Veterans fight for health care options closer to home

Aug. 22--The Veterans Administration Choice Act, signed into law about a year ago, was supposed to ease backlogs in care for veterans by opening access to non-VA treatment options. But advocates say the VA could be doing a much better job providing health care to Northwest Indiana veterans by allowing them to use their benefits locally.

Walt White, a 71-year-old Portage resident, suffered a stroke in November that immobilized his left arm and leg and affected his speech.

A veteran of the Marine Corps, Naval Reserves and Army National Guard, White was treated at a Chicago hospital before being transferred to a Merrillville nursing home. Since December, he's received physical therapy treatment twice a week at Crown Point's Adam Benjamin Veterans Administration Outpatient Center.

"I'm very satisfied with treatment that I get. The doctors take good care of us," White said. "But I think that I can benefit from getting three or more sessions a week.

"I'm making some headway, but I don't think that I'll get out of the nursing home any time soon."

White compares his situation to a nonveteran friend who had a stroke and is getting multiple therapy sessions per day, five days a week.

"I would kill for that," White said. "With that, I would have walked out of there months ago. I'm an old codger, who is set in his ways. I don't like being here, and I want to be on my own again."

White said he's talked to several veterans and found that some must wait for physical therapy treatment.

"The thing that aggravates me is the VA has billions of dollars, so you would think that they could get more than one or two therapists," White said. "For whatever reason, they haven't hired more. They spent all this money on a new facility but shortchanged it when it comes to staff."

In an email, Kevin White, a spokesman for the Jesse Brown VA Medical Center, said the number of physical therapy sessions is a clinical decision determined by a doctor, not due to any sort of backlog. He said patients who can't get an appointment within 30 days can use the relatively new VA Choice program.

Chicago-area VA facilities have been recruiting additional staff, with the VA Choice Act funding positions in primary care, specialty care and mental health, White said, because these were the areas with the greatest access challenges for veterans.

Travel for treatment

Long patient wait times and paperwork delays have plagued the VA for years. In response, Congress last year passed the VA Choice Act, which allows veterans to access health care outside the VA system in certain situations. But local veterans say much more needs to be done to fix a broken system that requires some Indiana veterans to travel more than 70 miles to Chicago for treatment.

The VA Choice Act allows veterans to seek health care at non-VA hospitals or doctors offices if they live more than 40 miles from a VA facility or if they've been on a waiting list for an appointment for at least 30 days. Veterans who live within 40 miles of Adam Benjamin VA Outpatient Center don't qualify for a VA Choice voucher even if the specialty care they require is unavailable at the Crown Point facility.

Dan Orlich, a Marine and Vietnam veteran, said he has been frustrated by the VA system since Chicago's Jesse Brown VA Medical Center became the main location where Northwest Indiana veterans were sent to seek specialty and inpatient treatment about eight years ago.

"It was at capacity for patients at the time we were shifted over there, and it overloaded the system," Orlich said.

Jesse Brown VA Medical Center serves veterans from Cook County, Ill., and six counties in Northwest Indiana: Lake, Porter, LaPorte, Jasper, Newton and Starke counties. During the week, three shuttles daily head to Chicago from Crown Point.

Last fall, U.S. Sens. Joe Donnelly and Dan Coats and U.S. Rep. Pete Visclosky expressed their concerns about the travel burden in a letter to VA Secretary Robert McDonald.

"While some of our constituents may live within 40 miles of the VA facilities in Crown Point and Chicago, if they are required to travel to Crown Point in order to take the shuttle transportation into Chicago, their total travel distance will almost certainly exceed 40 miles," the letter read. "This is an incredibly frustrating experience for older infirmed veterans, as local non-VA hospital care and medical services are readily available."

In a statement, Donnelly said he will continue to work with Visclosky and other congressional colleagues to expand veterans' access to the Choice Act and other means of seeking local care.

"We owe the men and women who served our country a debt of gratitude, and that gratitude should be demonstrated, in part, by providing the most accessible, highest quality health care," Donnelly said in the statement. "With more veterans seeking care and benefits than ever before, Congress needs to make sure that the VA has the resources it needs to properly care for all those who served our country. Meanwhile, VA needs to do a better job of getting veterans access to non-VA care."

Several local veterans have taken their concerns to staff members of Donnelly, Coats, Visclosky and U.S. Rep. Jackie Walorski.

The 40-mile rule was loosened with provisions inserted into the National Defense Authorization Act this summer, but the Senate version is still being reconciled with the House version before it heads to President Obama's desk.

The travel is challenging for veterans who need services such as physical therapy.

"The waiting lists for physical therapy at Jesse Brown are over six months long, but if you need physical therapy, you know that you need it now, not in six months," Orlich said. "I know a veteran who had a knee replacement, and they told him that they would schedule the physical therapy in nine months."

Dr. Jeffrey Ryan, Jesse Brown's associate chief of staff for ambulatory care, said there hasn't been a large number of veterans using the VA Choice program in the year since its inception. He said a "very small percentage of patients qualify."

Ryan said the program has helped ease the patient wait times somewhat, and the administrator of the plan has worked in recent months to expand the list of providers accepting VA Choice vouchers.

Some of the biggest treatment backlogs for Chicago-area veterans include physical therapy and Hepatitis C treatment, Ryan said.

Orlich said he's not confident that the VA Choice program is helping many veterans.

"In my (view), it's a bit of a farce," Orlich said. "You have to call the VA. They route you to a third party who decides whether or not you have to go to VA. You have to get approval to use (a VA Choice voucher.) If not, then to heck with you."

Spend money locally

Tom Pappas, who helps some veterans with their VA paperwork, said he believes the money spent to treat local veterans in Chicago should be spent in Northwest Indiana instead -- either by upgrading Adam Benjamin or giving veterans the choice to use local hospitals and doctors.

He recently filed a Freedom of Information Act request to the Jesse Brown VA Medical Center in July regarding how much was spent on Indiana residents receiving treatment and traveling to the center in May.

In one month, 4,840 Northwest Indiana patients visited the VA facility in Chicago for treatments costing $3.57 million. Transportation costs were more than $90,000, according to information Pappas received from the VA.

"Our issue is being forced to go to Jesse Brown for our secondary care when we have local hospitals that can provide quality care comparable to Jesse Brown," Pappas wrote in an email. "If there is a cost difference, then let us use Medicare to bridge the difference, and for veterans not old enough to use Medicare, either use Veterans Choice Act money or offer a low-cost supplement to bridge the difference.

"Staying local can infuse our local economy with a potential $45 million per year, (and) make it easier for veterans' families to visit."

The VA's White said veterans have always had the opportunity to get care in their own community, but the key question was whether the VA was obligated to pay for that care or if the veteran would need an alternative method such as Medicare or private insurance to pay for it.

Pappas said he doubts that increasing health care options for veterans would have a detrimental effect on the VA.

"It's not going to hurt," Pappas said. "Their caseload is overwhelming, and they've said that there aren't enough beds to meet their needs."

Orlich said something needs to change.

"It's an incompetent system," Orlich said. "Why we in Indiana have to put it up with it, I don't know."

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