August 17, 1998

Vernon Chong, M. D. Network Director

Heart of Texas Veterans Healthcare Network Department of Veterans Affairs

1901 N. Highway 360, Suite 350

Grand Prairie, Texas 75050-1494

Dear Dr. Chong:

The rumors are flying about the possibility of many changes that could be on the horizon for the VA Hospital here in Kerrville. We do not like to react to rumors but our concerns are mounting as this facility is one of key importance to our community as a service provider to veterans and also as a major employer.

We do not envy your responsibility of having to review programs in anticipation of budget reductions due to the five year flat budget funding that is now guiding the VA programs. Because we know you are having to deal with real funding issues, we want to share our concerns with you before decisions are made regarding this hospital and its future.

First, there are many veterans in this region of Texas who prefer the use of the Kerrville hospital and its services over other VA Hospitals because it has the reputation of being a very high quality care center and it is easy to access.

Quite often veterans chose to retire in this area because of this fine facility and this in turn is good for our community overall. One of the reasons veterans make this decision is because of their ability to access services through the Kerrville VA Hospital without the difficulty they experience trying to get to hospitals in larger cities. When veterans travel to metropolitan area VA Medical Centers, they must deal with excess traffic and congestion on the trip to and from the hospital. Once they get there, they experience the same frustrations with over-crowding and congestion inside the hospital. Too often it is this environment that deflects from the personal attention our veterans desire and should receive.

These same congestion concerns affect personnel you are able to attract and hire to provide veterans services through the VA Hospitals. People love living and working in the Kerrville area and to my knowledge, your ability to attract key professionals to provide services through the VA is much easier in our community than it is in others.

The Veterans Administration first located services here in 1923 with the establishment of the TS hospital. Through the years this community has worked hand in hand with the Veterans Administration and Congress to ensure the enhancement and development of services for veterans as this facility has grown to be the quality medical center it is today. Our community is ready and willing to work with you to address problems and concerns you may have and would

like the opportunity to bring a small delegation (3-5 community leaders) to Dallas to meet with you personally at your convenience. We believe we should have input to the future of this hospital and its services as changes do in fact affect our community overall.

We owe it to our veterans as they grow older to allow them the opportunity to maintain an independent lifestyle by being able to access services through the VA Hospital and Medical Clinic in Kerrville. The South Texas Veterans Health Care System, Kerrville Division is a quality facility that is easy to get to and one that is staffed by many fine doctors and support personnel. The veterans receive the personal service and attention they need and deserve.

We ask you to guide the decisions on behalf of the veterans and this hospital by making sure the services continue through the Kerrville Division of Network 17.


Sherry L Cunningham


October 15, 1998


Mr. Jose Coronado, FACHE

Department of Veterans Affairs

South Texas Heath Care System

Audie L. Murphy Memorial Veterans Hospital 7400 Merton Minter Boulevard San Antonio, TX 78284


Reduction of Services at Kerrville VA Hospital

Dear Mr. Coronado,

I have just finished reading your letter to the Honorable Lamar Smith responding to your constituents' concerns regarding possible downsizing or elimination of programs at the Kerrville Division---." I also received a copy of your White Paper that highlights cost saving initiatives for FY99. After carefully reading both documents, I have some concerns and questions.

First, let me introduce myself a little better. I am a 1 00% disabled Viet Nam Era veteran whose condition became worse while working in Maine with the Army Air Force Exchange Service.  Due to my permanent unemployability, we came back home to Texas, confident that I would receive compassionate and effective care at Kerrville VA Hospital, 22 miles away. I wrote letters and telephoned Kerrville to ensure they were not closing or cutting back on services. They assured me that since the merger with Audie Murphy, their full range of services and care were stable, with the exception of orthopedics. Now look what has happened!

The Kerrville Patient Handbook on Page 7 proudly states 'the Audie Murphy Memorial Hospital and its outpatient clinics consolidated with the Kerrville Department of Veterans Affairs HOSPITAL to form the "South Texas Veterans Heath Care System". It goes on to say, "The goal of this "System" is to provide comprehensive health care to South Texas veterans in a compassionate and effective manner while reducing duplication of services and health care expenditures.  What a wonderful goal, but why is ft not working? I do understand that Congressional Representatives from Texas, namely  Hutchinson, Gramm and Smith, voted to rob the veterans of billions of dollars for potholes and transportation. I also understand that reduced funding has greatly afforded the VA's ability to maintain the quality, compassionate and effective medical care promised to each veteran. Nevertheless, we still have unanswered questions!

How old is the letter you sent to Lamar Smith? It appears to be a photocopy of a form letter and dated with a hand date stamp. The font is different from the Letter and the characters are spaced identical to one of those old roll your own date stamps. I point this out because you do state in your letter, dated Aug 11, that "It should be emphasized that no final decisions have been made concerning any of these initiatives." Is this still true; nothing is final?

At the time of the consolidation, March 17, 1996, the Kerrville Division HOSPITAL had 380 beds, providing general, medical, surgical, psychiatric and nursing home care! As of this date, the HOSPITAL only has 68 beds and all inpatient services have ceased except for psychiatric and substance abuse patients. Likewise, the only surgery available is outpatient day surgery with no overnight stay. Why have these services gradually disappeared since the merger? Are you sure nothing is final?

Do you think it is effective and compassionate care for a  veteran to have to drive over 100 miles to receive definitive medical attention or minor surgery?


Do you think it is effective and compassionate to admit a veteran to Audie Murphy for a scheduled angioplasty that was postponed repeatedly. They kept him as an inpatient with weekend passes only. Three weeks later, he went home.

Do you think it is effective and compassionate to have veterans sit in your outpatient clinic, with an appointment, an average of 2 to 5 hours to be seen, as reported by your stay

Do you think it is effective and compassionate for a veteran, referred from Kerrville for a simple pathology procedure, to sit for 4 hours to see a doctor for three minutes? Then when he went to the lab to finalize his visit, they could not help him because the doctor did not do the scraping of the lesion to prepare it for testing. The patient returned home without the test completed, a full day wasted. Just a few things that puzzle me about your definition of compassionate and effective care. Veterans are people with all the qualities of a human being! They do not deserve to be treated as just another body.

Do you think it is compassionate and effective to limit a nursing home stay in our 154-bed nursing home, to 90 days? Did you know that many of the veterans do not have family or anyone to provide definitive care? Do you realize those severe cases of Alzheimer's and other geriatric illnesses do not respond to rehabilitation? GEM does a quality job in rehabilitating the aging veteran, if possible. Nevertheless, in accordance with the Graying of America, nursing homes are often the last stop before the grave. In my opinion, a blanket 90-day policy is ludicrous and unconscionable.

Why do you state in your letter "I can assure you that we would continue to maintain a strong primary care and extended care presence at the Kerrville Division?  If you reduce the number of inpatient beds to five, as is planned by December 1998, whom is the extended care going to benefit?  Will it be of benefit to the five million-dollar laundry facility you built at Kerrville to do your laundry?

Do you feel your 500-bed facility is adequate to care for 1 million or more veterans in South Texas, especially in an emergency? Why would you went to add another 18,836 veterans from the 14 county area served by Kerrville? Why should they change facilities when they are receiving effective and compassionate care at Kerrville VA without excessive driving? Are you trying to compete with large indigent hospitals, like Bexar County General?

All effective businesses prepare for the unexpected. Many expand laterally and bear the expense of maintaining a viable, fully functional overflow facility. Don't you think Kerrville VA is such a facility, since ft has been fully functional for 75 years, first providing care for the World War I veterans in 1923? Why would you want to eliminate inpatient beds and other services?

In your White Paper, you discuss eliminating the Dialysis contract and serving these patients needs at Audie Murphy. Can you do this without adding new equipment or staff? Have you had a feasibility study done to ensure it is a cost saving factor?

You also propose eliminating outpatient surgery requiring anesthesia at the Kerrville Division. Is this compassionate and effective care for the veteran? Surgery of any kind is traumatic and family presence is very beneficial. Due to excessive distance, lack of parking and a very large, impersonal city and hospital, the veteran and his family may be traumatized more than necessary, as well as spending more money to receive care. Is this part of your goal?

You also propose consolidation of the Inpatient Substance Abuse Program to Audie Murphy and implementing a sharing agreement with the Air Force for an Inpatient Psychiatry Ward at Wifford Hall. Kerrville VA currently has both Inpatient Programs, delivering compassionate and effective care. Why not use our "grandfather" our facility instead of burdening your facility even more? I personally believe the compassionate care, coupled with the serene, rural environment of this facility, will have a greater therapeutic value for the patient That is who is important, is it not?

Finally, how can we get the VA and Congress to hear us? Are you a veteran? Have you stared death in the team and lived to tell about it?  Have you sacrificed months on remote duty, fearing you may never see your family or America again? Many veterans experienced these situations, sacrificing their health to succeed. If you and Congress answer NO to these questions, then how does the veteran get the respect and empathy he or she deserves, We did not fail to serve our nation. However, the nation we served is failing us. What will it take for all of you to Wake-up? I am sitting with a group of angry, determined veterans who say "We marched on Germany, We marched on Japan, We marched on Korea, We marched on Viet Nam, maybe we forgot to march on Washington."

We know funding is a problem, but we want it fixed. We are tired of lip service, hollow promises, empire building, hidden agendas and all people who engage in these activities. Remember that there will always be veterans. The veteran population grows as the military population shrinks. With such unrest in today's world, the VA could be called upon in an instant to save wounded veterans.

                                                                        REMEMBER :VETS VOTE


Roger Noe


Cc. Mr. Togo West, Director of Veterans Affairs

Dr. Kizer, Dept of Veterans Affairs

Dr Chung, Director VISN

Gary Burns, DAV NSO Togus VARO, ME

Rep Lamar Smith Senator Gramm

Senator HLAchinson Kerrville VA Hospital

Kerrville Chamber of Commerce

General William Bacon (USAF Refired) American Legion Louis Jordan Post 4t244


                                                             South Texas Veterans Health Care System

                                                        Audie L. Murphy Memorial Veterans Hospital Division

                                                                        7400 Merton Minter Boulevard

                                                                                  San Antonio TX 78284

  Oct 21 1998                                                                                                                                                                                       in Reply Refer To:671/136

The Honorable Phil Gramm

United States Senator

2323 Bryan Street, #2150

Dallas, Texas 75201

Attn: Ms. Margaret Smith

Dear Senator Gramm

The letters your staff forwarded to my office, regarding the "down-sizing" and/or possible closure of the Kerrville Division (KD) of the South Texas Veterans Health Care (STVHCS), have been received in my office. I appreciate the opportunity to provide you and your staff, with a response to these concerns in a universal format:

The compliments you have extended to our staff at the KD of the STVHCS are appreciated. I would like to inform you and all the residents of the Kerrville, Tcw, area, that there is no intent to close the KD of the STVHCS. The transition that is taking place is one from an inpatient focused, specialty-driven, fragmented healthcare system to more of a coordinated continuum of care grounded in ambulatory and primary care. Simply put, the Department of Veterans Affairs (VA) is changing the way in which it delivers healthcare services to our veterans.

I know that this transition directly affects you residents of the Kerrville area. The KD has become not only a part of the local economy but also part of the fabric of the Texas Hill Country. Several generations of families have received their healthcare services through this VA medical facility. Its employees for the most part reside in the area, are family members of local veterans, are businessmen, and are patients themselves. Their families have grown up in the community, and many of our employees have retired into the area. Therefore, no decision to reduce or eliminate a service is an arbitrary one at the KD or any other VA healthcare facility.

Reductions in government spending are affecting VA facilities across the nation. The VA is being asked to expand the number of veterans served, to decrease costs, to improve access to services and to provide for all benefits included in the "Veterans Health Care Eligibility Reform Act of 1996.'

In our efforts to meet these challenges, changes in the nature of our healthcare delivery system are being actively explored. These include consolidation of inpatient programs that are duplicative, attempting to improve the efficiency of our inpatient operation, and simultaneously expanding access to primary services throughout the STVHCS. In this review, which is still ongoing, we have identified duplication of our inpatient substance abuse, surgery, and medicine units in San Antonio. and Kerrville. We have recommended that the smaller programs in the Kerrville facility be closedand that care provided by their programs at the Kerrville facility be closed and that care provided by their programs at Kerrville facility be managed in San Antonio. There is no intention to close the KD. If our recommendations are approved, an active primary care clinic and geriatric in and out patient facility will remain. In adition, a five-bed observationunit will remain to manage acute emergencies and short term hospital stays.

If you should have any further questions regarding VA healthcare services in the Kerrville area, you

may contact Mr. John Russ, Division Manager, KD, at (830) 792-2413.


Jose R. Coronado,FACHE