REPORT ON

CONGRESSIONAL VISIT

January 24-26,2000

 

Last week General Schellhase made a trip to Washington D.C. to discuss several Kerrville VA Hospital issues with our Congressmen.  Meetings were with Senator Phil Gramm, Representative Lamar Smith and Mr. Dave Davis, Legislative Aid to Senator Kay Bailey Hutchison.

 

In general, all meetings were of a positive nature.  Specific issues discussed were as follows:

 

Support for H.R. 3193 - This bill is the issue of “well grounded” rule regarding Veterans having to prove their own claim without VA assistance.  Representative Smith assured me he would co-sponsor this bill.  Both Senators said they would support a Senate version, when introduced, if not different from H.R. 3193.

 

GAO Reports - It was pointed out to all our congressmen that the last 5 GAO Reports to Congress have highlighted the 25-30,000 empty beds in the VA system.  The reports state that Veterans do not use the system but the reports never state why, other than there are fewer Veterans.  We contend, the empty beds are due to the system and not the need.  When only Priority A Veterans are allowed to use the system, the use drops off.  All assured me they would direct GAO to address this specific point in their next report to Congress which should be in April 2000.

 

H.R. 2116 - It should be noted that all Texas Congressmen voted for this bill -  know as the “Veterans’ Millennium Health Care and Benefits Act”. This bill was signed into law by the President last year and presents a couple of problems in it for the Kerrville VA Hospital.

 

First, the bill set a date of September 30, 1998 as the date at which level of service should be restored to.  In that much of our hospital was closed by this date, we need a date of 1996.

Therefore, we need to work to get this date amended in the law.

 

Second, the bill is so written that Texas is excluded from participation in the State Veterans Home funding.  This directly effects Kerrville in our work with the Texas Land Commissioner in working to renovate the 5th and 6th floors for a Texas Veterans Home.

 

Senator Gramm and Mr. Davis felt an amendment to the date was possible and that there may be a way to get these renovation funds and would work with Mr. John Snead of the Texas Land Commissioners office to that end. Mr. Davis said the Mr. Snead had plans to be in Washington next week to discuss this very matter.

 

Representative  Smith was aware of these problems with 2116, but Texas did not have enough votes to get the wording changed.  He will look into what can be done on both issues.


 

Mr. Davis said Senator Hutchison was aware of the issue and had co-signed a letter with Senator Gramm to Senator Specter, Chairman, Senate Veterans’ Affairs Committee requesting an amendment to fix the Texas Veterans Home problem. He seemed quite sure that Senator Hutchison would work with Senator Gramm to get the needed renovation funds.

 

Service provided by STVHCS - Current condition of services were discussed regarding: management in general, waiting time at hospital, waiting time to get appointment, overcrowded conditions, number of trips to hospital for different illnesses, transportation problems, etc.

 

We also discussed the improvements at Kerrville - The new PA (Physicians Assistance) added to staff, the eye contract with Dr. Priour, the hearing clinic with audio booths from Frank Tejeda Clinic, the assignment of a doctor from the “Blue Team” to the new Gastro Intestinal Shop  and the co-operative effort for the Texas Veterans Home.

 

Budget 2001 - As you all know from our web site, we asked you to write your Congressmen in support of the IBVSO proposal of $21.061 billion.  This proposal does not have Congressional support at this time.  We have our work cut out for us.

 

In general, all Congressmen felt the President will recommend a budget of about $1.0 billion over last years recommendation.  Senator Gramm felt the Senate will add another billion to the figure. That will put the VA Health Care budget at about $19.3 billion, about the same as 2000.  However, according to Senator Gramm the $900 million roll over from 2000 into 2001 will probably be taken into consideration in the manipulations of figures.  Which means the Veterans again take a big cut.

 

Examples - Several specific examples of how Veterans have been treated and the service received were discussed.  Each Congressmen assured me they would look into each one.

STATEMENT OF KENNETH W. KIZER


Undersecretary of Health VA Before the committee on Veteran's Affairs 29 Jan 1999

Discussion on the report of the commission on Service Members and Veterans Transaction Assistance
which has not been released. 

"A over-arching implicit theme is the desire to implicit the two health care systems to work more closely
together. Recommendations to combine congressional appropriations and oversight for DOD and VA
health care systems, as well as budget review at OMB, are included as well as a recommendation for a
joint policy staff serving both DOD and VA and a recommendation for a common information technology
system."


STATEMENT OF TOGO D. WEST, JR. 

Presentation to House Committee on Veteran Affairs 11 Feb 1999 
VII. Conclusion (quote) 


"Mr. Chairman, veterans from all periods of services should be satisfied that this budget is a budget that
protects their interest and lives up to the nations commitment to them."


TESTIMONY OF GEORGE C. DUGGINS
National President Vietnam Veteran of America 24 Feb 1999 

The ordinary processes of the Congress in the making of a budget will not be such as to allow for the adding of the 2.5 to 3.5
billion it will take just to preserve the delivery of existing health care. In the "business as usual" scenario, it is unlikely that much
more than 300 to 500 million will be added to the administrations inadequate request for health care, inasmuch as the budget
process is played as a zero sum game, and any money not requested by the President, must come from somewhere else. 

Mr. Chairman, Vietnam Vets of America urges that you join with Chairman Walsh of the Subcommittee on Appropriation ,as
well as the Chairman of your respective subcommittees ,and your distinguished colleagues on both sides of the isle to find a way
to fund the VHA ,at a level of at least $20 billion. Take the unprecedented step of sending the entire VA budget back to the
administration to come back with a more reasonable submission in a very short time.


TESTIMONY OF HARLEY L. THOMAS

Associate Legislative Director Paralyzed Veterans of America 24 Feb 1999 



Under Secretary for Health (Kizer) in his 8 Feb 1999 memo to Secretary West announced his intentions
to begin massive cut backs in staffing and resources now to prepare for even larger cuts imposed by the
disastrously 2000 budget. So called, "strategic planning initiatives", such as program adjustments, facility
integration, bed reductions, consolidations and mission changes, are basically designed to change and
downgrade the VA health care system as we know it today. 

Today President Clinton's office of Management Budget in one overt stroke is, calling for and presiding
over, the demise of the VA health through intentional budget strangulation. OMB's crafty design is clear,
to so weaken VA health in one bold stroke that it potentially becomes impossible to revive it. 

Based on Independent Budgets projection is to close the equivalent of 26 VA hospitals, a reduction of
8,000 health care staff and reduce the mission of scores of other facilities. 

Obviously, VA already has its plan as Dr. Kizer wrote in Feb 8th memo - the plan to "right size" the VA
system. Rather than keeping this plan a secret, we believe the veterans of this nation and the Congress
have a right to see it.

1) How many hospital beds are going to be shut down? 

2) How many doctors, nurses and health care providers are going to be fired? 

3) Above all, which hospitals are going to close? 

4) Where are these closures going to take place? In what areas of the country? 

5) In what states?

6) In whose congressional district?

Apart from the impact on veterans, we suppose the White House and OMB, obviously think it makes
sense to close VA hospitals and shut down health care for veterans right in the middle of the year 2000
election campaigns. Last year Dr. Kizer said he wanted VA to be able to admit all veterans to the VA
health care system, That is not going to take place now. We want to see the plan showing just who is
going to get into a VA hospital and who is going to be turned away at the door. All these plans exist. We,
as consumers of VA health care have a right to see them now to prepare our members for the dangers to
their health and well being coming down the road."
 


Joseph Bonham              

522 Rolling Green Drive Kerrville TX 78028 

Tel. 830-896-6323 FAX 830-896-6268May 3, 1999

To the Editor:
There's great irony, and not a little hypocrisy, in the fact that the same Administration which calls piously for the nation to support our troops in the Yugoslav campaign is turning its back on those who already have served their country.
Dozens of Veterans Administration hospitals are being closed or downsized into nursing homes, and thousands of doctors and nurses are being retired or fired
The Secretary of Veterans Affairs refused to appear before Sen. Arlen Specter and his Veterans Affairs Committee to explain reductions in veterans' healthcare. Secretary Togo West is quoted (by The Washington Post) as saying that he answers only to the President and does not have to explain his actions and policies to Congress.
At the local level, VA employees say that it's common knowledge that the WNte House has told its Office of Management and Budget to starve the VA by slashing its funds, or, at best, keep funding at current levels even though costs are rising by 10 to 12 percent annually. The resultant downsizing forces veterans onto Medicaid and Medicare roles -- if they qualify.
Senate staffers tell veterans groups that it will take $3 billion a year just to get the VA back where it was in the rffid-1990s. With Congress ordering pay raises for all federal employees -- including those in the VA -- and with Washington telling the VA to begin treating veterans who suffer from hepatitis C, hospital administrators say that there simply isn't enough money to do their job. They admit that they're cannibalizing smaller hospitals in order to keep larger facilities running -- and they say further that if the budget-squeeze continues, the big hospitals will be downsized as well.
Already, veterans complain of increasingly long lines and of having to wait weeks or months when they're referred to specialists.
More than a century ago, Rudyard Kipling attacked Britain's habit of turning its collective back on its soldiers -- its Tommies -- between wars:
. . . it's Tommy this, and Tommy that, and 'Tommy, how's your soul?'
But it's 'Thin red line of heroes' when the drums begin to roll.
. . it's Tommy this, and Tommy that, and 'Tommy, fall behind'
But it's 'Please to walk in front, sir' when there's trouble in the wind.
it's Tommy this, and Tommy that, and 'Chuck him out , the brute!'
But it's 'Savior of his country' when the guns begin to shoot."
That was then; this is now. We have GIs rather than Tommies, and sad to say, we don't have a Kipling. But welching on our national commitment to those who risked their lives for this country is as reprehensible now as it was in Kipling's day, and as obscene on this side of the Atlantic as it was in Victorian England.
 


Synopsis of presentation from Hill Co. Veterans Council to
 JOINT COMMISSION ON ACCREDITATION OF HEALTH CARE ORGANIZATIONS 
 Audie Murphy VA Medical Center on July 13, 1999

by: Lieutenant General Murphy Chesney, USAF Retired MC




We are here today as the Hill Country Veterans Council representing 18,000 veterans in the Hill Country. This takes in the area from San Antonio to El Paso east to west; Del Rio to Big Spring north and south. The Kerrville VA Hospital is the only VA medical facility of any type in that large area to support these 18000 veterans plus veterans all over the state who come to Kerrville to receive care. Our goal is to sustain the care for the future that the veterans have been receiving at Kerrville hospital for many years.

I am also here in support of the Kerrville VA physicians. Many of the physicians at the Kerrville VA Hospital have come to me unhappy with their present status and unhappy with the way they have been treated by Audie Murphy especially concerning the transfer of patients and other things. They somewhat feel that I personally have left them in an untenable situation since I hired most of them. These Kerrville physicians have not requested that I come to JACHO but they have asked me to support them. The Kerrville VA Hospital is more than 75 years old having been built in the mid 20s to support veterans across the state. Over the years it has been one of the best VA hospitals in the country with as many as 500 beds and now is down to 25 beds. When I was at the Kerrville Hospital five to ten years ago we had 283 operating beds including surgical specialties of all kinds, orthopedics, general, plastic, ophthalmology, and urology. It was supported by pathology, we also had psychiatry, alcohol drug and detox, a very good medical service including a pulmonary disease section, and a 160 bed extended care nursing home.

Four years ago the management of the Kerrville VA Hospital was turned over to Audie Murphy and in the interim between then and now, Audie Murphy has gradually closed down most of the Kerrville VA Hospitals facility. Beds have been closed; we've lost more than 100 staff people within the last year. It was announced last September that the hospital would be closed early in 1999 and the date was set for the 15th of March. In January of 1999, very suddenly, all surgical procedures requiring anesthesia were closed; we lost general surgery, ophthalmology, urology, pathology and psychiatry at the same time. Many patients who had been scheduled for surgery were taken off the roles and the surgery still has not been done for most of these patients. Sixty on the waiting list for opthmalogy have not been re-scheduled and most have not even been contacted.

When the closure was announced there was somewhat of a local revolt among veterans and Kerrville VA patients. Many meetings were held in the VFW Hall and American Legion Hall: a meeting was held on the grounds of the Kerrville VA Hospital with more than 300 people in attendance, including a band and speakers. Congressman Lamar Smith brought management from the Audie Murphy VA Hospital in San Antonio, and from the regional office in Dallas, for a general meeting at the Kerrville Municipal Auditorium . More than 1500 attended and more than three hours worth of discussion ensued. The Hill Country Veterans Council was then formed and has been very active in supporting the Kerrville facility. Our major problem with the Kerrville Hospital has been the closure of beds, the loss of other services, and the inability to have these patients taken care of at any other place. The transfer of patients as in-patients to Audie Murphy is very difficult. It takes somewhere between 3 to 14 days to accomplish a normal transfer. I, personally, have waited as long as two weeks to transfer a patient; and then ended up having to send the patient to Wilford Hall Medical Center for brain tumor surgery. Its a complex system where you have to call down and talk to the Secretary and find the Resident, or you have to talk to the staff man. Then "they" will make a decision whether they want the patient or not. Many times they will tell the Kerrville doctors to try "so and so" and, of course, that usually doesn't work. Waiting times for surgery averages about 4 months, and in some modalities such as neuro-surgery, the waiting time can be as long as 6 months to a year. I will give an example of something that happened in the previous week: a patient was admitted at night at Kerrville Hospital with severe right upper quadrant abdominal pain that was thought to be an acute and complicated cholecystitis. The patient was worked up, and it was the opinion of a board certified family practice physician, the ER doctor, and board certified surgeons, that the patient needed emergency surgery. Since this could not be done in Kerrville the patient was transported to Audie Murphy. When he arrived, the Ambulance Driver was told to keep the motor running and the ambulance there, as they would probably send the patient back. They examined the patient and sent him back to Kerrville without opportunity for the needed medical care, in the middle of the night.

Transfer of patients from the out-patient clinic in Kerrville to Audie Murphy is also very difficult. When a Kerrville doctor sees a patient that needs to be seen by a specialty clinic at Audie Murphy, he fills out a consult and transports the paperwork with the next busload down to Audie Murphy. There the secretary handles the request and gives it to a resident who will review it and then talk to the staff man. Audie Murphy may make a decision that the patient does not need to be seen at that time. I will give you an example of what has happened at Kerrville within the last 30 days:
 A Kerrville doctor had a patient who was having symptoms that made the doctor think the patient had coronary artery disease. A treadmill was done immediately and after walking a few steps on the treadmill the patient had an ST depression of 2 1/2 millimeters which is indicative of severe coronary obstruction, usually with 90 to 95% blockage of all three major coronary arteries. The patient needed a catheritization and surgery to relieve this condition. A consult was sent to Audie Murphy and
about 30 days later the resident called back to the Kerrville doctor and said that Audie Murphy had decided to not see the patient since he had no myocardial-infarction and was not having true angina at that time.

Another problem we are having at Kerrville has to do with our Nursing Home. The facility at Kerrville has been a long term nursing home facility and has kept patients up to 15 years.

We have a fairly large Alzheimer's Unit which takes intermediate state patients and is graded as one of the best Alzheimer*s Units in the world. We've had visitors down from Boston and other places just to see how our Alzheimer's Unit works. The decision was made by Audie Murphy that Kerrville would revert to a transitional care nursing home. That would mean patients will not be kept longer than 90 days. At this time patients that have been there for an extended time of one year or longer are being forced out of the Kerrville hospital Nursing Home. Most of these patients do not go out under VA care but are under the financial auspices of their spouses. Many of these patients have no one who can look after them. Many of our patients have lost confidence in Audie Murphy and do not wish to go back. About 1/3 of Kerrville's patients have asked never to be sent there and this fact is recorded in their charts.
The other major problem that Kerrville has to deal with is the morale of the people on staff. As I said before, we have lost more than 100 people. Everyone that works at Kerrville right now is worried about their job and don't know, day in or day out, when they are going to be called in and fired. So many of them have quit and now there is now a shortage of nurses at Kerrville. It is very difficult to hire nurses into a hospital where the length of operation is totally unknown. Kerrville VA Hospital employees are working on a day to day basis and many are looking for a good job opportunity.

Let me digress a minute and mention that nothing I have said here today should reflect on the medical care in the Kerrville Hospital or upon the leadership of Dr. Dan Bacon. We, the members of the Hill Country Veterans Council, think that Dr. Bacon has done an outstanding job trying to work for his San Antonio bosses to comply with their wishes as well as to continue to give outstanding care to the veterans of the Hill Country. He has been put in a very difficult position but is doing an outstanding job.

The Hill County Veterans Council feels that the Kerrville Hospital is one of the best veterans hospitals in the nation. In patient care surveys Kerrville has ranked first for many years. Although Kerrville is small, it gives personalized primary care to its patients, with the same doctor seeing to the individual patient each time. Whereas, when the patients come to Audie Murphy, they are seen by residents who are off-and-on service. Because of this, continuity of care is sometimes lost. We strongly support the Kerrville hospital. Now, as you know, we have sent a package to the Joint Commission highlighting some of the problems we have with medical care in the Hill Country. We have more than 100 letters from patients that were primarily written at the request of the local U. S. Congressman who wanted to know what was going on. Many of those who have had care at Kerrville and San Antonio wanted to come down here today to talk to the Joint Commission; however, we had to limit the number. We brought six people down. I will describe their problems and you can talk to them if you so desire.

The first is patient W. S. who was scheduled for ophthalmologic surgery last January, needing laser surgery on his eyes. His surgery was canceled when the whole surgical department was terminated. He has not been contacted or spoken to as of this time. We also hear of one patient who has allegedly lost his sight because of the delay of his medical care.

A second patient with the initials of BW was a Jewish prisoner of war of the Germans. Because of his religion he received especially harsh treatment and was put before a firing squad twice. He has multiple problems; primarily orthopedic. He's been to Audie Murphy many times and he has said he will not go back again. At times he has had to go to Audie Murphy as many as four times to see the right doctor. He's had some orthopedic problems with his feet and was told that nothing could be done. He's gone to a civilian doctor who was able to fix his problem.
The third patient, initials BB, has had extensive care at Audie Murphy VA Hospital. He detailed many medication errors and reported having to return to the hospital 3 times before he got his treadmill done. Finally, when it was finally completed, he had some kind of coronary event and has said he will not return to Audie Murphy.

The fourth patient, initials BH, has been treated at Audie Murphy and has had problems with post operative and nursing care associated with it. Immediately post surgical, he was put into a room without nursing care, messed on himself and on the bed and could get no one to help him. Finally one of the other patients got up and aquired some clean clothes and cleaned him off. He is also said he will not return to Audie Murphy.

Fifth patient is Mrs. G. L. whose husband has been in the nursing home in Kerrville for more than one year. At one time he was placed out, but did so poorly in a non-Kerrville VA care unit, that he's had to be brought back in. He has multiple medical problems, including post cerebral hemorrhage and other things. He has now been notified that he will be forced out of the Kerrville hospital sometime during the next 4 to 6 weeks. Mrs. G. L. found a nursing home for him but she's afraid he will die outside of the facility that has given him the best care.

Patient number 6 initials TN had cancer of the throat in 1993 with radiation and other treatment. This has totally blocked his ability to swallow (even liquids). He has a hole in his stomach and is force fed through a gastric tube with bags and pump. He's always obtained these pumps and bags from Audie Murphy and Kerrville Hospital, and one a day is required. The packaging for these materials indicates that it should not be used longer than 24 hours as it can become contaminated and is a threat to the patient if it is not changed regularly. However last year AM pharmacy committee decided they were spending too much money on these and started giving him one bag and pump for every 6 days. Mr. TN had problems with this. He developed multiple symptoms, including recurrent diarrhea and pneumonia, (probably from aspiration), three times during this period. He has finally gone back repeatedly to the committee and has won his case. They are now giving him his one tube and pump per day but there are probably 200 people who may or may not be receiving that change in care.

I would like to thank the Joint Commission for allowing us to appear here today and we will try to answer any questions. Thank You!


Meeting with Dr. Chong
 

 

DR. BACON
I HAVE SOME CONCERNS ABOUT THE IDEAS THAT WERE PRESENTED AT THE MEETING
YESTERDAY. BECAUSE I PROVIDE MENTAL HEALTH CARE FOR THE KERRVILLE
VETERANS AND HAVE SOME INSIGHT INTO THEIR THINKING,
I WOULD LIKE TO SHARE WITH DR. CHONG WHAT I BELIEVE WOULD DEFUSE
SOME OF THE ANGER/RESENTMENTS TO WHICH HE IS RESPONDING.
FIRST OF ALL, THE WWII AND KOREAN VETERANS ARE MORE ORGANIZED. ARTICULATE.
AND FINANCIALLY ABLE TO PROMOTE THEIR INTERESTS. THUS. IT IS THIS
GROUP'S CONCERNS THAT NEED TO BE ADDRESSED POLITICALLY.
RESUMING CATARACT. AS SUGGESTED YESTERDAY. AND PERHAPS OTHER SURGERIES AT KD WOULD BE PLEASING TO THEM. HOUSING DRUG ADDICTS/ALCOHOLICS WILL IS VIEWED AS A WASTE OF MONEY TO THEM; THAT IN THEIR OPINIONS* IS NOT A HEALTH PROBLEM ASSOCIATED WITH THEIR AGE GROUP.
BY THE COMMUNITY, THAT WOULD BE VIEWED AS BRINGING IN "RIFF-RAFF" OR
UNDESIRABLES.
SOME OF THE SERVICES THEY HAVE EXPRESSED A DESIRE FOR ARE A POW MEDICAL
CLINIC, WHICH WAS HELD HERE PREVIOUSLY, SUPPORT FOR POW WIVES. AND A CARDIOLOGY CLINIC* THEY HAVE ALSO TALKED ABOUT NEEDING A CARDIOLOGIST FOR OUTPATIENT APPOINTMENTS HERE. I UNDERSTAND THAT WE ARE TRYING TO GENERATE REVENUE. HOWEVER, TO VETERANS, OFFERING CARE TO NON-VETERANS IS TAKEN AS AN AFFRONT: "THEY ARE CUTTING OUR SERVICES BUT THEY WILL SEE SOMEONE WHO'S NEVER BEEN IN THE MILITARY." THIS GENERATES EXTREME ANGER AND UPSET SINCE THEY PERCEIVE THIS AS DISCOUNTING THEIR SERVICE TO THEIR COUNTRY-WE DON'T COUNT." THIS IS JUST A VERY SENSITIVE ISSUE FOR THEM.
I WOULD LIKE FOR SOMEONE TO ASK THE VETERANS WHAT SERVICES THEY CONSIDER MOST NEEDED HERE AT KD. WE CAN GO TO GREAT LENGTHS TO PROVIDE ADDITIONAL SERVICES BUT IF WE DON'T PROVIDE THE ONES THEY ARE EXPECTING/DESIRING, THE VETERANS WILL STILL NOT BE SATISFIED AND THE POLITICIANS WILL CONTINUE TO QUESTION THE SERVICES. SO RATHER THAN WASTE TIME. MONEY, AND EFFORT.
COULDN'T WE ASSESS THE VETERANS TO ACTUALLY ASCERTAIN WHAT SERVICE, OR FEW SERVICES, THEY MOST WANT INITIATED OR RESTORED AT KD?

THANK YOU FOR READING THIS.,

DEBBIE BAILEY, RNCS


Congressional Vote 
Motion to Waive C.B.A. Re: Wellstone Amdt. No. 1747
H.R. 2684

 

September 22, 1999
Senate Roll Call No. 285
106th Congress, 1st Session

During consideration of this measure today, Senate also took the
following action: By 36 yeas to 63 nays (Vote No. 285),
three-fifths of those Senators duly chosen and sworn, not having
voted in the affirmative, Senate rejected the motion to waive the
Congressional Budget Act with respect to the consideration of
Wellstone Amendment No. 1747, to increase the amount
appropriated for the Veterans Health Administration of the
Department of Veterans Affairs by $1,300,000,000.
Subsequently, a point of order against the amendment pursuant to
section 302(F) of the Congressional Budget Act was sustained,
and the amendment thus fell. 

Vote Tally for the Wellstone Amendment No. 1747 follows:

Voted Yea: 36 Mbs

Tim Hutchinson (R-AR)
Barbara Boxer (D-CA)
Ben Nighthorse Campbell (R-CO)
Christopher Dodd (D-CT)
Joseph Lieberman (D-CT)
Joseph Biden (D-DE)
Max Cleland (D-GA)
Daniel Akaka (D-HI)
Charles Grassley (R-IA)
Tom Harkin (D-IA)
Richard Durbin (D-IL)
Edward Kennedy (D-MA)
John Kerry (D-MA)
Olympia Snowe (R-ME)
Susan Collins (R-ME)
Paul David Wellstone (D-MN)
Max Baucus (D-MT)
Kent Conrad (D-ND)
Byron Dorgan (D-ND)
J. Robert Kerrey (D-NE)
Robert Smith (I-NH)
Jeff Bingaman (D-NM)
Harry Reid (D-NV)
Charles Schumer (D-NY)
Ron Wyden (D-OR)
Gordon Smith (R-OR)
Arlen Specter (R-PA)
Rick Santorum (R-PA)
Jack Reed (D-RI)
Tom Daschle (D-SD)
Tim Johnson (D-SD)
Charles Robb (D-VA)
Patrick Leahy (D-VT)
Jim Jeffords (R-VT)
Patty Murray (D-WA)
John Rockefeller (D-WV)
 

Voted Nay: 63 Mbs

Ted Stevens (R-AK)
Frank Murkowski (R-AK)
Richard Shelby (R-AL)
Jeff Sessions (R-AL)
Blanche Lambert Lincoln (D-AR)
Jon Kyl (R-AZ)
Dianne Feinstein (D-CA)
Wayne Allard (R-CO)
William Roth (R-DE)
Bob Graham (D-FL)
Connie Mack (R-FL)
Paul Coverdell (R-GA)
Daniel Inouye (D-HI)
Larry Craig (R-ID)
Michael Crapo (R-ID)
Peter Fitzgerald (R-IL)
Richard Lugar (R-IN)
Evan Bayh (D-IN)
Sam Brownback (R-KS)
Pat Roberts (R-KS)
Mitch McConnell (R-KY)
Jim Bunning (R-KY)
John Breaux (D-LA)
Mary Landrieu (D-LA)
Paul Sarbanes (D-MD)
Barbara Mikulski (D-MD)
Carl Levin (D-MI)
Spencer Abraham (R-MI)
Rod Grams (R-MN)
Christopher Bond (R-MO)
John Ashcroft (R-MO)
Thad Cochran (R-MS)
Trent Lott (R-MS)
Conrad Burns (R-MT)
Jesse Helms (R-NC)
John Edwards (D-NC)
Chuck Hagel (R-NE)
Judd Gregg (R-NH)
Frank Lautenberg (D-NJ)
Robert Torricelli (D-NJ)
Pete Domenici (R-NM)
Richard Bryan (D-NV)
Daniel Patrick Moynihan (D-NY)
Mike DeWine (R-OH)
George Voinovich (R-OH)
Don Nickles (R-OK)
James Inhofe (R-OK)
John Chafee (R-RI)
Strom Thurmond (R-SC)
Ernest Hollings (D-SC)
Fred Thompson (R-TN)
Bill Frist (R-TN)
Phil Gramm (R-TX)
Kay Bailey Hutchison (R-TX)
Orrin Hatch (R-UT)
Robert Bennett (R-UT)
John Warner (R-VA)
Slade Gorton (R-WA)
Herbert Kohl (D-WI)
Russ Feingold (D-WI)
Robert Byrd (D-WV)
Craig Thomas (R-WY)
Michael Enzi (R-W)



Not Voting: 1 Mbs
John McCain (R-AZ)

 

COSPONSORSHIP OF SENATE BILL TO CLARIFY AND IMPROVE VETERANS' CLAIMS AND APPELLATE PROCEDURES
Take Action Now!


 

Senator Patty Murray of Washington intends, in the near future, to introduce a bill in the Senate that would amend title 38, United States Code, to clarify and improve veterans’ claims and appellate procedures. Among other things, this bill, if enacted into law, would clarify that the Department of Veterans Affairs (VA) has a duty to assist veterans in developing all facts pertinent to their claims, without any preliminary burden upon the veteran to first supply evidence that the claim is well grounded. 
The courts have misinterpreted the law as requiring veterans, without government assistance, to produce enough evidence to prove their claims are well grounded before VA has any duty to assist them in gathering evidence to substantiate their claims. This defeats the duty to assist because it means that a veteran is not entitled to government assistance in obtaining evidence until he or she has first obtained evidence on his or her own. If the veteran is able to obtain the necessary evidence from government and private sources without VA assistance, he or she then needs no assistance from VA. If the veteran is unable to obtain the necessary evidence alone, the claim is denied as not well grounded. This misinterpretation of law by the courts has unduly and unnecessarily burdened veterans and immensely complicated the claims process for both veterans and VA.

The bill also includes several other provisions that are beneficial to veterans. The DAV views this as one of the most important bills for veterans to be introduced in the 106th Congress.

We therefore request that you contact your Senators and urge them to cosponsor this bill, entitled "Veterans Claims and Appeals Procedures Clarification and Improvement Act of 1999."


PRESIDENT SIGNED VA/HUD APPROPRIATION BILL ON OCTOBER 20, 1999
TAKE ACTION NOW!


 

On October 8, 1999, the House/Senate Conferees on VA/HUD appropriations finalized their consideration of the fiscal year (FY) 2000 appropriations. The final agreement:

Provides a $1.7 billion increase for veterans’ health care. However, there is a provision in the bill to allow the Department of Veterans Affairs (VA) to save some of the increase until next year, FY 2001. Language in the conference report would allow more than half of this increase, $900 million, to be used in FY 2001 instead of during the current fiscal year. This budget concept is referred to as "advance appropriations" and makes the total amount appropriated look larger than the amount that will actually be spent this fiscal year.

Provides a $5 million increase for Veterans Medical and Prosthetic Research over the President’s request and the FY 1999 level, bringing FY 2000 funding to $321 million. 

Provides an extra $51 million over FY 1999 for the Veterans Benefits Administration (VBA) to expedite claims processing. Total FY 2000 funding for VBA is $913 million. 

Fully funds the President’s $97 million request for the National Cemetery Administration, $5 million over FY 1999. 

More than doubles the President’s request for Veterans State Extended Care Facilities from $40 million to $90 million for FY 2000. 

The House and Senate are scheduled to vote on this conference report later this week.

On behalf of the entire legislative staff, I wish to thank each of you for playing an important role in fulfilling the DAV’s mission of serving America’s service-connected disabled veterans and their families.

Keep up the great work, and thank you for your assistance. Without your effort, VA health care would not have received this increase.

 


DAV Outraged at Proposed VA Health Care Budget Cuts WASHINGTON

October 28, 1999 

National Commander Michael E. Dobmeier, in letters to President Clinton, House Majority Whip Tom DeLay (R-Tex.), and every member of the U.S. House of Representatives, said that a proposed 1.4 percent reduction in the fiscal year 2000 Department of Veterans Affairs (VA) health care budget would threaten the health and lives of the nation's 2.3 million disabled veterans. Commander Dobmeier called on President Clinton to exercise his leadership to stop the effort to cut veterans health care funding. "This proposed across-the-board spending reduction flies in the face of the needs of our veterans and ignores the intent of Congress and the Administration which approved a $1.7 billion increase in veterans health care funding," Commander Dobmeier said in his letter to Rep. DeLay. "The $1.7 billion increase is less than required to fulfill our nation's promise to adequately care for veterans. This is especially true since most of the $1.7 billion increase essentially will be delayed until fiscal year 2001. Any further reductions will catastrophically affect veterans health care and breach the promises made to our men and women who served this nation so honorably." The DAV and others had clearly identified the need for an additional $3 billion in fiscal year 2000 funding for VA health care in order to continue the same level of services to America's sick and disabled veterans. Commander Dobmeier said that a statement by Congressman DeLay alleging $480 million in mismanagement and waste in VA health care does not make the case for additional funding reductions. "If such fraud and waste exist, I 
urge that the VA identify such cases and eliminate them," he said. "If the VA can't, then Congress is required to act. But reducing VA funding and then searching for cost savings is not an effective mechanism to ensure that veterans receive adequate health care." Commander Dobmeier urged President Clinton to exercise his leadership in defeating "this movement toward fiscal irresponsibility which would adversely affect the health and lives of fellow veterans. Our nation is based on the premise of liberty, which has been bought and paid for with the lives and limbs of millions of American men and women." The Disabled American Veterans, a non-profit organization founded in 1920 and chartered by the U.S. Congress in 1932, represents 2.3 million disabled veterans. It is dedicated to one, single purpose: building better lives for our nation's disabled veterans and their families


Proposal for P.A. Operations for Year 2000
NATIONAL DIRECTORS' PERFORMANCE STANDARDS 
FY 2000
November 9, 1999

 

1. Reduce the share of patients reporting coordination of care problems in the outpatient setting to 14% by FY 2001 and 12% by FY 2005.

2. By 2005, 100% of funded research projects will be relevant to VA's healthcare mission in designated research areas.

3. Increase the number of nique patients treated in the healthcare system by 20% by FY 2002. Reach 18% by FY 2001.

4. Increase the scores on the Chronic Disease Care Index to 91% by FY 2001 and 95% by FY 2005.

5. Increase the scores on the Prevention Index to 83% by FY 2001and 90% by FY 2005.

6. Expand to 659 by FY 2003 the number of Community Based Outpatient Clinics (CBOC) at which veterans and eligible dependents can receive outpatient care. Achieve 635 by FY 2001.

7. Increase all alternative revenues to 6.4% in FY 2001 and 7.6% in FY 2005 including medical recoveries, Medicare, and other sharing revenue as a percentage of the Medical Care operating budget. (FY 1997 baseline: $5,458). Achieve 24% by FY 2001.

8.Increase the percent of customers rating VA healthcare as very good or excellent to 68% in FY 2001 and 72% in FY 2005 (inpatient and outpatitent)

9. Reduce the average cost per patient by 30% in FY 2002. (FY 1997 baseline: $5,458). Achieve 24% by FY 2001.

10. Increase percentage of spinal cord injury respondents to the National Customer Feedback Center (NCFC) who rate their care as very good or excellent to 58% by FY 2001 and 62% by FY 2005.

11. Increase the percentage of veterans who acquired Independent living arrangements at discharge from a Domicilary Care for Homeless Veterans (DCHV) Program or a community-based contract residential care program to 56% by FY 2004. (FY 1997 baseline = 8,502)

12. By FY 2001, treatment will be provided for patients who are Hepatitis C for whom treatment is medically appropriate and desired. A baseline of data will be developed in FY 2000.

13. Implement primary care by increasing the percentage of patients who know there is one provider or team in charge of their care to 84% in FY 2001 and 89% in FY 2005.

14. By FY 2001, see 72% of all patients with scheduled appointments at VA healthcare facilities within 20 minutes of their appointments. By FY 2005, see 80% of all paients within 20 minutes.

15. Increase education time and other learning experience time to a minimum of 2% of total work time or 40 hours per year for 70% of all permanent full-time employees by FY 2005.

Please consider this proposal carefully, and indicate your agreement, disagreement, or any suggestions you may have by E-mail. (Click on the "E-Mail" above or below to bring up a ready-to-post letter)
Thank you for your feedback, it's important to us all !
 


Joseph A. Violante, National Legislative Director Concerning 
COSPONSORSHIP OF H.R. 3193

SUBJECT: LEGISLATIVE ALERT-E-MAIL MESSAGES TO HOUSE MEMBERS

DATE: November 4, 1999


On our legislative advocacy program, accessible from our Internet web site, we currently have a prepared E-mail message for House members requesting their cosponsorship and support of H.R. 3193. This is a bill Congressman Lane Evans (D-Ill.) introduced. It will amend the law to correct the problems resulting from the courts' misinterpretation of the rule on "well-grounded" claims and duty to assist. E-mail messages and letters need not be sent to the following House members because they have already cosponsored H.R. 3193: Bob Filner (D-Calif.), Mike Doyle (D-Pa.), Ciro Rodrigues (D-Tex.), Ronnie Shows (D-Miss.), Julia Carson (D-Ind.), Shelly Berkley (D-Nev.), Neil Abercrombie (D-Hawaii), and Tim Holden (D-Pa.). However, you are encouraged to send thank-you letters to these
members of Congress from your state.

Because H.R. 3193 is an extremely important bill, we ask that all National Service Officers and support staff, DAV departments, chapters, and members send this message to their members of Congress. For those on the Internet, access the service through the DAV home page at www.dav.org and select the "Legislation Action" button. Then, select "Write to Congress."

JOSEPH A. VIOLANTE
National Legislative Director
 


HILL COUNTRY VETERANS COUNCIL
1700 Sidney Baker, Suite 100
Kerrville, Texas 78028
Ph 830-896-1157 Fax 830-896-1175




22 December 1999

Mr. Stephen P. Backhus, Director
Veterans' Affairs & Military Health Care Issues
Department of Veterans Affairs
810 Vermont Avenue, N.W.
Washington, DC 20420

Dear Mr. Backhus:

I have recently had the opportunity to read your testimony before the GAO last July. I found it
very interesting that your study over the past 5 years was based on: 1) location visits, 2) visits to
VHA headquarters, 3) discussions with officials, 4) reports by inspectors generals, and 5) private
sectors consultants.

Where were the visits with the millions of Veterans being served by the VA? Also your report
included nothing about why the utilization of our hospitals is on a decline. Your report failed to
disclose that when VA changes the rules as to who can receive treatment at a VA facility the
utilization goes up or down depending upon the rule being changed.
As an example, in 1992 as a Priority Group 7, I was entitled to medical care at our local VA
hospital. In 1998, because of the so called budget constrains, I was no longer eligible for care. In
Oct 1999 the rules were again changed so that I could receive care and so could my wife. So
utilization is totally dependent up the rules at the time.
It would have appeared to me that GAO and Congress should be told how the rules effect the
utilization. If utilization is the basis for changes, consolidations, closures, etc., you should
determine why the under utilization occurs.
Granted, many or our facilities are old, run down, poorly maintained and poorly staffed. Is there
any possibility that these conditions account for the poor utilization? I think yes.

I would suggest for your next GAO report: I ) an in-depth survey of Veterans - those using the
VA facilities and those not using them - to report a Veterans view on what health care he or she
needs, 2) a complete review of utilization and why. Starting with the assumption the Veterans
are out there (25 - 30 million of us), so why don't they use our facilities?

Our figures show ( as do most Veterans organizations) that the number of Veterans in this
country will continue to grow until about 2005 - 2008, not decrease. The reason being Veterans are living longer and new ones continue to enter the system. After 2008 there will be a decline
that will continue thru the year 2020 at which time there will be a leveling off of total Veteran
count. The year 2020 is totally predicated on the fact the US has no additional major conflicts.
However, until 2005 - 2008 we should not be worried about saving 1 1/2 - 2 % per year, but providing those dedicated Veterans what was promised - quality health care.
Your report also failed to disclose the millions the VA spends on research and teaching in
conjunction with universities. Sure some is needed, but not at the expense of adequate health
care for our Veterans.

Sincerely,
Walter Schellhase
President
Hill Country Veterans Council


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