA
healthcare system by veterans living in rural areas. Continuing to
expand VA community based outreach clinics by either leasing existing
space or new construction should be one of the priorities of the VA and
Congress. The goal of these clinics is to bring health care to a local
level for our veterans, and expanding these types of facilities into
rural areas only makes good sense. The Community Based Outpatient
Clinics provide basic healthcare needs, with an emphasis on preventive
measures to screen and test for such things as diabetes, heart
conditions, prostate cancer, and mental health conditions. The clinics
staff registered nurses and licensed social case workers, who provide
medical and mental healthcare covering an average of six counties both
in the clinic office and at the veterans personal home. Studies have
shown that VA healthcare is less costly than in the private sector.
Expansion of these clinics would potentially save the taxpayers
millions of dollars, and continue to bring medical treatments on a
local level rather than the past practice of a regional VA medical
center. If the primary doctor feels the veteran needs to see a
specialist, then he will make an appointment at one of the VA medical
centers; however, this causes a problem for veterans living in rural
areas, because these centers can be hundreds of miles from his home
with no public transportation available. This forces him to either
provide his own transportation or rely on a family member or a friend
to transport him for his appointment.
The VA does provide gas mileage reimbursement to VA medical
facilities for appointments, but not at the present IRS rate of 48
cents per mile currently allowed to any businessman or county, state or
Federal employee--the VA allows veterans only 11 cents per mile. Most
veterans I work with find this to be a complete joke, and will not even
bother filling out the paperwork for the reimbursement. Not only do I
agree that this is a complete joke, but also I feel this is a total
insult to those who honorably served this country. I would ask Congress
to investigate, and find a solution to allow a gas reimbursement that
reflects today's high gasoline cost, not that of 1960. The majority of
veterans must make multiple trips to these regional VA medical
centers--for example on average it takes three trips for hearing aids,
dental crowns, and eyeglasses, and cancer treatments of radiation and
chemotherapy can take ten trips. To someone living in an already
economically depressed region, can you imagine the difficulty and
personal expense to the veteran and his family?! Is this what Congress
meant in 1996 when legislation was passed, stating that all honorably
discharged veterans were eligible for VA health care as long you can
get there?!
The VA Health Administration has developed a program to provide
more home care to patients. The program, which would allow
practitioners to manage more patients, is called care coordination.
This program would help eliminate the need for frequent visits by
patients to VA medical facilities. Through the Internet, telephone
lines and telemedicine units such as glucometer devices, VHA medical
professionals will remotely observe patients with multiple chronic
conditions such as mental illness, diabetes, congestive heart failure,
and spinal cord injury. One such device, called a Telebuddy, attaches
to a patient's phone jack. The patient responds to questions about how
he is feeling and whether he took his medication. If there is no
problem, the device flashes green. If the patient does not answer, the
patient's case manager is notified. This is an extremely useful tool to
those VA staffers who make these house calls, especially on the mental
health side, these units are programmed to ask targeted questions that
could provide early warning that the veterans possible depression or
PTSD condition maybe at a level dangerous to himself or his family.
Construction of new CBOCs cannot happen over night, and in the
meantime, short term solutions need to be addressed. Some of those
short-term solutions presently being considered by Congress are the
following:
h.r. 92, the veterans timely access to health care act;
h.r. 315, the healthy vets act; h.r. 339
The VFW strongly supports the intent of these types of legislation.
We do have concerns, however, with the potential for overuse of
contracting care but there are certainly areas where its use is proper.
Fee-basis care is more expensive than that of the VA, and we believe
that it would do great harm to those veterans who elect to stay in the
high-quality VA health care system by taking away funding for the
system as a whole.
h.r. 1426
The VFW strongly opposes this legislation, which would allow any
veteran to elect to receive contracted care whenever they choose.
Although this legislation aims to expand the coverage available to
veterans, it would only dilute the quality and quantity of the services
provided to new and existing veterans today and into the future. That
is unacceptable.
draft bill, the rural veterans health care act
The VFW supports this bill, which would make changes and
improvements to the availability of health care for rural veterans.
With over 44 percent of returning servicemembers living in rural areas,
the access problems they and all veterans face are of increasing
importance. This legislation acknowledges that, and we are happy to
support it.
Lastly, I would ask Congress to bear in mind the long-term cost of
care for those wounded servicemembers returning from the War on Terror.
Head and limb injuries are signature wounds of this war, because Iraqi
insurgents have made the IED their weapon of choice. Modern armor and
rapid care mean that most of the injured survive, but many live with
traumatic brain injuries and amputations. I would point out the hidden
danger with respect to head injuries--between January 2003 and April
2006, of the 692 traumatic brain injuries treated at Walter Reed Army
Hospital, nearly 90 percent had non-penetrating head injuries from the
sheer concussion of the blast from IEDs. Returning combat veterans may
not know they have suffered such a wound, and since this type of injury
isn't immediately apparent or visible to the naked eye, medical
personnel may miss the diagnosis if the proper screening methods are
not used. Coupled with TBI type injuries is Post Traumatic Stress
Disorder (PTSD). Many servicemembers have had multiple deployments to
combat zones, and studies now show there is a 50 percent greater chance
these combat veterans may develop issues involving PTSD; and in most
cases these are young men and women with serious service-connected
disabilities, who will need expensive care for many years. My hope is
more emphasis will be put on screening for TBI, depression, and PTSD. I
do not wish to have another sobbing mother sit in my office personally
blaming herself for her twenty-year old marine reservist son's suicide,
who just returned from a tour in Iraq.
The VA System may not be perfect, but when adequately funded in a
timely manner by Congress, the ability to deliver quality healthcare
and reduce lengthy claims waiting periods for service-connected
disabilities could be achieved.
Senator Brown and Representative Space, this concludes the VFW's
testimony, I would be happy to answer any questions you may have.
Thank you.
Senator Brown. Thank you very much, Mr. Moore.
George Ondick, his wife, Monica, graduated from Avon High
School, a community in Lorain County where I live. He is
Executive Director of AMVETS Ohio, currently the Vice President
of the Ohio Veterans' Hall of Fame Foundation. He graduated
from high school and entered the United States Marine Corps,
was discharged in 1971.
Mr. Ondick, glad to have you. Thank you.
STATEMENT OF GEORGE ONDICK, EXECUTIVE DIRECTOR, DEPARTMENT OF
OHIO, AMVETS
Mr. Ondick. Thank you, Senator.
Mr. Chairman, Members of the Committee, I'm pleased to
appear today to offer testimony on behalf of the Ohio AMVETS
related to Department of Veterans' Affairs remote and rural
veterans' issues.
In a 2004 study of more than 767,000 veterans by Veterans'
Affairs researchers shows those in rural areas are in poorer
health than their urban counterparts. The findings reported in
the October American Journal of Public Health, validate the
recent and ongoing VA efforts to expand healthcare for rural
patients.
``We need to think about veterans who live in rural
settings as a special population, and we need to carefully
consider their needs when designing healthcare delivery
systems,'' said study leader William B. Weeks, a physician and
researcher with White River Junction VA Medical Center and
Dartmouth Medical School. Senior author on the study was
Jonathan B. Perlin, VA Acting under-
secretary for health.
The study included 767,109 veterans who had used VA
healthcare between 1996 and 1999. VA had then just begun
setting up community-based outpatient clinics (CBOCs) to
provide primary care closer to home for rural veterans. Today,
there are nearly 700 CBOCs in the VA's nationwide system, and
recent recommendations from the VA's Capital Asset Realignment
for Enhanced Services initiatives call for the establishment of
more than 150 additional CBOCs.
Many veterans living in remote areas have found several
problems on reaching the VA Medical Centers and VA Clinics;
some due to their inability to obtain transportation, and
others due to inability to pay for their transportation. In
Ohio, most county Veterans Service Commissions will provide
transportation for ``qualified'' veterans. However, a disabled
veteran going for VA healthcare, may receive from the VA a
mileage allotment of 11 cents per mile, with a $3 deductible
each way. Compare that 11 cents to a VA employee receiving 48.5
cents, which is considerably more for the same trip, and no
deductible. Why is there a difference? The veteran has to pay
the same $3.50 for fuel, as does the VA employee.
Veterans' Affairs community-based outpatient clinics were
established to change from the centralized idea of admitting
many veterans to a hospital for treatment, to smaller, more
localized service on an outpatient basis. This, seemingly, is
much better for the patient, the family, and the VA budget. It
has worked quite well until the veterans' healthcare outreach
was stopped due to budget
restrictions.
The VA Health Administration had an outreach program that
worked quite well. The VAMCs would send a team, a doctor,
nurse, technician, and an administrative clerk, to various
remote areas to do routine healthcare. In southern Ohio, there
were many examples; a team went to Pomeroy, 88 miles away from
the Chillicothe VAMC, and Jackson, 45 miles away from the
Chillicothe VAMC, as well as several other locations. In
Jackson, they set up shop in a veterans service organization
post. In Pomeroy, they used part of the Holzer Clinic. There
were may outreach clinics in operations, until the budget
problems in January 2003 caused their closing.
The VA policy on establishing VA CBOCs was established so a
veteran would not have to travel over 35 miles to obtain
healthcare. It was changed to 40 miles. Now the strange thing
is, in northern Ohio, there are VA clinics fairly well covering
all geographic areas, and only one facility is scheduled to
close, and it is within the 40 mile limit.
Now, I was just reviewing the map with Mr. Montague, and
the CBOCs are in a 30-mile radius; however, the drive time and
distance is greater. The infrastructure in rural areas is not
the same as in urban areas.
Mr. Ondick. I'd like to correct that, and move on.
Those veterans who depended on outreach visits must now
travel 80 miles or more to visit a doctor to get their
treatments, and then drive back 80 miles or so. For those
needing radiation, they are further transferred to Cincinnati
in a van. In Cincinnati, they are given their radiation
treatment, which causes great nausea, then delivered back to
their vehicle for the 80 miles or more drive home. What a way
to say thank you for your service.
The understandable rationale is that the VA facilities are
set up in areas that will service the largest number of
veterans, and thus, being cost-effective. This put us in our
present conundrum of providing for veterans's in remote and
rural areas. These veterans served and sacrificed just as much
as their counterparts in large populated areas. It is AMVETS'
position that we need the VA medical outreach re-established
for those in remote and rural areas of Ohio, and the Nation. We
owe our rural veterans this service, and more.
The AMVETS is currently providing outreach to veterans in
southern Ohio, filing claims on their behalf. With each claim
we file, we create another access dilemma for the veterans we
serve. Again, it is the AMVETS' position that we need the VA
medical outreached re-established for those veterans in remote
and rural areas of Ohio and this Nation. I also believe the VA
created an Office of Rural Health Care, it should be funded and
supported.
I would also like to take this time to reiterate the AMVETS
legislative priorities for 2007, and they are as follows. I'm
not going to go into great detail on this. I will headline
those, because they've been brought to the Committee's
attention in the past, and you have the testimony.
The President's Budget Request for VA in Fiscal Year 2008
seeks approximately $86.7 billion for veterans' benefits and
services. This amounts to $39.4 billion in discretionary
funding, and $44.9 billion in mandatory appropriations. In
Fiscal Year 2008, AMVETS requests roughly $43.6 billion in
discretionary funding.
We seek mandatory funding for VA healthcare, extended
enrollment for OEF and OIF veterans, seamless transition, Post
Traumatic Stress Disorder, and Traumatic Brain Injury care for
our veterans, VA burial allowance, and taking care of the VA
claims
backlog.
I'd like to thank you for this opportunity to testify, and
if you have any questions regarding these priorities, or you
need additional information, you can reach me at my office. I'd
like to thank you for holding this hearing, and providing us
the opportunity to present testimony.
[The prepared statement of Mr. Ondick follows:]
Prepared Statement of George Ondick, Executive Director,
Department of Ohio, AMVETS
Mr. Chairman and Members of the Subcommittee:
I am pleased to appear today to offer testimony on behalf of Ohio
AMVETS related to Department of Veterans Affairs (VA) remote and rural
veterans' issues.
In a 2004 study of more than 767,000 veterans by Veterans Affairs
researchers shows those in rural areas are in poorer health than their
urban counterparts. The findings, reported in the October American
Journal of Public Health, validate recent and ongoing VA efforts to
expand health care for rural patients.
``We need to think about veterans who live in rural settings as a
special population, and we need to carefully consider their needs when
designing healthcare delivery systems,'' said study leader William B.
Weeks, M.D., MBA, a physician and researcher with the White River
Junction VA Medical Center and Dartmouth Medical School. Senior author
on the study was Jonathan B. Perlin, M.D., Ph.D., VA's acting Under
Secretary for Health.
The study included 767,109 veterans who had used VA healthcare
between 1996 and 1999. VA had then just begun setting up Community
Based Outpatient Clinics (CBOCs) to provide primary care closer to home
for rural veterans. Today there are nearly 700 CBOCs in VA's nationwide
system, and recent recommendations from VA's Capital Asset Realignment
for Enhanced Services (CARES) initiative call for the establishment of
more than 150 additional CBOCs.
Many veterans living in remote areas have found several problems on
reaching the VA Medical Centers and VA Clinics; some, due to their
inability to obtain transportation, and others due to inability to pay
for their transportation. In Ohio, most County Veterans Service
Commissions will provide transportation for ``qualified'' veterans.
However, a disabled veteran going for VA Healthcare, may receive from
the VA mileage of 11 cents per mile with a $3 deductible each way.
Compare that 11 cents to a VA employee receiving 48.5 cents which is
considerably more for the same trip and no deductible. Why is there a
difference? The veteran has to pay the same $3.50 for fuel as does the
VA employee.
Veterans Affairs Community Based Outpatient Clinics (VA CBOCs or
CBOC) were established to change from the centralized idea of admitting
many veterans to a hospital for treatment, to smaller, more localized
service on a outpatient basis. This seemingly is much better for the
patient, the family and the VA budget. It had worked quite well until
the veterans' healthcare outreach was stopped due to budget
restrictions.
The VA Health Administration had an outreach program that worked
quite well. The VAMCs would send a team (a doctor, nurse, technician
and admin clerk) to various remote areas to do the routine healthcare.
In southern Ohio, there were many examples: a team went to Pomeroy, 88
miles away from the Chillicothe VAMC, and Jackson, 45 miles away from
the Chillicothe VAMC, as well as several other locations. In Jackson,
they set up shop in a VSO post. In Pomeroy, they used part of the
Holzer Clinic. There were many ``outreach clinics'' in operation, until
the budget problems in January 2003 caused their closing.
The VA policy on establishing VA CBOCs was established so a veteran
would not have to travel over 35 miles to obtain healthcare. It was
changed to 40 miles. Now the strange thing is in northern Ohio, there
are VA Clinics fairly well covering all geographic areas and only one
facility is scheduled to close and it is within 40 miles of VA clinics
on each side (see attached map showing VISN 10 only so the NW corner of
Ohio appears uncovered). This gives us an idea of the problem. In the
western portion, the Cincinnati area, there are plenty of VA
facilities, many within 30 miles of one another. In remote/rural
southeast Ohio, it is a different story. The CBOC program has been
curtailed. There are VA CBOCs in Athens, Portsmouth and Marietta, which
cover as much area as 20 facilities in other areas of Ohio. Those
veterans who depended on outreach visits must now travel 80 or more
miles to visit a doctor to get their treatments and then drive back 80
or so miles. For those needing radiation, they are further transferred
to Cincinnati in a van. In Cincinnati, they are given their radiation
treatment, which causes great nausea, then delivered back to their
vehicle for the 80 miles or more drive home. What a way to say thank
you for your service to our great Nation!!!
[GRAPHIC] [TIFF OMITTED] 37533.001
[Note: Since the map is not printed in color, the following
describes the legend.]
Chillicothe VAMC = Blue
Cambridge CBOC, Lancaster, Marietta, Athens, Portsmouth.
Cincinnati VAMC = Yellow
Hamilton CBOC, Clermont County CBOC, Bellevue CBOC, Florence, KY
Ft. Thomas, IN campus.
Louis Stokes Cleveland VAMC = Green
Lorain CBOC, Painesville, Sandusky, McCafferty, Ravenna, Akron,
Mansfield,
Warren, Youngstown, Canton, East Liverpool, New Philadelphia.
Chalmers P. Wylie Outpatient Clinic = Red
Marion CBOC, Grove City CBOC, Newark, Zanesville.
Dayton VAMC = Magenta
Lima CBOC, Richmond IN CBOC, Sprinfield, Middletown.
The understandable rationale is that VA facilities are set up in
areas that will service the largest number of veterans and thus being
cost effective. This put us in our present conundrum of providing for
veterans in remote/rural areas. Those veterans served and sacrificed
just as much as their counterparts in large populated areas. It is
AMVETS' position that we need the VA medical outreach reestablished for
those in remote/rural areas of Ohio and the Nation. We owe our rural
area veterans this service and more.
The AMVETS is currently providing outreach to veterans in southern
Ohio, filing claims on their behalf. With each claim we file, we create
another access dilemma for the veterans we serve. Again, it is AMVETS'
position that we need the VA medical outreach reestablished for those
in remote/rural areas of Ohio and the Nation. I also believe the VA
created an Office of Rural Health Care it should be funded, and
supported.
I would also like to take the time to reiterate the AMVETS
legislative priorities for 2007, they are as follows:
the department veterans affairs (va) fiscal year 2008 budget
The President's budget request for VA in Fiscal Year (FY) 2008
seeks approximately $86.7 billion for veterans' benefits and services.
This amounts to $39.4 billion in discretionary funding and $44.9
billion in mandatory appropriations. In FY 2008, AMVETS requests
roughly $43.6 billion in discretionary funding.
mandatory funding for va health care
In May 2001, President George W. Bush signed Executive Order 13214
creating the President's Task Force to Improve Health Care Delivery for
Our Nation's Veterans (PTF). In May 2003, the PTF issued its final
report and recommended that ``the Federal Government should provide
full funding . . . and that full funding should occur through
modifications to the current budget and appropriations process, by
using a mandatory funding mechanism.'' Recent history demonstrates why
Congress should pass legislation to make VA health care funding
mandatory spending. In FY 2005, VA faced a $1.3 billion shortfall in
spending and Congress had to include additional funding in emergency
appropriations. For FY 2007, Congress failed to pass the annual VA
spending bill and the department is operating under a Continuing
Resolution well below FY 2007 requested levels.
extend enrollment for oef/oif veterans
H.R. 612 and S. 383 introduced in the House of Representative and
the Senate, respectively, would extend from 2 years to 5 years,
following discharge or release from active duty, the eligibility period
for veterans who served in combat during or after the Persian Gulf War.
Continued eligibility would allow veterans to receive hospital care,
medical services, or nursing home care provided by the Secretary of
Veterans Affairs, notwithstanding a lack of evidence to conclude that
their condition is attributable to such service. AMVETS fully supports
the passage of legislation to extend the 2-year priority enrollment for
OEF/OIF veterans.
seamless transition
In March 2007, GAO testified that the Department of Defense (DOD)
and VA were still having problems sharing the necessary medical records
the VA needed to determine whether servicemembers' medical conditions
allowed participation in VA's rehabilitation activities. Congress
should require the two agencies to develop electronic medical records
that are interoperable, bidirectional, and standards-based. Congress
should also require DOD to conduct mandatory separation physicals for
all separating service personnel and also utilize the Benefits Delivery
at Discharge (BDD) joint separation exam that was developed and agreed
to by both agencies.
post traumatic stress disorder (ptsd)
and traumatic brain injury (tbi)
VA operates a network of more than 190 specialized Post Traumatic
Stress Disorder (PTSD) outpatient treatment programs throughout the
country. Vet Centers are seeing a rapid increase in their enrollment.
Equally important, AMVETS is concerned about the lack of awareness and
screening among health care professionals for Traumatic Brain Injury
(TBI). PTSD and TBI clinically present the same symptoms and the
problem for medical personnel is trying to differentiate between PTSD
and TBI. VA's approach to PTSD is to promote early recognition of this
condition and the same must be done for TBI. In addition, there is no
medical diagnostic code specific to TBI. AMVETS is asking Congress to
increase funding for PTSD and TBI, with an emphasis on developing
improved screening techniques and assigning a new medical code
specifically for TBI.
va burial allowance
VA reimbursement benefits were first instituted in 1973 and
provided $150 in reimbursements for deaths that were not service-
related. In 2001 the plot allowance was increased for the first time in
more than 28 years, to $300. The non-service-connected burial allowance
was last adjusted in 1978 and now also provides $300. AMVETS supports
increasing the non-service-connected burial benefit from $300 to $1,270
and increasing the plot allowance from $300 to $745, an amount
proportionally equal to the original benefit. In 2001, Congress
increased the burial allowance for service-related deaths from $500 to
$2,000. Prior to this adjustment, the allowance had been untouched
since 1988. AMVETS recommends increasing the service-related burial
benefit from $2,000 to $4,100, restoring the value of burial costs to
its original proportionate level.
va claims backlog
The VA Claims Backlog is now over 600,000 outstanding claims and it
continues to grow at a rapid rate. VA's estimates that over 263,000
OEF/OIF veterans will seek VA services and most will want to file a
claim. At the end of FY 2006, rating-related compensation claims were
pending an average of 127 days, which is 16 days more than at the end
of FY 2003. During the same period, the inventory of rating-related
claims grew by almost half, in part because of increased filing of
claims, including those filed by veterans of the Iraq and Afghanistan
conflicts. Meanwhile, appeals resolution remains a lengthy process,
taking an average of 657 days in FY 2006. Overall, a lack of quality
control is central to this issue and VA must establish a long-term
strategy focused on attaining quality and not merely achieving quotas
in claims processing. AMVETS supports increased funding for VA to hire
more Full Time Equivalents (FTEs) in order to address the backlog.
AMVETS also supports the practice putting adjudication officers in VA
offices aboard active duty military bases.
If you have questions regarding these priorities, or you need
additional information, I can be reached at (614) 431-6990 Again, thank
you for holding this hearing and providing AMVETS the opportunity to
present its views.
Senator Brown. Mr. Ondick, thank you. And if you would like
to correct the CBOCs part of your testimony and resubmit, that
would be fine, if you would like to make those written changes.
And I'd like to introduce Mr. Montague. Thank you for joining
us from Stokes. He is the CEO of Stokes Medical Center which
coordinates most of veterans' care in the state. Thank you for
joining us, Mr. Montague.
Congressman Space.
Mr. Space. Thanks, Senator Brown. I'd like to thank you,
the first three witnesses. Before I introduce the remaining
witnesses on this panel, I would ask or remind you to speak as
closely to the mic as you can to eliminate feedback. And if you
hear that sound, that means that you've surpassed the 7-minute
limit, and we'd ask that you begin to wrap-up your testimony.
I'd like to now present Mr. Robert Bertschy, who is a World
War II and Korean era Navy veteran, and is also serving as
Senior Vice Commander of the Disabled American Veterans for the
Department of Ohio.
Mr. Bertschy.
STATEMENT OF ROBERT BERTSCHY, SENIOR VICE COMMANDER, DEPARTMENT
OF OHIO, DISABLED AMERICAN VETERANS
Mr. Bertschy. Thank you, sir. On behalf of more than 41,000
members of the Disabled American Veterans and its Auxiliary in
Ohio, I am honored to appear before you this morning to discuss
the agenda and major concerns of our Nation's wartime disabled
veterans and their families. Herman Morton, DAV Department of
Ohio Commander, sends his regrets that he could not attend this
hearing due to another commitment.
Senator Sherrod Brown and Representative Space, I want to
personally congratulate you for hosting this hearing, and
wanting to learn more about our veteran issues here in Ohio.
The Disabled American Veterans mission is service to veterans.
I am proud to report that our Ohio DAV Transportation
Network has 43 DAV vans, with 130 volunteer drivers,
transporting thousands of veterans to and from the VA Medical
Centers and community-based outpatient clinics. There are five
VA Medical Centers, 29 CBOCs in Ohio, VA VISN 10. Louis Stokes
Cleveland VA has two VA Medical Centers, and 12 CBOCs serving
veterans.
Louis Stokes Cleveland has 18 vans, and 40 drivers;
Chillicothe has 15 vans and 40 drivers; Dayton has 3 vans with
10 drivers; Columbus has 4 vans with 11 drivers, and Cincinnati
has 2 vans with 10 drivers.
DAV volunteer drivers are saving the VA thousands of
dollars. Ohio Veterans Service Commission County Offices has
paid drivers that also transport veterans to and from the VA
Medical Centers.
Although there have been cases where veterans living in
rural areas encounter difficulty in obtaining transportation on
a timely basis, this has been more of problem for such veterans
getting to Cincinnati VA Medical Center than others. It is not
felt that the lack of transportation is a real problem.
We have a lot of veterans coming home from Iraq and
Afghanistan. Are we prepared to help them? What good are all
these medical centers and clinics, volunteer drivers and vans,
if we aren't getting the VA appropriations from Congress on a
timely manner? Additional funds for hiring more doctors and
nurses at the VA medical centers are needed to improve the
delays in providing timely clinic appointments for our
veterans. Many veterans will have serious injuries requiring
long-term care. Amputations, traumatic brain injuries, vision
loss, and mental health issues are only a few healthcare issues
facing our veterans, as well as the VA in providing services.
Our veterans must not be forgotten for their sacrifices made in
time of war. Their sacrifices and service to our great Nation
shall not be in vain. We need your commitment that Washington
will not forget our veterans. Please make this commitment a top
priority for their service.
At the veterans' joint meeting in Washington, DC, in
February, we asked the new senators and representatives to
support VA mandatory funding. The 2008 Fiscal Year Budget comes
close to providing adequate funding. It does not guarantee that
VA funds will be available, when needed, since even though it
is in the budget, the majority of VA funds are subject to the
legislative process throughout the fiscal year, and is subject
to the ravages of other funding constraints. Mandatory funding
will not cost more tax dollars, and would prompt timely, and
proper management of the VA budget, and, thus, provide better,
more timely care for our sick, wounded and disabled veterans.
At the beginning of each fiscal year, mandatory funding will
not force the VA to go into a shut-down fiscal mode until
Congress figures it out.
Also, we ask you to repeal the attorney fee provisions,
Public Law 109-461.
Ranking Member of the U.S. Senate Committee on Veterans'
Affairs, Senator Larry Craig, inserted provision in this bill
to remove the bar against attorneys charging veterans a fee for
filing a claim. Our DAV Service Officers are very well trained
to assist veterans and their families in filing VA claims for
benefits they have earned, and we do it for free. It has been
this way since the Civil War. As the saying goes, why fix it if
isn't broke?
The Disabled American Veterans is a non-partisan veterans
service organization, but I personally feel that Senate
Majority Leader Harry Reid should stop his negative attitude,
and accusations of defeat in Iraq.
At a press conference on Capitol Hill, he claimed that
``this war is lost and the surge is not accomplishing
anything.'' He claims that the Iraqi War was a ``failure''.
What kind of message does this send to our soldiers, Marine and
Sailors overseas? This is having a negative impact on our
troops that are in harm's way.
In effect, statements of this type by our elected leaders
gives aid and comfort to our enemies, serving to prolong the
conflict, and cause hardship and loss of lives of our brave
soldiers.
If you look at all of the cars with signs, ``Support Our
Troops'', on them, and then have our politicians say we are
losing the war is shameful. He would have us quit on our
troops, even though they haven't quit on us, or their mission
in Iraq.
Be assured, DAV will continue supporting our veterans,
their families, and VA hospital programs. Again, DAV National
Service Officers, professional staff are the very best trained
who are representing thousands of veteran filing VA claims for
earned benefits, and we do not charge for our services.
The VA must hire more adjudicators to process veterans'
claims for benefits they have earned and are not receiving them
in a reasonable time, especially for our World War II veterans.
I want to thank you for all that your Veterans' Committees
in Washington, DC, have done for our disabled veterans, and for
all you will do in the future. Thank you for allowing me to
appear before you on behalf of the Disabled American Veterans,
Department of Ohio. God Bless all of you, God Bless our
American troops in harm's way, and God Bless the USA.
[The prepared statement of Mr. Bertschy follows:]
Prepared Statement of Robert H. Bertschy, Vice Commander,
Department of Ohio, Disabled American Veterans
On behalf of more than 41,000 members of the Disabled American
Veterans (DAV) and its Auxiliary in Ohio, I am honored to appear before
you this morning to discuss the agenda and major concerns of our
Nation's wartime disabled veterans and their families. Herman Morton,
DAV Department of Ohio Commander, sends his regrets that he could not
attend this hearing due to another commitment.
Senator Sherrod Brown and Representative Zach Space, I want to
personally congratulate you for hosting this hearing and wanting to
learn more about our veterans issues here in Ohio.
The Disabled American Veterans mission is service to veterans.
I am proud to report that our Ohio DAV Transportation Network has
43 DAV vans with 130 volunteer drivers transporting thousands of
veterans to and from the VA Medical Centers (VAMCs) and Community Based
Outpatient Clinics (CBOCs). There are 5 VAMCs, 29 CBOCs in Ohio VA VISN
10. Louis Stokes Cleveland VA has 2 VAMCs, and 12 CBOCs serving
veterans.
------------------------------------------------------------------------
Volunteer
VAMC drivers Vans
------------------------------------------------------------------------
Louis Stokes Cleveland.......................... 40 18
Chillicothe..................................... 40 15
Dayton.......................................... 10 3
Columbus........................................ 11 4
Cincinnati...................................... 10 2
------------------------------------------------------------------------
DAV volunteer drivers are all volunteers saving the VA thousands of
dollars. Ohio Veterans Service Commission County Offices has paid
drivers that also transport veterans to and from the VAMCs.
Although, there have been cases where veterans living in rural
areas encounter difficulty in obtaining transportation on a timely
basis. This has been more of a problem for such veterans getting to
Cincinnati VAMC than others. It is not felt that lack of transportation
is the REAL problem!!
We have a lot of veterans coming home from Iraq and Afghanistan.
Are we prepared to help them? What good are all of these medical
centers and clinics, volunteer drivers and vans if we aren't getting
the VA appropriations from Congress on a timely manner? Additional
funds for hiring more doctors and nurses at the VA medical facilities
are needed to improve the delays in providing timely clinic
appointments for our veterans. Many veterans will have serious injuries
requiring long-term care. Amputations, traumatic brain injuries, vision
loss and mental health issues are only a few healthcare issues facing
our veterans as well as the VA in providing services. Our veterans must
not be forgotten for the sacrifices made in time of war. Their
sacrifices and service to our great Nation shall not be in vain. We
need your commitment that Washington will not forget our veterans.
Please make this commitment, a top priority, for their service.
At the Veterans' joint meeting in Washington, DC, in February, we
asked the new senators and representatives to support ``VA mandatory
funding''. The 2008 Fiscal Year Budget comes close to providing
adequate funding. It does not guarantee that VA funds will be available
when needed since, even though it is in the budget, the majority of VA
funds are subject to the legislative process throughout the fiscal year
and is subject to the ravages of other funding constraints. ``Mandatory
Funding'' will not cost more tax dollars and would prompt, timely and
proper management of the VA budget and thus provide better, more timely
care for our sick, wounded and disabled veterans. At the beginning of
each fiscal year Mandatory funding will not force the VA to go into a
shut-down fiscal mode until Congress figures it out.
Also, we ask you to repeal the attorney fee provisions, Public Law
109-461. Ranking member of the U.S. Senate Committee on Veteran'
Affairs, Senator Larry Craig, inserted provisions in this bill to
remove the bar against attorneys charging veterans a fee for filing a
claim. Our DAV Service Officers are very well trained to assist
veterans and their families in filing VA claims for benefits they have
earned and we do it for free. It has been this way since the Civil War.
Why fix it if it isn't broke?
The Disabled American Veterans is a nonpartisan veterans service
organization, but I personally feel that Senate Majority Leader Harry
Reid should stop his negative attitude and accusations of defeat in
Iraq. At a press conference on Capitol Hill, he claimed that ``this war
is lost and the surge is not accomplishing anything.'' He claims that
the Iraqi War was a ``failure.'' What kind of message does this send to
our soldiers, marines and sailors overseas? This is having a negative
impact on our troops that are in harm's way. In effect, statements of
this type by our elected leaders gives ``aid and comfort'' to our
enemies, serving to prolong the conflict and cause hardship and loss of
lives of our brave soldiers.
If you look at all of the cars with signs, ``Support Our Troops,''
on them and then have our politicians say we are losing the war is
shameful. He would have us quit on our troops, even though they haven't
quit on us or their mission in Iraq.
Be assured, DAV will continue supporting our veterans, their
families and VA hospital programs. Again, DAV National Service Officers
professional staff are the very best trained who are representing
thousands of veterans filing VA claims for earned benefits and we do
not charge for our services.
The VA must hire more adjudicators to process veterans' claims for
benefits they have earned and are not receiving them in a reasonable
time. Especially for our WW II veterans.
Thank you for all that your veterans' committees in Washington, DC,
have done for our disabled veterans and for all you will do in the
future. Thank you for allowing me to appear before you on behalf of the
Disabled American Veterans, Department of Ohio. God Bless all of you,
God Bless our American troops in harm's way and God Bless the USA.
Mr. Space. Thank you, Mr. Bertschy. I'd like to now
introduce Mr. Tom Burke, President of the Vietnam Veterans of
America, Buckeye State Council. I'm privileged to introduce Mr.
Burke. Not only are you a panelist today, but you are also a
constituent. I understand that you live just a few blocks from
here, where we sit this morning.
Good morning, and thank you for your anticipated testimony.
STATEMENT OF TOM BURKE, PRESIDENT, BUCKEYE STATE COUNCIL,
VIETNAM VETERANS OF AMERICA
Mr. Burke. Thank you. On behalf of the members and families
of the Vietnam Veterans of America, Buckeye State Council, we
bid you welcome. To Congressman Space we say, ``Welcome Home.''
We'd like to thank you all for what it is that you do for us.
We wish to express our deep appreciation to you all for taking
time out of your schedules to come to New Philadelphia for the
purpose of hearing veterans concerns firsthand.
It is my great privilege to speak to you today to present
the thoughts and comments gathered from Vietnam Veterans of
Ohio on issues that impact members of small town America.
Funding you approve in the interest of Veterans Across America,
certainly make us better than we were many years. The recent
funding increase of $3.6 billion for the veterans Healthcare is
certainly important and necessary. It goes without saying that
sufficient funding for veterans must be met, or nothing
happens.
In preparing for today's hearing, I have spoken to many
veterans. Not surprisingly, the number one issue that comes up
across the board is their concern for healthcare. More than
half of the veterans who avail themselves of VA facilities here
in Ohio are without medical insurance of any kind. VA hospital
facilities located in the Cleveland, Cincinnati, Chillicothe,
and Dayton, access to VA facilities in urban areas is
practically unlimited because veterans can go to VA emergency
wards for treatment of ailments. However, this is not the case
for rural veterans.
We have the VA clinics in smaller cities on this side of
the state. The clinic here in New Philadelphia is said to be
the fastest growing clinic in the state. This is due to the
ever-increasing medical needs by not only older veterans, but
by the new crop of veterans currently returning from the war
zone. It is not secret that the media sources report that the
VA is at the breaking point.
These reports concern many veterans because they fear the
VA will attempt to scale back their care because of limited
funding, or because of the influx of current Iraq and
Afghanistan veterans returning from the combat zone. VA clinic
facilities are situated in Canton, Youngstown, Akron, each
providing different specialties for the veterans. The medical
help that these facilities provide through dedicated doctors,
nurses, and staff is absolutely critical to the healthcare of
veterans in non-urban areas.
An issue that many veterans grimace at in Oho is this;
veterans whose incomes are at the poverty level have little
choice concerning healthcare. However, they are fortunate that
the system does provide care for them. veterans turn to the VA
for medical assistance for a variety of reasons. Reasons cited
by veterans include those whose income or lack of service-
related disability forces them into Category 7 and 8, but a
majority of these veterans have no medical insurance. Others
have no employer sponsored medical insurance, and still others
are deemed uninsurable by the private sector. Most of these
veterans can ill afford private insurance under any
circumstances. Many veterans in Ohio and elsewhere are denied
care by the current Administration as a matter of policy.
Fortunately, some got in during the open enrollment period
before the Administration closed the door. Estimates of these
veterans now sitting out there are roughly 500,000 since 2003.
Gentlemen, this closed door policy must be rescinded. It is
time to reopen the VA health care system to Priority 8
veterans, who were restricted from enrolling since January of
2003.
The closest VA hospital for us here in this area is
Cleveland. To get to the Cleveland Wade Park VA hospital is
approximately 200 miles round trip, or more, at best, depending
on the veteran's location of residence. The VA current mileage
scale allows veterans going to any facility 11 cents per mile.
Gasoline currently is better than $3 a gallon. First of all,
this computation does not compute. A majority of Priority 6, 7,
and none of the Priority 8 veterans who are currently in the
system get any mileage at all. The VA simply says ``you make
too much money''. Yet, others of higher priority, regardless of
their income, still receive mileage. This does not make sense
to most veterans, nor do they believe it is fair.
I have a check here from one veteran that lives in Carolton
that was going to the VA facility at Canton. They held back $18
as a hold-back, and he went to the--if you don't go to the
facility more than three times a month, you don't get the full
pay. Well, the government issued him a check for mileage for 16
cents. It seems a little incredible that a veteran going to a
VA facility gets a mileage check for 16 cents. The paper and
the administration fees would cost more than that to put it
out. It doesn't make any sense to us.
I've been in many conversations concerning veterans not
only here in Ohio, but about everywhere I go concerning the
backlog of VA claim adjudication. No one seems to know what the
actual number is, four, five, six hundred thousand, but one
thing is sure, it's a big number, and must be dealt with as
quickly as possible. Many veterans are concerned about the time
that it takes to get a rating at all after there claims have
been submitted. I am advised by our VSO people that waits of
one to two years are not out of the question for initial
claims. If one appeals a decision, add another two to five
years. Gentlemen, this is simply not acceptable. With the new
crop of veterans returning from our current war zone, there is
a high concern among older veterans that their claims are
getting lost in the bureaucratic log jam. We understand that
new adjudicators are coming, but we need to be assured that the
new kids on the block are properly trained, and held
accountable for their work.
Gentlemen, the balance of my comments are submitted for the
record. That concludes my comments. Thank you.
[The prepared statement of Mr. Burke follows:]
Prepared Statement of Thomas R. Burke, President, Buckeye State
Council, Vietnam Veterans of America
To the distinguished Members of the House/Senate Veterans Affairs
Committee who have come to the fair City of New Philadelphia, Ohio this
morning. On behalf of the members and families of Vietnam Veterans of
America, Buckeye State Council we bid you welcome. To Congressman Space
we say ``Welcome Home.'' To all we thank you for what it is that you do
for us. We wish to express our deep appreciation to you all for taking
the time out of your schedules to come to New Philadelphia for the
purpose of hearing veterans concerns firsthand.
It is my great privilege to speak to you today to present the
thoughts and comments gathered from Vietnam Veterans of Ohio on issues
that impact our members of small town America. Rather than providing
you with a laundry list, I will attempt this morning is to bring to you
only those issues that arose in conversation time and again. We are
aware that difficult decisions must be made by this Committee for the
benefit of all veterans. Funding you approve in the interest of
veterans across America, certainly make us better today than we were
many years ago. The recent funding increase of $3.6 billion for
veterans health care is truly important and necessary. It goes without
saying that sufficient funding for veterans must be met or nothing
happens. We also know that many issues remain.
funding veterans health care and rural care
In preparing for today's hearing, I have spoken to many veterans.
Not surprisingly the number one issue that comes up across the board is
their concern for health care. Ohio currently has one million plus
veterans. Nearly 8,000 of those veterans call Tuscarawas county their
home. Funding for veteran issues concerning research, toxic exposure,
the effects of Traumatic Brain Injury, Post traumatic stress disorder,
prosthetic limbs, homeless veterans, our POW/MIA's issues, improvement
of facilities that treat all our veterans and combat wounded. All these
and more must be funded by money distributed from Congress from non-
discretionary funding sources. This is the only way that veterans can
be assured that their issues will not be lost.
More than half of the veterans who avail themselves of VA
facilities here in Ohio are without medical insurance of any kind. VA
hospital facilities are located in Cleveland, Cincinnati, Chillicothe,
and Dayton. Access to VA hospital facilities in urban areas is almost
unlimited because veterans can go to the VA emergency wards for
treatment of ailments. However, that is not the case for rural
veterans. We have VA Clinics in smaller cities on this side of the
state. The clinic here in New Philadelphia is said to be the fastest
growing clinic in the state. This is due to the ever increasing medical
needs by not only older veterans, but by the new crop of veterans
currently returning from the war zone. It is no secret that media
sources report that the VA is at the breaking point.
These reports concern many veterans because they fear VA will
attempt to scale back their care because of limited funding or the
influx of current Iraq and Afghanistan veterans returning from the
combat zone. Additional VA clinic facilities are situated in Canton,
Youngstown and Akron each providing different specialties for veterans.
The medical help that these facilities provide through dedicated
doctors, nurses and staff is absolutely critical to the health care of
veterans in non-urban areas.
For the most part veterans rate services provided by clinics and
hospitals as good to excellent. However, we find that medical clinic
access seems to vary from clinic to clinic. A veteran will usually get
in to see a doctor at a clinic about once very 6 months as part of a
routine wellness physical if he or she is in the system. Should you be
a new patient seeking treatment you may wait a longer period of time.
Many of the veterans stated that if they become ill between their
normal visits to the clinic, that they are unable to see a VA doctor if
they request appointments. All believe that this is a result of VA
limiting staffing policies. At a time when VA should be gearing up
personnel, i.e., current veterans returning, putting more pressure on
the system to perform, they seem to be going the other way. Veterans
who seek help at the VA facilities that are rated 100 percent are
admitted within a couple of days. Others who are less than a 100
percent may not get in at all if they are sick. The same also holds
true for dental care as well. Some veterans have come to believe their
access to VA facilities may be based on their Priority status or lack
thereof. Perhaps a facility that has a larger staff may afford that
clinic to accommodate the veteran needs. Veterans note that there does
not seem to be any uniformity between facilities.
An issue that many veterans grimace at in Ohio is this. Veterans
whose incomes are at the poverty level have little choices, concerning
health care; however, they are fortunate that the system does provide
care for them. Veterans turn to the VA for medical assistance for a
variety of reasons. Reasons cited by veterans include those whose
income or lack of service related disability, forces them into Priority
7 and 8, but a majority of these veterans have no medical insurance.
Others have no employer sponsored medical insurance and still others
are deemed uninsurable by the private sector. Most of these veterans
can ill afford private insurance under any circumstances. Many veterans
in Ohio and elsewhere are denied health care by the current
Administration as a matter of policy. Fortunately some got in during
the open enrollment period before the Administration closed the door.
Estimates of these veterans now sitting out there are roughly 500,000
since 2003. Gentlemen, this closed door policy must be rescinded. It is
time to reopen the VA health care system for Priority 8 veterans, who
were restricted from enrolling in January 2003.
Additionally, insufficient funding by Congress to take care of all
who were promised health care as a condition of their service, still
others who are forced to private health care and cannot afford
prescription medications they need. We add a big thank you for VA
prescription drug service, in some cases a life saving service.
Ironically, Congress always seems to be able to find funds to wage war,
which is necessary to support current combat troops. We certainly need
to support our troops. However, once home, the Congress must find the
necessary funds to treat and care for our veterans.
revamping
A revamping of the funding for veterans health care is an
overwhelming issue that must be dealt with. H.R. 1382 is a start,
Mandatory Funding for Veterans Health Care 2008. Gentlemen the current
discretionary funding method for VA medical care simply does not work.
VVA has long maintained that accountability must be built into any
system of funding for the VA. Simply throwing cash at a problem will
probably not work either. We must find long term solutions. Veterans in
Ohio are certainly willing if not eager to work with whoever it takes,
to find a way to ensure the VA has the funding to meet its mandate to
``care for them who have borne the battle.'' If we cannot find a way to
maintain and improve care as time proceeds, we may find all veterans
without benefits. This is a fate that we cannot let happen. Perhaps a
bipartisan group should be formed whether in our state or on a national
level to study the issues, options and hopefully solutions.
mileage issue
The closest VA hospital for us is Cleveland. To get to Cleveland
Wade Park VA hospital is a 200-mile roundtrip or more at best depending
on the veterans' location of residence. The VA current mileage scale
allows veterans going to any facility eleven (11) cents per mile.
Gasoline currently is better than three dollars a gallon. First of all
this computation does not compute. A majority of Priority six (6) seven
(7) and none of the Priority eight (8) veterans who are currently in
the system get any mileage at all. The VA says ``you make too much
money''. Say what? Yet others of higher priority regardless of their
income still receive mileage. This does not make sense to most
veterans, nor do they believe it is fair.
outreach
In the State of Ohio, we have found that many veterans who have
served honorably simply are unaware of benefits and or services that
they are entitled too. Many were not told of available benefits or
services when they left their branch of service and never thought
another thing about it. Outreach should be an ongoing effort to all
veterans but especially in country veterans so they become aware that
their likelihood of contracting a dreadful disease is much higher than
the general public.
adjudication of claim backlog
I have been involved in many conversations concerning veterans not
only here in Ohio but about everywhere I go concerning the current
backlog of VA claim adjudication. No one seems to know what the actual
number is, four, five, six, and hundred thousand. But one thing is for
sure. It's a big number and must be dealt with as quickly as possible.
Many veterans are concerned about the length of time that is takes to
get a rating at all after claims have been submitted. I am advised by
our VSO people that waits of 1 to 2 years are not out of the question
for an initial claim. If one appeals a decision add another 2 to 5
years. This is simply not acceptable. With the new crop of veterans
returning from our current war zone, there is high concern among older
veterans that their claims are getting lost in the bureaucratic log
jam. We understand that new adjudicators are coming, but we need to be
assured that the new kids on the block are properly trained and held
accountable for their work.
employment, training
It seems that the so called ``veterans preference'' which we all
know is on the books nationally certainly does not appear close to
being enforced. Veterans both National Guard and Reservists returning
to Ohio have faced no job or a job that has been reengineered, in
effect again losing their career position. To veterans who return with
less of a body than they started with they certainly deserve to be
given chance to maintain employment if they are physically able to do
so for their own well being. To assist veterans who are unemployed or
underemployed with new or additional training seems vital to us.
Veterans who lose their jobs should have the opportunity to get a re-
education and work skill upgrades. S. 22, S. 644, and H.R. 1102 would
establish educational assistance for various veterans and Reserve
elements. Ohio Vietnam Veterans feel these initiatives should be
supported. With respect to our older veteran population national
standards now cite retirement age increasing to a minimum age of 66.
Federal, state, and private employers need to start rethinking their
priorities toward older veterans and workers in general when it comes
to keeping them in the workforce. With the increased standards,
veterans reaching fifty years old or older are being shelved for
younger less experienced people because their income combined with
group benefits provided has reached a level that employers increasingly
are not willing to pay. Federal agencies that provide job services to
veterans should note this reality shift and make priority changes so
veterans cannot only maintain their jobs, but find new ones if
necessary.
pow/mia
The Vietnam Veterans of Ohio, along with The POW/MIA Families, on
this issue have the strongest possible feelings. Prisoners of War and
those missing in action must be accounted for and not left behind. We
urge the Congress pass a resolution. Such resolution should be
presented to the government of Vietnam to give up relevant wartime
documents, so the remains of war dead may be brought home and those
listed as MIA should be accounted for.
I speak from personal experience when I tell you that having a
brother KIA in Korea was bad enough for my family. I cannot imagine
what it would have been like especially for my parents if they had not
known the fate of their fallen son.
Distinguished Members of the House and Senate Veterans' Affairs
Committee that concludes my testimony on behalf of the Vietnam Veterans
of America, Buckeye State Council.
Mr. Space. Thank you, Mr. Burke.
And I'd like to introduce our last witness on the first
panel, Mr. Donald Lanthorn, a Vietnam veteran, and the
Department Service Director from The American Legion,
Department of Ohio.
Thank you, Mr. Lanthorn, for being here today, and
presenting your testimony.
STATEMENT OF DONALD LANTHORN, SERVICE DIRECTOR, DEPARTMENT OF
OHIO, THE AMERICAN LEGION
Mr. Lanthorn. Senator Brown, Representative Space, it's my
pleasure to be here today. Thank you for this opportunity to
provide our organization's views on VA healthcare, its
accessibility, and needs to be considered by Congress from the
point of view of Ohio veterans and members of our organization.
My first experience with VA healthcare was 30 years ago. At
that time, VA Medical Centers had long lines, inadequate
waiting areas, and few facilities. I was appalled by patients
having to sit in hallways, on the floor, waiting for their
opportunity to see a doctor, after having traveled perhaps 100
miles within Ohio to be seen.
However, even in those trying times, medical care was
comparable to the private sector, but few with the alternatives
available through health care insurance would select VA as the
health care provider of choice. Even veterans with service-
connected
conditions would often opt for private sector treatment for the
convenience.
The 1980s saw some improvement in access, as VA Medical
Centers in Ohio expanded the ambulatory care clinics, opened a
few outpatient clinics, and moved toward outpatient, rather
than inpatient care, as the preferred method of treatment.
Beginning in 1994, Dr. Kenneth Kizer, VA Undersecretary for
Health, began revamping the system to his vision of
accessibility, quality, and safety. He is arguably credited
with setting in motion the plan that closed under-used
facilities, established hundreds of new access points with
clinics, and created a business model of efficiency utilizing
available technology to digitize records, to common sense in
informing patients about their medications.
As word spread of the quality of VA healthcare, veterans
left their private plans and sought VA healthcare in droves.
Without funding to handle the patient influx, VA was forced in
2003 to again restrict access, as waiting lists grew, so now
only service-
connected and low income veterans were eligible to enroll,
slamming the door to hundreds of thousands of veterans planning
on using VA healthcare in retirement, or sooner.
A vital part of the VA transformation was the accessibility
created for veterans by establishing community-based outpatient
Clinics. They brought healthcare closer to where veterans live,
and provide mental health services, often otherwise not
available in rural communities.
Ohio has CBOCs in Athens, Cambridge, Lancaster, Marietta,
and Portsmouth affiliated with Chillicothe VA Medical Center,
and Clermont County near Cincinnati VA Medical Center. Dayton
VAMC has CBOCs in Lima, Middletown, and Springfield. Columbus
VA Outpatient Clinic serves Grove City, Marion, Newark, and
Zanesville with CBOCs. Cleveland VAMC, the most aggressive of
all Ohio Medical Centers in establishing VA points of access,
has CBOCs in Akron, Canton, East Liverpool, Lorain, Mansfield,
McCafferty in downtown, New Philadelphia, Painesville, Ravenna,
Sandusky, Warren, and Youngstown.
Additionally, Ohio medical facilities have established
CBOCs in Indiana and Kentucky, which serve Ohio veterans, as
does the Toledo Clinic, a satellite of Ann Arbor VAMC, and
other Ohio CBOCs in Ashtabula and St. Clairsville, established
by VA facilities in bordering states.
The Ohio American Legion strongly supports the
recommendation of the Capital Asset Realignment for Enhanced
Services (CARES), recommendations for more CBOCs, and expanded
services in those now operating, especially those in rural
areas. However, limited VA discretionary funding has slowed the
number of clinics authorized each year. Field stations
partially meet access needs, but are not sufficient in
availability or services.
The current war and its estimated toll on veterans' mental
health make these services vital in CBOCs for our returning
troops ease of access. We urge sufficient VA funding to ensure
adequate staffing.
Traumatic Brain Injury veterans similarly find few
community resources in rural areas for TBI-related problems,
and many cite transportation as a major obstacle. We have
addressed the transportation issue in Ohio with state
legislation requiring County Veterans Service Commissions to
provide it. Now VA must provide the services with the patient
at the doorstep.
Vet Centers are another resources VA provides, which is not
readily available in rural communities. Veterans should not be
penalized or denied quality healthcare because of where they
choose to live. We urge Congress and VA to improve access to
quality primary care, specialty healthcare, and mental health
services in rural areas.
As important as access as may be, just as critical is
timeliness of services. VA has established its own standards
for access to primary care of 30 days. That is unacceptable to
most Americans, and especially does not meet the obligations of
VA to our veterans.
The Ohio American Legion does not point fingers at problems
without offering a means of resolution. We disagree with the VA
decision to deny access to any eligible veteran. Many of these
veterans have third-party insurance that could reimburse VA, or
are Medicare-eligible, yet little has been done to improve
third-party reimbursements for private insurers, and nothing to
allow VA to receive reimbursement from the Nation's largest
healthcare insurer, the Centers for Medicare and Medicaid
Services, as both the Indian Health Services and Department of
Defense are authorized to bill, collect, and receive.
Full funding for VA healthcare, full eligibility for all
veterans, and Medicare reimbursement to VA is the first step
needed to assure quality healthcare to rural Ohio veterans.
Thank you, Mr. Chairman, for providing the Ohio American
Legion this opportunity to address the issues of VA healthcare
in Ohio, and the disparities that exist in access to quality
healthcare in rural areas.
[The prepared statement of Mr. Lanthorn follows:]
Prepared Statement of Donald R. Lanthorn, Service Director,
Department of Ohio, The American Legion
Mr. Chairman, Members of the Committee. My name is Donald R.
Lanthorn. I am the Service Director and Legislative Agent for The Ohio
American Legion.
It is my pleasure to be here today. Thank you for this opportunity
to provide our organization's views on VA health care, its
accessibility and needs to be considered by Congress from the point of
view of Ohio veterans and members of our organization.
My first experience with VA health care was thirty years ago. At
that time VA Medical Centers had long lines, inadequate waiting areas
and few facilities. I was appalled by patients having to sit in
hallways, on the floor, waiting for their opportunity to see a doctor,
after having traveled perhaps one hundred miles within Ohio to be seen.
However, even in those trying times, medical care was comparable to
the private sector, but few with the alternatives available through
health care insurance would select VA as the health care provider of
choice. Even veterans with service-connected conditions would often opt
for private sector treatment for the convenience.
The 1980s saw some improvement in access, as VA Medical Centers in
Ohio expanded the ambulatory care clinics, opened a few Outpatient
Clinics and moved toward outpatient, rather than inpatient care, as the
preferred method of treatment.
Beginning in 1994 Dr. Kenneth Kizer, VA Undersecretary for Health,
began revamping the system to his vision of accessibility, quality, and
safety. He is arguably credited with setting in motion the plan that
closed underused facilities, established hundreds of new access points
with clinics, and created a business model of efficiency utilizing
available technology to digitize records, to common sense in informing
patients about their medications.
As word spread of the quality of VA health care, veterans left
their private plans and sought VA health care in droves. Without
funding to handle the patient influx, VA was forced in 2003 to again
restrict access, as waiting lists grew, so now only service connected
and low income veterans were eligible to enroll, slamming the door to
hundreds of thousands of veterans planning on using VA health care in
retirement or sooner.
A vital part of the VA transformation was the accessibility created
for veterans by establishing Community Based Outpatient Clinics
(CBOCs). They brought health care closer to where veterans live and
provide mental health services often otherwise not available in rural
communities.
Ohio has CBOCs in Athens, Cambridge, Lancaster, Marietta and
Portsmouth affiliated with Chillicothe VAMC, and Clermont County near
Cincinnati VAMC. Dayton VAMC has CBOCs in Lima, Middletown, and
Springfield. Columbus VA Outpatient Clinic serves Grove City, Marion,
Newark, and Zanesville with CBOCs. Cleveland VAMC, the most aggressive
of all Ohio Medical Centers in establishing VA points of access, has
CBOCs in Akron, Canton, East Liverpool, Lorain, Mansfield, McCafferty
in downtown, New Philadelphia, Painesville, Ravenna, Sandusky, Warren
and Youngstown.
Additionally, Ohio medical facilities have established CBOCs in
Indiana and Kentucky, which serve Ohio veterans, as does the Toledo
Clinic, a satellite of Ann Arbor VAMC, and other Ohio CBOCs in
Ashtabula and St. Clairsville, established by VA facilities in
bordering states.
The Ohio American Legion strongly supports the recommendation of
the Capital Asset Realignment for Enhanced Services (CARES)
recommendations for more CBOCs, and expanded services in those now
operating, especially those in rural areas. However, limited VA
discretionary funding has slowed the number of clinics authorized each
year. Field Stations partially meet access needs, but are not
sufficient in availability or services.
The current war and its estimated toll on veterans' mental health
make these services vital in CBOCs for our returning troops ease of
access. We urge sufficient VA funding to ensure adequate staffing.
Traumatic Brain Injury (TBI) veterans similarly find few community
resources in rural areas for TBI related problems, and many cite
transportation as a major obstacle. We have addressed the
transportation issue in Ohio with state legislation requiring County
Veterans Service Commissions to provide it. Now VA must provide the
services with the patient at the doorstep.
Vet Centers are another resource VA provides, which is not readily
available in rural communities. Veterans should not be penalized or
denied quality health care because of where they choose to live. We
urge Congress and VA to improve access to quality primary care,
specialty health care and mental health services in rural areas.
As important as ``access'' may be, just as critical is
``timeliness'' of services. VA has established its own standards for
access to primary care of 30 days. That is unacceptable to most
Americans, and especially does not meet the obligation of VA to our
veterans.
The Ohio American Legion does not point fingers at problems without
offering a means of resolution. We disagree with the VA decision to
deny access to any eligible veteran. Many of these veterans have third-
party insurance that could reimburse VA, or are Medicare eligible, yet
little has been done to improve third-party reimbursements from private
insurers and nothing to allow VA to receive reimbursement from the
nation's largest health care insurer, the Centers for Medicare and
Medicaid Services (CMS), as both the Indian Health Services (IHS) and
Department of Defense (DoD) are authorized to bill, collect, and
receive.
Full funding for VA health care, full eligibility for all veterans,
and Medicare reimbursement to VA is the first step needed to assure
quality health care to rural Ohio veterans.
Thank you, Mr. Chairman, for providing The Ohio American Legion
this opportunity to address the issues of VA health care in Ohio and
the disparities that exist in access to quality health care in rural
areas.
Senator Brown. Thank you, Mr. Lanthorn.
I will begin the questioning, and feel free, any of you, to
jump in if the question is directed at one of you. Feel free to
also add your thoughts to the answers.
Mr. Anderson, Mr. Moore talked about contracting out. I'd
like to pursue that a bit. Mr. Moore, you said that contracted
care takes money out of the system, and potentially dilutes
quality of care. Mr. Anderson, you said that you fear that the
VA will become the insurer of care, not the provider of care.
That results in a diminution of the quality of care. Would each
of you expand on that a bit? Mr. Moore first, then Mr.
Anderson.
Mr. Moore. Well, again, we're very concerned with that
aspect. When we're looking for our dollars, and we're fighting
for our dollars continually, that if you--in the past what I
saw is simply that when we've contracted in the past to private
entities, the veteran always end up, seems to me, to suffer.
The billing system gets messed up. He doesn't get his care on
time, or it doesn't get paid on time. He gets threatening
letters continually that that private sector hospital is going
to turn it over to a collection agency because it hasn't been
paid by the VA; and, therefore, he's responsible for it. That's
one of the issues I see that bothers me with contracting care
out. I've seen that happen several times in the Columbus area
when they contracted out for some of the--University Hospital,
a veteran came in with all kinds of problems, threats if the
bills weren't paid, and everybody is arguing back and forth
between them and fee-basis, who's responsible for that. Well,
they are, they aren't. In the end, the poor veteran is sitting
there suffering, and he's being threatened by ruining his
credit and everything else. That's one fear I have about
contracting out. Unless, again, Congress and the VA itself, and
any of these contracted out medicals really need to look at it
and keep auditing that system, keep a very strong hand on it,
making sure that it's done properly.
Senator Brown. Have you seen an increase in the number of
veterans who serve with those problems, with the problems of
the mix of privatized or contracted out care?
Mr. Moore. Fortunately, most of them in Ohio, we have a
very strong VA healthcare system in there, thanks to Director
Montague and others that pushed that. When you look at Ohio
compared to its sister states that in that Appalachia area that
we're talking about, West Virginia and Kentucky, you're looking
at roughly 20 probably rural CBOCs and whatnot within Ohio, but
in West Virginia you're looking at six or seven CBOCs, in
Kentucy about the same. And it's very difficult for those
individuals to get in and get timely healthcare appointments.
I'm worried that, I think CBOCs and those people who reach out
to the veterans who make those house calls on those that are
house-bound, and/or have mental health conditions that make it
difficult for them to come in, we are very short on those types
of people. We need more of them. They do an excellent job.
They're very committed, but I think we're at the point where
we're starting to overwork them. Mental health individuals have
to make assessments of some cases in the field, supposed to be
about an hour or less than that to try to make some kind of
assessment. I would like to see more of that expansion of
technology out in the field for those rural people, such as not
only the Telebuddy, but they have tele-video where the mental
health individual actually sees that individual on a screen and
can make assessments, and they can have somewhat of a
consultation right there at their home.
Senator Brown. Thank you. Mr. Anderson, about the
diminution of quality of care. Pull the microphone a little
closer.
Mr. Anderson. When you asked me that question, Mr.
Chairman, I looked at myself, and I think I've received some of
the best care in the world from the VA. I am a product of that
service. I'm specialized service intern of spinal cord injury.
I've been receiving service 27 years, and I've gotten some of
the best spinal cord injury service around. I've received three
surgeries there at the VA Medical Center, and I'm going in for
a third one in another month for Harrington rods, I've been
experiencing some Harrington rod problems, and the service I
received from the VA has been excellent. And as specialized
service, only through the VA have I been able to get that
quality care of services. And the veterans that I've worked
with and serve with, only through the VA have we been able to
get that kind of service. So we have received topnotch service,
and nowhere have we received such quality care.
Senator Brown. Mr. Ondick and Mr. Lanthorn, you both talked
about 700 CBOCs around the country, 150 cares recommended. Do
you specifically recommend expansion? We just announced this
week--well, I talked to the Secretary of the VA this week about
the Hamilton and Parma new expanded CBOCs. Do you specifically
recommend more in Ohio? And if so, does that potentially take
money away from other things that the VA is doing? What is your
thought about additional CBOCs in Ohio, and even specifically
where, if you are recommending that? Your view, and I'd like to
ask both of you, but either/or.
Mr. Ondick.
Mr. Ondick. I have covered in my testimony the list of the
facilities that there are in Ohio. There is a significant need
for a couple of CBOCs in northwestern Ohio, which is not in
VISN 10, but it is in VISN 11 out of Michigan, and Indiana fall
into that VISN. Most significantly, that's where our needs need
to be addressed. However, we could use a couple of CBOCs in----
Senator Brown. There is one in Lima now. Correct?
Mr. Ondick. Yes. Yes, there is.
Senator Brown. Nowhere between Lima and Toledo?
Mr. Ondick. Actually, Finley and Defiance would probably be
two good locations, or Finley and Bryan, not knowing where
there might be one in Michigan.
Senator Brown. But now there's--outside of Toledo, there's
Lima, there's Lorain, east of Toledo, nothing in Bowling Green,
nothing in anywhere else other than Lima at this point?
Mr. Ondick. And Toledo, yes.
Senator Brown. And Toledo, yes.
Mr. Lanthorn. If Mr. Montague would just hold up the map of
Ohio right here, you can see the locations of all the CBOCs,
and where the need is.
Senator Brown. That would be out of the Michigan Center,
though, correct?
Mr. Ondick. Marion. In southeastern Ohio, we are dependent
upon CBOCs in Huntington.
Senator Brown. They're in East Liverpool, they're here,
they're Athens, Chillicothe.
Mr. Ondick. But we are dependent upon CBOCs that are
located in St. Clairsville, and then, of course, the VA Center
in Huntington to service Ohio veterans, as well.
Senator Brown. So there's one in Marion. Correct?
Mr. Ondick. Yes.
Senator Brown. So Marion and Lima, and Mansfield.
Mr. Lanthorn. You could see the areas that need coverage,
that northwest corner. The areas down in Cincinnati, Dayton are
covered quite well. There are a few small pockets, and, again
from my conversation with Mr. Montague earlier, some of the
small pockets along the river, and up along the eastern part of
the state are covered by--correct me if I'm wrong, Mr.
Montague, but they're covered by CBOCs in other states?
Mr. Space. Mr. Lanthorn, while we're on the subject of
CBOCs, my understanding is there are five of them in Ohio's
18th Congressional District. That would include one here in New
Philadelphia, which I have been told is one of the fastest
growing CBOCs in the state, community-based outpatient clinics.
In addition, we've got one in St. Clairsville, Cambridge,
Zanesville, and Newark. Is that correct?
Mr. Lanthorn. Yes, sir.
Mr. Space. Those are the five serving----
Mr. Ondick. The one in St. Clairsville is not part of VISN
10. That's one we're depending on another VISN.
Mr. Space. Right. Those are the five. And the principle
behind the CBOC concept is, it's kind of--I've heard the
analogy ``hub and spoke,'' with the hubs being the medical
centers, like the one we have in Chillicothe, or the one we
have in Cleveland; with the spokes being the various CBOCs
situated strategically around the state, try to serve those
veterans who are not within a short drive to those medical
centers. I mean, the concept is a good one, and certainly, we
are encouraged by the recent announcement that there are going
to be more CBOCs constructed, but the fact of the matter is
that some of the CBOCs, all of them, actually, have some
serious limitations when dealing with special needs. And I
think it was Mr. Ondick that used the example of someone who
has to travel 80 miles for radiation therapy, and then travel
80 miles back home. Forget about the fact that the insult of 11
cents per mile, the mere travel and distance, and inconvenience
occasioned by that travel is, in and of itself, a significant
problem that affects almost exclusively rural veterans.
Aside from making that statement, I wanted to ask you
whether--and this applies to anyone on the panel--if you've got
some ideas, some creative thoughts on how we can expand access
to specialized care in rural America, rural Ohio, in
particular, over and above what's presently being offered by
the CBOC hub and spoke system.
Mr. Ondick. Mr. Chairman, it would certainly behoove the VA
to, as they provide services in the CBOCs, to provide some
specialty services at certain CBOCs so that like Women's
healthcare services be available, if not within the 30-mile
radius at every CBOC, perhaps overlay those maps with 50 or 60-
mile circles that would assure that those specialty services
would be available within a certain time and transportation
frame for all veterans in the state. This is something that
could be done, I'm sure.
Mr. Space. Anyone else on the panel have suggestions on how
we could enhance specialized care for rural veterans?
Mr. Burke. Congressman, I know that some of my guys that
have commented about the clinic here in New Philadelphia, it is
said to be one of the fastest growing in the state. That is
because there have been a lot of participation by the veterans
in this area. I'm told that the clinic here will soon have eye
care, and foot care, podiatry, and the veterans that I've
talked to have commented that this is really going to be of a
help to them. The more expanded care that can be provided in
the small town clinics is certainly going to diminish the time
that the veteran has to travel to the major hospital for
whatever purpose he has to go there for. So I suggest that the
expansion of services at the local clinics would certainly do
much to help the veterans in the area.
Senator Brown. Perhaps Mr. Ondick could answer this. Are
there five VA medical centers in the State of Ohio? How many
are there in the State of Ohio?
Mr. Ondick. We have Chillicothe, Cincinnati, Dayton,
Cleveland.
Senator Brown. It seems to me that every region of Ohio is
served by a medical center, with the exception of the
southeastern area of Ohio.
Mr. Bertschy. You've got the--one of the problems is
Harrison County. I think it's Harrison County, and one other
county, I think it's Jefferson County, that have to go to
Pittsburgh, and there is no CBOC. Steubenville has a CBOC, or
close-by, but if you look at the ones close to the Ohio River,
talking about Morton's Ferry and them areas in there, they have
to go to Pittsburgh. That's the only place they can go. There
is no CBOC within a 30-mile radius for them. I think if they
could expand the old type, what we had, the fee-basis or the
fee-basis where they could go to their local hospitals to get
this care would help an awful lot.
Senator Brown. Excuse me. There's a CBOC in East Liverpool,
and St. Clairsville. Right?
Mr. Bertschy. Right. There is----
Senator Brown. Where?
Mr. Ondick. St. Clairsville, is it open yet?
Mr. Bertschy. St. Clairsville is open.
Mr. Ondick. I was thinking it wasn't open.
Senator Brown. So where are they not getting service?
Steubenville doesn't have one, but it's served by----
Mr. Bertschy. Steubenville has to go to East Liverpool.
Senator Brown. East Liverpool, or south of there, Mango
Junction maybe goes to St. Clairsville. I don't know, but where
do they have to go, to Pittsburgh?
Mr. Bertschy. Most of them are going--anyone I talked to, I
don't know in Jefferson County, in Steubenville, that most of
them will go to Pittsburgh.
Senator Brown. Rather than St. Clairsville, or East
Liverpool.
Mr. Bertschy. Yes.
Senator Brown. Let me pursue, and Mr. Burke, maybe this is
for you. You all talked about the 11 cents a mile, and we all--
that's just an embarrassment to all of us. But my understanding
is there are some cases where people in the community,
particularly someone is driving, they simply can't drive
because of their disability, because of their illness, because
of whatever reason, they don't have car, and I know that
community organizations that support veterans' groups,
sometimes, obviously, veterans service organizations and others
will provide transportation. My understanding is, sometimes
they are not eligible for reimbursement at all? Someone that's
helping. Mr. Burke, if you have to go and you can't drive
yourself, and you get some help from somebody in the community,
they don't get reimbursed at all. Is there a loophole in the
law that disqualifies or some prohibition for reimbursement?
Mr. Bertschy. Well, if you're not service-connected, and if
you're a Category 7 or 8, if your income is above certain
levels, the VA simply says you're not eligible for any
reimbursement as far as mileage goes.
Senator Brown. So if it's Category 7 or 8.
Mr. Bertschy. Category 7 or 8, and----
Senator Brown. Or if you're above a certain income level.
Mr. Bertschy. And if you're above a certain income level,
and if you're a veteran, but you have no service-connected
disability, that is another obstacle to receive----
Senator Brown. You're eligible to go to the CBOC in East
Liverpool, but you can't get mileage.
Mr. Bertschy. Correct.
Senator Brown. Mr. Moore.
Mr. Moore. You can't get enrolled if you're a Category 7 or
8.
Senator Brown. You can't get enrolled.
Mr. Bertschy. Right now, that's correct. I'm sorry. That's
right. Right now, if you're a Priority 8, you can't even get
enrolled because they've been locked out.
Mr. Moore. If I could, Senator Brown. Rural areas are
basically, they use HUD for figuring those financial incomes
for families, probably for a married couple you're looking at
rural areas of about $32,280 for a married veteran, and about
$25,000-$26,000 for a single veteran. If he is that income or
over that, then he's Category 7 non-service connected, and he's
not available, or he's not eligible for healthcare.
If I could, one more. You had asked earlier in regards to
outsourcing, why it's another reason why we wouldn't want the
VA to do that; because the VA has a unique ability to treat
some of these specialized injuries in mental illness that
nobody has. Nobody else there in the private sector sees the
amputees, and the burn victims, and the PTSD. They've dealt
with that for years, and they are the ones with the expertise
to really handle and give the best healthcare to those injured
individuals.
Senator Brown. Thank you all very much for being with us
and sharing your thoughts, and your experience, and your
wisdom. Stay in touch with both of us, personally, stay in
touch with the Veterans' Committee in both houses. I will see
you all regularly, I'm sure, in the years ahead. And thank you
for coming to New Philadelphia, and joining us today. Thanks
very, very much.
Mr. Space. If I could, before you exit the stage, I just
had a couple of things I wanted to bring up. First of all, Mr.
Bertschy, I wanted to commend you for what appears to be having
logged 85,000 volunteer miles in helping to transport veterans.
I got that from your resume, and I wanted to commend you for
that.
And if I could just, before we leave this subject, because
of the peculiar concerns of rural Ohio when it comes to
healthcare; and, Mr. Moore, I want to address this to you,
again, any others feel free to jump in, but I understand your
concerns about privatization and pulling funds away from
speciality treatment that the Veterans' Administration is able
to administer better than anyone else. I think Mr. Bertschy may
have mentioned a reference to the prospect of providing local
community care for some veterans who don't have immediate
access to veterans' care. And, Mr. Moore, are there situations
where contracting for healthcare outside of the Veterans'
Administration, would be appropriate, and would enhance
veterans' care?
Mr. Moore. Yes. Like I said, with proper use, there are
areas I think in need, in rural areas. Obviously, as we talked
about, chemotherapy treatment and radiation, even when we have
transportation, even in some of our counties to the medical
centers at Stokes, when you started getting into that eighth
and tenth treatment, you get so ill that just getting on the
public transportation, or having to wait for the other guys to
come back in a van is just tough on them. Something like that,
if we could have it specialized where that and a fee-basis
could be outsourced, they get their--obviously, most areas
there's somebody, or a medical facility close by that does have
chemotherapy and radiation treatment.
Mr. Space. So it might be something worth studying,
particularly with respect to rural----
Mr. Moore. Yes, the Veterans of Foreign Wars are not
totally against that. We think in certain particulars, it could
be of use. But it has to be, obviously, audited and looked over
very strongly when you're doing that.
Mr. Space. All right. Well, thank you, Mr. Moore. Thank you
all of our panelists. I wish we had more time, but we're on a
rather tight schedule. When we're through here, I'd ask that
you exit the stage, and we have seats arranged for you in the
first row. And our second panel will approach the stage. We're
going to take about a 5-minute break, and we'll launch into our
second panel. Thank you.
[Recess.]
Mr. Space. We've got the panelists. I ask that all audience
members take their seats. We'd like to move forward with our
second panel. Our second panel this morning is Terry Carson,
Chief Executive Officer of the Harrison Community Hospital in
Cadiz, Ohio, which is in Harrison County.
Mr. Carson, I'm privileged to introduce you this morning
both as a panelist and, again, as a constituent. We look
forward to hearing your remarks.
STATEMENT OF TERRY CARSON, CHIEF EXECUTIVE OFFICER,
HARRISON COMMUNITY HOSPITAL
Mr. Carson. Senator Brown and Congressman Space, we thank
you very much for taking the time this morning. Frankly, you're
the only two offices that responded to our letters of issues,
so we appreciate you taking the personal time, and also the
time out here in the field.
I've been for 15 years attempting to meet the challenges of
providing healthcare to rural communities. My background is
primarily a big city, Cleveland boy, so when you come out to
the rural, there are special challenges that you try to meet
because you take for granted that they're out there, and
sometimes, it's a very rude awakening when they're not.
I was drafted in 1965, and I spent my next two years at
Walter Reed in Washington, DC. And, of course, I was sort of
dismayed when I heard the reports in the papers not too many
weeks ago about some of the conditions that have been
developing. We know that as a first-class military institution.
I don't think that's a veterans' facility. But when I was
there, I was a kid coming out of Cleveland, Ohio, never had a
stitch, never broke anything, and we were treating and serving
the kids that came right in from Vietnam, and many times they
had their field bandages on them. So I think it's a system we
can be awfully proud of, and I think our entire VA system is
one that we can be proud of. But I think the conditions that
took place there are probably a good example of you just can't
pour money down a rat hole and think it's going to develop into
something. Someone has to watch it, and monitor it, and has to
make sure that it's working.
And that's really our message in my brief statement that I
presented to you folks, is that there has to be a better way to
tend to those patients who have critical issues out in the
rural communities, without having them go hundreds of miles to
a center, because their name happens to be registered there for
their treatment.
Sometimes you need to think out of the box, and instead of
pouring money into a system that perhaps isn't meeting
everyone's needs, how do you come up with ways to make it work?
And I was listening to some of the panelists here, and it's
very humbling to have gone through my military time without
having an injury, and seeing people that have had some pretty
devastating things taking place in their lives. But if we can,
perhaps, take a little chance to improve the system in the
offering that we're giving, maybe it's time well spent.
But it may well be something that you could have a panel of
hospitals, and a panel of physicians who are willing to sign
onto the VA program, much like we do with the Medicare program
in offering these services in various communities. If you want
to put your outpatient clinics adjacent to, or in closer
proximity to rural facilities, rather than duplicate all the
programs. You can just pay for--I know darned well it cost a
whole lot less to provide services in Cadiz, Ohio, than it does
in downtown Pittsburgh in the VA Hospital. I know because I
can't hire the nurses, I can't hire the doctors. We can't
afford to hire them away. And perhaps a decentralization
approach to this whole thing is one that will make it work a
little bit better.
The samples I gave you were those types of patients who
come to the hospital with an emergency or an urgent situation
in their personal life, and they can't get treatment at our
facility because they're on the VA system. We have had problems
logistically getting them to the facility because either a bed
wasn't available, or the surgeons weren't available to do the
work. When we finally did get approval, it is not uncommon for
that to be taken and withdrawn, so that patients have to go
back to the hospital and spend two or three days at the
hospital before they're able to go back up.
I think there's a level of inconsistency with regard to the
kind of information that's provided to providers. One might
tell you to go ahead and do the service because we'll pay for
it over the long haul, and I heard that issue this morning
about then the hospital starts dunning the patients because
they haven't paid the bill. You could have an arrangement much
like the Medicare program where you know what you're going to
pay for procedures, and people sign up to do it. That would be
an acceptable payment situation.
The other thing is actually getting patients to the
facilities. Very often, if a community doesn't have a van
service, it is really the responsibility of a family member, or
a very good friend. That's not always the best time in their
lives, anyway, so friendships could strain pretty thin, when
you start going up to these long facilities, and getting
someone to take you up and bring you back. So our approach, and
our discussion really this morning is the logistics of how to
get patients in the system, how to treat them. And when they
present themselves as an emergency, it truly is an emergency.
It's one that would be an emergency for you, or anyone else who
presented themselves with a crisis.
I gave you a specific example of someone who broke their
hip, I think three days later before we could ship them up to
get the hip taken care of. So our concern is getting those
patient's services. We want to do it in a very positive, open
way. We think there are opportunities to work together, and I'm
really here on behalf of our fellow constituents that we both
serve. And we think we do a nice job serving your constituency.
We just want to be able to make it easier for their access to
it.
[The prepared statement of Mr. Carson follows:]
Prepared Statement of Terry M. Carson, Chief Executive Officer,
Harrison Community Hospital
The Harrison Community Hospital is a Critical Access Hospital
serving a population of approximately 15,000 citizens in Southeast
Ohio. Included in our service are our veterans that require various
levels of care.
The problem that we experience has to do with treating initial
emergency/urgent situations and having little success in being able to
transfer veterans to the appropriate Veterans' Hospital Center.
Often, we wait days to receive transfer approval, and it is not
uncommon for those approvals to be withdrawn during the actual
transfer, and change of direction mid-stream.
These delays do not serve patients well, and often puts the
hospital in the position of proceeding with treatment because the care
needs to be provided. We even have to find alternative facilities to
accept the patients, knowing that they too will have difficulty
receiving reimbursement for the care.
The simple solution would be for facilities such as ours to be
given approval to treat patients in our community and have the local
doctors render the necessary care. To be mandated to send patients 65
to 100 miles away during their crisis really doesn't make that patient
a priority, just a convenience for the VA Center.
To offer a coordinated system seems to require better access, local
treatment or a combination of both.
Thank you for your interest and the opportunity to discuss this
important gap in the system.
attachment
Patient, 85, was brought to the ER on 02/23/07. Patient had fallen
at home and was brought in by ambulance. X-ray showed a fracture of the
femoral neck left leg. He had only VA insurance. The VA Hospital in
Pittsburgh was called and we were told it was full. Cleveland VA
Hospital was also contacted regarding bed availability. They referred
him to Pittsburgh since he is a patient of this area. We also called
the VA office in St. Clairsville, Ohio, and they stated that he was a
patient of theirs and Pittsburgh. Dr. Sandhu, our ER Physician, spoke
with an ER physician, Dr. Ruhl, at the Pittsburgh VA, who advised him
to send the patient to that hospital's ER and he would see him. While
transporting the patient, we received a call from Pittsburgh VA
refusing to accept him, so we had to turn the squad around and bring
him back. Dr. Modi accepted the patient and he was admitted here. We
were told to call in the morning to see if there was a bed available.
The VA hospital was called each day regarding bed availability. On 02/
25/07, a comment was made to Pat Worrell (Nurse Manager) by Mr.
Anderson, AOD, Admission's Director, that ``possible transfer on
Monday, transfer may cause further damage to fracture''. He also said
that ``they are using too much of the OR time on bones, this is a
regional center for kidney and liver and they are getting bones from
everywhere in the region''. Dr. Modi attempted to get another
orthopedic physician to accept the patient. He finally got in touch
with one at UPMC who agreed to accept the patient, but the hospital
wanted the patient to be counseled and sign a form, witnessed, stating
that he may be responsible for the bill before accepting the patient.
After speaking with Administration at the VA Hospital and again to the
St. Clairsville VA Clinic, we were notified that the Pittsburgh VA
Hospital had a bed and the patient was transferred on 02/26/07.
Patient, 75, came to the ER on 02/28/07. Found unresponsive at home
with a blood sugar of 22 and respiratory problems. He was diagnosed
with sepsis, hypotension, dehydration, hypoglycemic reaction and acute
pyelonephritis. He required large amounts of IV fluids to maintain BP.
Attempted to transfer the patient to the two VA hospitals but both did
not have any beds. Also attempted to transfer the patient to several
local hospitals with East Ohio Regional Medical Center agreeing to take
the patient.
Patient, 35, came to the ER with suicide ideation. He did not have
any insurance and his mother stated that he had been at the VA Hospital
in Pittsburgh before. We called that hospital and they put his name on
the list, they did not have a bed and we were to call every day to see
if a bed was available. Pam Parrish (Social Services) contacted Chuck
at the Cadiz VA Office requesting assistance to find a bed. He called
the VA Hospital, and also was told the same thing, no bed available,
his name was on the list, and they would try to get him in as soon as
possible. We also tried the Cleveland VA hospital and left a voice
mail, but no one called back. The patient was eventually transferred to
Belmont Community Hospital's Mental Health Unit.
Senator Brown. Thank you, Mr. Carson.
Dr. Gerald Cross, who's been with the VA for many years, is
now the Acting Principal Deputy Under Secretary for Health.
We appreciate your coming to New Philadelphia, and speaking
with us today, Dr. Cross.
STATEMENT OF GERALD M. CROSS, M.D., ACTING PRINCIPAL DEPUTY
UNDER SECRETARY FOR HEALTH, DEPARTMENT OF VETERANS AFFAIRS
Dr. Cross. Senator Brown, thank you very much for having me
here, and I want to say I'm a family physician. I grew up on a
farm in a rural environment in Virginia. I was a member of the
4-H Club, and I guess those are my best credentials. I'm here
with Jack Herrick, Director. Jack, can you stand up so people
can see you. And we've already had a chance to talk with Mr.
Carson this morning, so this meeting has already served a
purpose in that we started the channels of communication to
work out some of the issues that he's talking about. And, by
the way, we'll continue that.
I've ditched my speech, and I've just written down a few
notes I want to comment on, based on what I heard this morning.
Rural healthcare is, in fact, very important to us. It's about
39 percent of our enrolled population for healthcare. And,
indeed, we have established and are developing an Office of
Rural Health at the Central Office in Washington. But much more
than just creating a new office in Washington, I want to tell
you what we're really doing that's making a difference.
Strategically, we are doing geographic dispersion. We were
very much a tertiary big medical center-based organization a
decade or two ago, and we're changing dramatically, much more
to continuity, comprehensive care, outpatient care, primary
care. And we followed through on that. We now have 717
community-based outpatient clinics. We're planning 20 or more
of them for 2007, and more for 2008; 207 Vet Centers, and more
planned in the coming years. These wonderful organizations that
are so accessible in terms of lack of bureaucracy, just walk in
and say hello, and somebody there will say hey, welcome. Sit
down, have a cup of coffee, let's talk.
Telemedicine and mental health, to make sure that we can do
specialty consultation, diagnosis, follow-up even at our small
community-based outpatient clinics of some our specialists,
like dermatologists, or mental health, especially mental
health.
And we don't expect our patients who get medicine every
month for blood pressure, cholesterol, or whatever to have to
come to the pharmacy of the big medical center, or even at the
CBOC. We mail it to them. We deliver the medicine to the home
wherever that home may be, month after month, year after year.
And we're moving into a new direction, home-based primary
care, where we actually send providers out to the home to take
care of people who are restricted to the home and unable to get
up and about; $175 million in our 2008 budget just for that one
program, and many millions of more for other similar, related
programs.
So here are the results at the moment. Within 60 minutes of
care nationwide, 92.5 percent of our enrolled population for
healthcare. Within 90 minutes nationwide, it's 98.5 percent.
Mental healthcare is especially interesting. In 1996, the
average distance traveled for mental healthcare was 26 miles by
a veteran going to a VA facility. It's now 13 miles,
approximately.
Satisfaction among our patients in the rural environment
exceeds that of those in our urban environment. Quality of care
is measured by standard indicators, of which we have many.
Almost exactly matches, on average, that's received in urban
care.
Now, sir, I'd like to say just a word about OIF and OEF.
The secretary some years back opened two years of eligibility
for anyone returning from the combat theater, that includes OIF
and OEF. The two years of eligibility that the secretary opened
sometime back for OIF and OEF still makes it possible for an
individual coming back from the combat theater to get the care
they need, and gives them time, if they're going to go through
a disability process, to get that disability claim done. I
should say that in the Senate right now, there is a bill to
extend that two years to five years. And I testified, I think
about two weeks ago, that we were in support
of that.
We're adding staff, doctors, nurses, psychologists,
especially mental health staff. We're screening everyone coming
back from the combat theater OIF and OEF for TBI, Traumatic
Brain Injury. This is something the VA does better than anyone
else, because of our comprehensive electronic health record.
And we're doing the same thing for PTSD. We're doing the same
thing for substance abuse, and we're doing the same thing for
depression.
We're the only organization, I believe, that can make those
statements. And then we're going to follow-through on them.
We're doing research to find out more about these conditions,
as we've done a tremendous amount of research, for instance, on
PTSD. But I want to tell you about two new things, just very
briefly, and that will be my conclusion.
Transition Assistance Advisors are in place in every state
working through the National Guard in the Office of the
Adjutant General, right in the Governor's office. The states
can provide services that on a federal level, we don't really
do, such as providing employment, providing link-ups to the
local community to find employers ready to hire these returning
veterans. And these individuals in the Governor's office also
help to make sure that individual is aware of all the state
services, and all of the federal services.
And something very new, and I want you to know about this.
Transition Patient Advisors, a hundred of them being GS-11s,
don't have to be medical care workers. We're putting them in
Ohio, and every other state. And when a new veteran seriously
injured shows up at Walter Reed or Bethesda, they fly there to
meet with them, to meet with the family, to follow them a
couple of times a week, and to make sure that there's no
falling through the gaps. That concludes my statement, sir.
[The prepared statement of Dr. Cross follows:]
Prepared Statement of Gerald M. Cross, M.D., Acting Principal Deputy
Under Secretary for Health, Department of Veterans Affairs
Good Morning, Members of Congress. Thank you for the opportunity to
discuss VHA's ongoing efforts to provide safe, effective, efficient and
compassionate health care to veterans residing in rural areas.
My remarks will briefly review the national challenge presented by
rural health care, VHA's strategic direction and initiatives underway.
Among the entire enrolled VA population, 39 percent were classified
as rural at the end of FY 2006. And among the entire enrolled VA
population, 2 percent were classified as ``highly rural.'' Highly rural
refers to counties with less than 7 citizens per square mile.
Researchers have studied the rural health care experience,
including a number of articles that looked at VA rural healthcare.
Three studies have found that veterans living in rural areas tend to be
slightly older, and more likely to qualify in Priority group 5--that
is, non-service-connected, zero percent service connected, and low
income. These same veterans were also less likely to be employed. The
studies agree that rural veterans had slightly more physical health
problems but fewer mental health conditions--as compared to suburban
and urban veterans.
VHA's strategic direction is to enhance non-institutional care with
less dependence on large institutions. Instead, we are providing more
care at home and in the community.
VHA now has 717 Community Based Outpatient Clinics or CBOCs. Of
this total, 320 or 45 percent of these are located in rural or highly
rural areas. We've created Consolidated Mail-Out-Patient Pharmacies or
CMOPs so that medications are delivered to the patient's home--instead
of having the patient travel to the hospital. We provide home based
primary care--devoting more than $175 million to this program in FY
2008, and more than 95 million dollars for other home based programs.
We are using tele-medicine and tele-mental health to reach into the
veterans' homes and into community clinics. This allows us to evaluate
and follow patients without them having to travel to large medical
centers. We are far along with our mental health enhancement initiative
that will add resources and greater mental health expertise in primary
care clinics. We are also using a special Internet site, providing
information to veterans in their own home, including up-to-date
research information, access to portions of their medical records, and
the ability to refill medications online.
To accomplish this, VHA is emphasizing primary care and spreading
out geographically. At the end of FY 2006, 92.5 percent of our 5.4
million patients were located within 60 minutes of a VA healthcare
facility. And 98.5 percent were within 90 minutes. Among those who live
outside the 60-minute range, some are those veterans in highly rural
areas and some are veterans living in Tribal areas.
In 2006 evaluations of veteran patient satisfaction, comparing
rural versus urban veterans, we found that rural patients were more
satisfied with their health clinics than their urban counterparts.
We also looked at the quality of care, comparing rural versus urban
clinics. Looking at 40 standard measures, quality was virtually
identical overall between rural and urban clinics.
To continue this strategic support for access and rural health care
we have over 20 CBOCs for 2007. Forty three percent of these CBOCs are
in rural or highly rural areas. In addition to these clinics, VA is
currently working on telecommunications strategies to provide Care
Coordination/Home Telehealth services in rural areas. Since January
2004, VHA has trained over 3,500 staff nationally to provide care via
CCHT.
In Ohio, there are 5 VA Medical Centers and 32 Community Based
Outpatient Clinics (CBOCs). In close proximity to Appalachia, (the
region in the United States that includes the southern Appalachian
Mountains, extending roughly from southwestern Pennsylvania through
West Virginia and parts of Kentucky and Tennessee to northwestern
Georgia) we have 9 CBOCs in Southeastern Ohio and 2 in Kentucky.
Specifically, East Liverpool (Columbiana County), New Philadelphia
(Tuscarawas County), Athens (Athens County), Lancaster (Fairfield
County), Cambridge (Guernsey County), Marietta (Washington County),
Portsmouth (Scioto County), Batavia (Clermont County), and Zanesville
(Muskingum County). The 2 (two) Kentucky CBOCs are in Bellevue
(Covingnton, KY) and in Florence, KY. These CBOCs are located in rural
areas of Ohio bordering southern Pennsylvania, West Virginia, and parts
of Kentucky.
In addition, the Vet Center program provides quality readjustment
counseling and removes unnecessary barriers to care for veterans and
family members. Vet Centers engage in extensive community outreach
activities to directly contact and inform area veterans and to maintain
active community partnerships with local leaders and service providers
to facilitate referrals for veterans in need.
Some Vet Centers are maintained in rural areas to ensure that rural
veterans and families have access to readjustment counseling services.
Additionally, we have established Vet Center outstations in rural
areas. Outstations are administratively connected to a full sized Vet
Center, use permanently leased space and are usually staffed by one or
two counselors who provide full time services to area veterans on a
weekly basis. The Vet Centers also maintain nontraditional hours to
accommodate veterans traveling in from greater distances.
Vet Centers in Wheeling, Parkersburg and Huntington, West Virginia
all located on the Ohio River provide outreach and readjustment
counseling to veterans in rural Ohio.
In addition to our internal efforts outlined earlier, VA continues
to look for ways to collaborate with complementary Federal efforts to
address the needs of health care for rural veterans. We also have
partnerships with HHS, including the Indian Health Service and Office
of Rural Health providing health care in rural communities. We are also
working to establish relationships with other entities, such as with
the National Rural Health Association.
VHA recognizes the importance and the challenge of service in rural
areas, and we believe our current and planned efforts are addressing
these concerns for our current and emerging veterans.
This concludes my statement. At this time I would be pleased to
answer any questions that you may have.
Mr. Space. Thank you, Dr. Cross, and I apologize for having
to cut you off. We are running short on time.
Incidentally, I think the Patient Advocate Program you just
referred to is still in its early stages, but I think it's a
very valuable addition to the Administration.
I want to talk a little bit about the CBOCs, again. And you
had mentioned that there are plans to build more than 20 right
now. Do you have any indication, if the 18th Congressional
District for the State of Ohio will receive any additional
CBOCs?
Dr. Cross. For Ohio, I think there were two, and, Jack, you
can help me with this. I think one is in Hamilton, and the
other is----
Mr. Herrick. Hamilton and Parma were announced this week.
Mr. Space. Oh, Parma and Hamilton. So that will not
facilitate or enhance the care of veterans in southeastern
Ohio. And, second----
Dr. Cross. We do have other options besides CBOCs.
Mr. Space. Right.
Dr. Cross. Outreach Clinics that work for a CBOC, that can
go into communities. Often they lease space, and we have a
number of these now. And they're not listed as CBOCs, but they
can be open for a day a week, or a couple of days a month, and
provide services for those very small groups of veterans in
these more remote communities. And we're doing that more and
more.
Mr. Space. Right. Now I understand last week we passed
legislation that will allow for mobile units to enhance TBI
treatment and care in rural areas, which is also an encouraging
sign. But the fact remains that many veterans in rural Ohio are
having to do things like travel 80 miles for radiation
treatment, and then 80 miles back home again. And as
Representative of this area, I'm trying to ascertain means by
which to help solve those problems associated with veterans
care. And I can't help but get around what may be, to me, an
apparent need, seemingly a need for the construction of
additional medical centers, those primary care facilities that
render services of a broad range to veterans. I understand you
can't build one in every county.
We've got 16 counties in my District, we've got five CBOCs
servicing those counties, and many residents in my District,
who require specialized care, of course, drive 70, 80, 90, even
more miles to receive care. Do you see a perceived need for the
construction of a medical center in southeastern Ohio?
Dr. Cross. To tell you the truth, sir, I don't know,
because the CARES process that we've gone through, I want to
refer to that and see what the findings were from that. That's
a piece of information I can certainly get for you.
Mr. Space. You would agree with me that veterans in rural
areas of America, and specifically in Ohio, do suffer from a
lower standard of care than those veterans in urban areas,
simply because of their proximity, or lack thereof, to those
medical centers.
Dr. Cross. I don't agree with that for the VA. We've done
the statistics on the performance measures related to the
quality of care.
Mr. Space. I'm not talking about the quality of care.
Dr. Cross. Absolutely. I understand what you mean. I
certainly do share that, the access issue by itself. I do need
to put out one cautionary comment, talking about radiation
therapy. Radiation oncologists and the equipment that goes with
radiation therapy is something that wouldn't be found,
necessarily, in the rural environment anywhere. And so that's a
real challenge for us, and for everyone else in the civilian
community, in Medicare, and so forth, to deal with those
special circumstances. And I think the VA is, in fact, flexible
about this. And on a case-by-case basis, can make arrangements
to do what's best for the veteran.
Mr. Space. And just as a brief follow-up, I mean, it is a
fact, is it not, that rural Americans have shouldered more than
their fair share of not just this war, but wars past, as well.
Correct?
Dr. Cross. Sir, I expect that that is true.
Senator Brown. Thank you both, again. Monday, in
celebrating Memorial Day, there were a couple of numbers I
wanted to bounce off you, Dr. Cross, and ask for your thoughts
on. Something along the lines of the Harper's Index, that they
use that as sort of the box, 27 percent of veterans of the War
in Iraq and Afghanistan have filed for disability with
Veterans' Administration, and these are the two upcoming
numbers that I think are the most significant. Ten percent of
soldiers given medical discharge in 2001 were given permanent
disability benefits, but only 3 percent of soldiers given
medical discharges in 2005, who got permanent disability
benefits. Why would that be, that 10 percent of those not in
wartime who left the military were getting permanent disability
benefits, but only 3 percent of those discharged in 2005? Do
you have any thoughts about that?.
Dr. Cross. I think my response would be it's early, and
over time, we'll get a better picture of what their real
pattern is going to be. I think it may be a bit premature to
say what their long-term disability outcome is going to be, at
this point.
Senator Brown. Sir, maybe that's right, but I'd be more
likely to accept that if the military were not doing a bit of a
better job, certainly a better job than contrast to Vietnam,
when several people from the last panel came home from Vietnam,
they, one, weren't welcomed home in too many cases. But,
second, certainly didn't have the kind of interaction with the
VA, to talk to them about any kind of physical or mental injury
they might have had. Today, we're not doing a splendid job, but
we're doing better, as you suggest with some of your outreach.
So shouldn't those numbers be higher as a result of that?
Dr. Cross. Again, I think individuals don't apply for
disability necessarily right away. There's no limit, there's no
time limit on when a veteran can apply for disability. We've
seen veterans applying for disability now for Vietnam.
Senator Brown. And we're seeing people now from Vietnam,
because of the attention paid to Iraq, I know. And I know those
numbers are again going----
Mr. Cross. So I think----
Senator Brown. I would like to explore this more. Let me
shift to continue questioning, for you, Dr. Cross, but
particularly about Mr. Carson's issue. We've heard from him
that community hospitals and patients are faced with
unreimbursed care when after stabilizing emergency patient,
they can't transfer them to a VA facility because there are no
beds available in a county as rural as Cadiz and Harrison
County. We're looking at legislation to ensure that this
doesn't continue, but two questions. Why is this happening, in
the first place? And, does the VA actually have the discretion
to pay these claims? I guess a third question then, if the
answer is no, is legislation necessary?
Dr. Cross. There is legislation that relates to the Mill
Bill. I forget what year that was, I think it was about 2000,
which sets up emergency care funding for situations where an
enrolled veteran who has been seen within the previous 24
months, if I recall correctly, is eligible so that they can go
to the nearest emergency room and get care. We didn't want a
situation to occur where a person is having a heart attack and
drives past the community emergency room to get to a VA
facility which is some further distance away, which would not
be to their advantage in that situation. So the Mill Bill
created, as I understand it, a possibility to get that care
delivered and covered for a period of about three days, the
intent then being to transfer them back to a VA Medical Center.
What I'm hearing this morning, though, I think, and that's
the value of this hearing, especially to make these kinds of
link-ups, is that we have some communication issues with Mr.
Carson's hospital. And I've got my VISN Director here, and
other staff to make sure that we work some of those out to deal
with those issues that he's pointed out, and very appropriately
pointed out.
Mr. Space. Given the late hour, I just simply don't have
much more time for questions. Your testimony will be entered
into the record.
Dr. Cross, I'm going to revisit, as my last question; and
that is, given, once again, that we've got a very large area in
southeastern Ohio served by, what I understand to be about
65,000 veterans who are living here right now. We've got five
CBOCs in 16 counties, and admittedly, those rural veterans are
suffering from a lower standard of care, simply because of the
drive time to and from medical centers. My request of you is
that you take measures to inquire with your superiors, and
conduct a research study whether or not this area of Ohio would
be a suitable and appropriate location for the construction of
a VA medical center.
Dr. Cross. Yes, sir, we'll do that. And I would like to
also say that we will be delighted to meet with your staff, and
sit down and discuss any issue that you'd like directly.
Mr. Space. Thank you, Dr. Cross. Mr. Carson, briefly.
Mr. Carson. Congressman Space, just one comment on that,
for what it's worth. I mean, you can look at a map and say
well, it's just 20 miles, but for those of you who drive the
District, and the limit is 55, I challenge you to get up to 55
miles an hour on some of these roads, so that really----
Mr. Space. Point well taken, Mr. Carson. I'd like to thank
you both, again, for your testimony.
Senator Brown. One question, before you close off, if I
could. And thank you, Congressman Space, I've thought for some
time that the VA is, in fact, I think probably so the best
healthcare, when we fund it, the best healthcare in the country
in terms of medical, lowest numbers of medical errors,
outcomes, the specialty and the general care that the VA gives.
I've also seen a commitment, and with some results so far of a
much better coordination. A commitment from the Secretary with
a much better coordination from DOD and to veterans'
healthcare, because it's been uneven, at best, over the last
years, and I give the VA credit for that.
But then I see the message that it sends to our troops, to
our men and women in uniform, when the President and Secretary
Nicholson ask for a budget billions of dollars less than the
Independent Budget that the veterans service organizations ask
for, and they brag to our Committees in both houses that we're
spending, I think the number they say is 77 percent more than
2001. Well, yes, but there's been not, certainly new Vietnam
Vets coming on line, coming to the VA, that weren't coming
before, and certainly from this war. So I just would ask you,
Dr. Cross and Mr. Montague, to take back to the VA the message
that sends to our men and women in uniform, when we're willing
to spend $2.1 billion a week on a war, and we're not willing to
fund to the level with the Independent Budget in mandatory
funding of the VA. And I know you, as a physician, probably
agree with much of this, but take that message back, how
important that is.
So I thank you both for being here, thank you to our
panelists. And thank you all who have joined us. Why don't you
close it off, Congressman Space.
Mr. Space. Thank you, again, Senator Brown. Thank you to
the panelists, both in the first and second panel. And thank
you to everyone who came out today in the interest of the
State's rural veterans.
Again, I'd like to send a special thanks to Dean Andrews
and his team here at Kent State for hosting us. Thank you to my
veterans' Advisory Board for their continued direction and
knowledge. And thank you to our witnesses, once again, who have
traveled to get here and present their views, so that we can
all recognize the serious issues that stand in the way of rural
veterans obtaining comprehensive care, and access to VA
services.
Where a veteran chooses to live should not affect his or
her access to care. Our country is committed to provide
healthcare, educational, vocational, and other services to our
Nation's veterans, and we must follow-through on that promise.
Telling a veteran that his home, or her home, falls into a
geographical region that is not cost-effective to serve is not
in line with keeping the promises previously made to our
country's heroes. A veteran from rural Ohio gave just as much
in service to our Nation, and sacrificed just as much, as a
veteran from New York City, Los Angeles, or Cleveland, Ohio.
This hearing has given us valuable knowledge about how
Congress can move forward on important issues facing rural
veterans. This hearing has brought together many of those who
are directly involved in caring for these rural veterans, who
make up approximately 40 percent of our Nation's veterans
population. I'm extremely optimistic that given the ideas that
we've heard today, Senator Brown and I will be able to move
forward with innovative solutions, including legislation. I
plan on working with Members of the House Veterans' Affairs
Committee, as well as my colleagues on both sides of the aisle,
to advance the agenda of rural veterans.
Today, the day after Memorial Day, we've met to discuss how
to move forward in better caring for those who have served our
Nation. Let us also remember to look back on where we've come
from. Let us remember those brave servicemembers who have given
their lives in defense of our Nation; 16 from this District in
this most recent war.
I wish, also, to thank the veterans in our audience, the
men and women currently serving, and their families who support
them, for their past and continued service and sacrifice. It's
an important honor to work on your behalf, and please know that
I will continue to do so for as long as I serve in Congress.
Again, thank you all for being here. Thank you, Senator Brown.
[Applause.]
[Whereupon, at 12:02 p.m., the joint hearing adjourned.]