House Approves VA Disability COLA
August, 2001


The Veterans Benefits Act of 2001, passed this week by the House, includes a provision that gives veterans or their surviving dependents receiving VA disability payments a 2.7 percent cost-of-living adjustment effective December 1. The increase will match the Social Security COLA.

More Benefits from Vet Bill

The legislation (previous item) also would correct what Veterans' Affairs Committee chairman Chris Smith, R-N.J., calls a "Catch-22" in which a Gulf War veteran would lose compensation for a poorly defined illness once the illness was diagnosed. The veterans or survivors who would gain from this measure, Smith said, include "more than 170,000 veterans rated 100 percent disabled who would get an additional $767 each year added to their existing benefit." The bill also would establish a two-year nationwide pilot program to expand the available hours for the VA's toll-free information service. Finally, the legislation would allow payment of National Service Life Insurance or United States Government Life Insurance benefits to alternate beneficiaries if the first beneficiary can't be found within three years of the insured's death.
 


Express-News: Military 
Expanding list of GI ailments advances 

By Jim Abrams 
Associated Pres



Web Posted : 08/01/2001 

WASHINGTON The House voted Tuesday to expand the list of service-connected illnesses for Vietnam and Persian Gulf veterans and approve a cost-of-living increase for veterans' benefits.

The legislation, passed 422-0, would add Type II diabetes to the list of diseases presumed to be service-connected in Vietnam veterans exposed to Agent Orange and other herbicides.

It also, as of next April, would add chronic fatigue syndrome; fibromyalgia, a painful disease of the connective tissue; and chronic multisymptom illness to the list of undiagnosed diseases that can qualify a veteran of the 1991 Gulf War for compensation.

"There are thousands of veterans, who bravely served during the Gulf War, today suffering from undiagnosed illnesses deserving of compensation," said Rep. Christopher Smith, R-N.J., chairman of the Veterans' Affairs Committee.

Smith, the sponsor, said the bill also would extend the period for providing compensation to Persian Gulf veterans to Dec. 31, 2003, so newly eligible veterans have time to have their claims considered. 

The bill next goes to the Senate for consideration.

Scientists have looked into nerve gas, anti-anthrax vaccines, depleted uranium and other possible factors, but have been unable to find a specific cause for some of the illnesses including fatigue, skin rashes, cancers and muscle pain afflicting tens of thousands of troops who served in the Gulf War.

The bill gives the nation's 2.3 million disabled veterans, or survivors of disabled veterans receiving compensation, a 2.7 percent cost-of-living adjustment, effective Dec. 1. 

Meanwhile, a House Armed Services Committee panel endorsed hefty pay raises for all military personnel Tuesday and a 50 percent increase in defense health service operations while paving the way for disabled military retirees to keep more benefits.

The pay increases, to start Jan. 1, amount to $6.9 billion, a 9.2 percent increase for a new total of $82.3 billion for personnel. 

There would be across-the-board increases of 5 percent for officers and 6 percent for enlisted personnel, plus raises of 6.3 percent to 10 percent for noncommissioned officers and mid-grade commissioned officers.

08/01/2001


IMMEDIATE RELEASE
SMITH SEEKS AGENCY COORDINATION, NEW PROGRAMS FOR HOMELESS VETERANS
August 2


Estimates 225,000 veterans homeless in typical day; Bill emphasizes prevention,
reintegration to labor force



WASHINGTON, D.C. - Featuring up to 2,000 new low-income housing vouchers, increased grants, inter-agency coordination, and renewed emphasis on existing programs, House Veterans' Affairs Committee Chairman Chris Smith (NJ-4) introduced Thursday the Homeless Veterans Assistance Act of 2001, H.R. 2716.

"There are an estimated 225,000 veterans who are homeless each and every night," Smith said. "For these veterans, access to VA benefits, specialized services and
effective outreach are vital components to any hope of individual stability and improvement in their prospects."

"My legislation, H.R. 2716, puts some teeth in existing programs for homeless veterans and creates new ones to re-integrate them into their communities," Smith said. "The key provision would authorize 500 'Section 8' housing vouchers
in fiscal year 2002, increasing the totals to 1,000 in 2003, 1,500 in 2004, and 2,000 in 2005. This is an expansion of the very successful HUD-VASH (HUD Veterans Affairs Supported Housing) program."

"This legislation would also provide $60 million in fiscal year 2002 for the VA's Homeless Grant and Per Diem Program, and $75 million annually in fiscal years 2003-2005," Smith said. "It would also authorize the VA Secretary to award $250,000 in grants of up to $5,000 each for community-based efforts to assist veterans recovering from alcohol or substance abuse."

In coordination with VA case managers HUD would provide housing vouchers to homeless veterans who are receive and agree to continue VA care, especially for mental illness or substance abuse disorders. Smith's bill would require VA case managers to administer the HUD-VASH program. The bill would also:

Authorize $5 million for both fiscal years 2003 and 2004 to support expanding domiciliary care for homeless veterans through the establishment of 10 new Domiciliary Care for Homeless Veterans programs;

Strengthen the requirement that the Department of Labor's Homeless Veterans Reintegration Program (HVRP) assist the return of homeless veterans to the labor force through training and counseling;

Direct the VA to expand contracts with community agencies that serve veterans incompetent to manage their own financial affairs;

Encourage the Secretaries of HUD and VA to consult closely to assure accurate reporting of homeless veterans' demands for services and to make sure grant and contract recipients of government funding know their responsibilities toward homeless veterans, and;

Direct the Secretaries of Labor and VA to undertake a six-site demonstration program of referrals and counseling for about-to-be-freed incarcerated veterans.

"Many problems and difficulties among homeless veterans could be traced to an individual's experience in military service, exposure to combat, or return to a seemingly uncaring civilian society," Smith said. "In fact, we know that a majority of homeless veterans today suffer from serious mental illness, including post-traumatic stress disorder. Furthermore, substance abuse problems often complicate their situations."

"While the VA offers a broad array of medical services to veterans through VA medical facilities, without better coordination of federal programs relief for some of our veterans may only temporary," said Smith. "Far too often veterans released from VA health care are exposed to the same challenges that created mthese conditions in the first place. That's why prevention and accountability are the crucial to our legislation," he said.
_____________________________________________________________________________
Please visit http://veterans.house.gov, the House Committee on Veterans' Affairs web site, named 'One of the Best Web Sites in Congress' by the Congressional Management Foundation, May 3, 1999.


IMMEDIATE RELEASE
MORAN BILL TO PROVIDE SERVICE DOGS TO DISABLED VETERANS
August 3, 2001
 


Bill Also Expands Veterans' Health Care Access and Eligibility

WASHINGTON, D.C. - Disabled veterans would receive service dogs, eligibility to VA health care would be expanded, and the VA would explore improved coordination of ambulatory and community hospital care for veterans who live too far from major VA facilities if H.R. 2792, introduced in the House Thursday night before the August break, is signed into law.

The Disabled Veterans Service Dog and Health Care Improvement Act of 2001, introduced by VA Subcommittee on Health Chairman Jerry Moran (KS-01) would authorize service dogs for veterans enrolled in VA health care. These service dogs would assist those with disabilities or diseases that impair their mobility, hearing, or other activities of daily living. In addition, eligible veterans would receive travel reimbursement for the costs involved in training or adjusting to the dog.

Moran said he hopes to repeat with this bill the success of a similar effort as a freshman Senator in the State Senate of Kansas.

"At the time, the Senate rules did not allow an employee to bring her service dog on to the floor," Moran said. "Her work required her to be on the floor, but due to her disability, the assistance of her service dog was a necessity."

"It should be no different for our veterans," Moran continued. "For many disabled veterans, a service dog can mean the difference between living independently and requiring full-time care."

The bill would also modify VA's "ability to pay" means test for health care by applying the "Low Income Index" the U.S. Department of Housing and Urban Development (HUD) uses for housing assistance. The VA income standard would be retained as an income floor for health care eligibility, but the HUD standard, which adjusts for differing economic conditions in 61 metropolitan centers, would set the income ceiling.

Moran said he believes this new approach would be a better measure of a veteran' s true ability to pay.

"The one-size-fits-all standard doesn't reflect local costs of living and either denies some veterans a full range of health care or forces them to make co-payments they wouldn't have to make if they lived somewhere else," Moran said. "The current VA income floor of $23,688 can mean two very different things, depending on where a veteran lives and their economic situation."


The third key provision authorizes $50 million a year for a four-year, four-site pilot project in which an enrolled veteran who lives too far from an urban VA hospital could be referred on a volunteer basis to a local hospital for short-stay general medical-surgical inpatient care. Under this provision:

Care would be managed by selected VA outpatient clinics where 70 percent of the veterans served live at least two hours driving distance from a supervising VA hospital;

VA could make co-payments required by the participating veterans' health plans or third-party insurers, including Medicare, and ;

VA would manage and coordinate admissions to local hospitals and take steps to return the veterans to VA follow-up care as soon as practicable.

Other provisions of the bill would:

Require each regional Veterans Integrated Service Network (VISN) to maintain a proportional share of capacity in specialized medical programs. Included are programs for veterans with serious mental illnesses (such as substance and post
traumatic stress disorders), and those needing care for spinal cord injuries, amputations, and blindness;

Establish a four-year pilot program of applied managed care through an outside contractor under VA's $500 million fee-basis and contract care programs. The programs are generally available to service-disabled veterans in serious medical emergencies, those who live too far from a VA health facility, or whose VA facility lacks the resources to treat them.

"This bill addresses many of the needs that veterans' have brought to my attention during recent hearings," Moran concluded. "America owes it to our veterans to take the steps necessary to ensure their health and well-being. It is in our national interest to take good care of those who defend our freedom."

Please visit http://veterans.house.gov, the House Committee on Veterans' Affairs web site, named 'One of the Best Web Sites in Congress' by the Congressional Management Foundation, May 3, 1999.
 

ARMED FORCES NEWS
AMVETS Blasts Proposed Vets Day Change
August 10

AMVETS Blasts Proposed Vets Day Change

The National Commission on Federal Election Reform wants                                                                                  to combine Veterans Day and Election Day into one national holiday, and AMVETS commander Arthur C. Stahl calls the idea "an affront to those who have worn our nation's uniform." The commission, whose co-chairs include former presidents Gerald Ford and Jimmy Carter, proposes to shift Veterans Day in even-numbered years to "the Tuesday next after the first Monday in November and serve as our Election Day." Stahl said, "Congress established this date to commemorate the end of World War I fighting on the 11th hour of the 11th day of the 11th month, and the symbolism inherent in that special date holds deep significance for veterans of all wars."

New Bill Would Speed DoD-VA Health Cooperation Nineteen years after Congress called for increased cooperation between the Defense Department and the Department of Veterans Affairs on health matters, things are still moving slowly. So House Veterans' Affairs Committee Chairman Chris Smith, R-N.J., has taken a step to speed them up. His bill, the DoD-VA Health Resources Access improvement Act of 2001, would direct the agencies to agree on five sites that have health care facilities close enough to permit cooperative operations. Both agencies would be authorized to waive regulations and policies that might impede the project. They would be required to submit a joint "prospectus" within two years for the construction of a new, more accessible and unified federal health care facility in an area where both agencies need a replacement facility.
 


FEDERAL DAY
House Armed Services Committee 
Moves to Change Benefit Law

August 12, 2001

Before adjournment for their August vacation, the House Armed Services Committee took an important step toward changing a controversial benefits law that many veterans believe treats them unfairly. The panel recommended that disabled military retirees receive full military retirement pay and their disability compensation.

Under current law, retirement pay of military retirees with service-related disabilities is reduced to offset disability compensation from the Department of Veterans Affairs. But the committee said veterans are entitled to both payments because their pensions were earned through long years of service and their disability pay is compensation for lost earning potential.

The dual payments will take effect if legislation is enacted to cover the additional costs, projected to run into the millions of dollars.

ARMED FORCES NEWS
VA Launches CHAMPVA for Life

August 17, 2001

Effective October 1, a new medical benefit called "CHAMPVA for Life" will kick in for certain veterans' spouses or dependents who are 65 or older and have Medicare Parts A and B. CHAMPVA beneficiaries who reached age 65 as of June 5, 2001, but were not enrolled in Medicare Part B on that date, will be eligible even though not enrolled in Part B. In all cases, the veteran must have a permanent and total service-connected disability, or must have died of a service-connected condition, or must have been
totally disabled from a service-connected condition at the time of death. CHAMPVA for Life is payable after payment by Medicare or other third-party payers. For services not covered by Medicare or other insurance, such as outpatient prescription medications, CHAMPVA will be the primary payer. CHAMPVA coverage remains unchanged for beneficiaries 65 and older who do not qualify for Medicare.
 


ARMED FORCES NEWS
VA Proposes Aid for Radiation-Exposed Veterans

August 17, 2001

VA Proposes Aid for Radiation-Exposed Veterans Under regulatory changes proposed by the Department of Veterans Affairs, veterans exposed to radiation and diagnosed with cancer of the bone, brain, colon, lung,
or ovary, and their survivors, would be eligible for compensation. Veterans are currently presumed to be
eligible if they participated in a radiation-risk activity and later developed one of the following diseases: leukemia (other than chronic lymphocytic leukemia); cancer of the thyroid, breast, pharynx, esophagus, stomach, small intestine, pancreas, gall bladder, bile ducts, salivary gland, or urinary tract; multiple myeloma, lymphomas (except Hodgkin's disease), primary cancer of the liver (except if cirrhosis or hepatitis B is indicated), or bronchiolo-aveolar
carcinoma. "Radiation-risk activities" include occupation of Hiroshima or Nagasaki, internment as a POW in Japan, or involvement in atmospheric nuclear weapons tests. The changes would add exposure related to underground nuclear tests at Amchitka Island, Alaska, before January 1, 1974, and service at gaseous diffusion plants in Paducah, Ky.; Portsmouth, Ohio; and Oak Ridge, Tenn.


HILL COUNTRY VETERANS COUNCIL

1700 Sidney Baker, Suite 100
Kerrville, Texas 78028
830-896-1157 
Fax 830-896-1175
www.hcvc.org 

Walter Schellhase, President                    

Gene Higgins, Board Member 

Bill Stacy, Vice President        

  Jack Ledford, Board Member

Bill Bacon, Past President              Ben Low, Board Member
Murphy Chesney, Board Member   Gene Richie, Board Member
Joe Benham, Board Member                                Joe Strange, Board Member
Bill Bowden, Board Member Bob Weinberg, Board Member

 


ISSUES PAPER
22 August 2001

The following items are topics for discussion with Secretary Principi and General Schellhase reference the VA Medical Health Care at the Kerrville VA Hospital.

1. Can you tell us anything about the status of the new STVHCS director and the new VISN 17 director? We understand from the grape vine that Mr. Coronado will not be selected for the VISN 17 director and that it is rare for a deputy to be moved up to director. Is this true? If so, where does this leave Mr. Tim Shea?

Secretary Principi: Under Secretary for Medical Health Care Mr. Garthwaithe has resigned and I have placed three candidates on President Bush's desk with my recommendation. The President should make that announcement with in the next week. I would like to give the new Under Secretary the opportunity to review the candidates for the VISN director's job and in turn let him review the STVHCS director's job. I will tell you that Mr. Coronado in not on the list for the VISN director's job. 

General Schellhase: Does that mean that Coronado will return as the STVHCS director and Tim Shea will revert to his old job?

Secretary Principi: I cannot answer that at this time. I will tell you that Jose is a close friend of mine. I will also tell you that I have not agreed with him on many of the decisions he has made in San Antonio.

2. Congressmen Smith made a public announcement in Kerrville last March that the Kerrville hospital will receive the funding to complete the Adult Day Care Facility. Was this an error on Congressmen Smith's part or is this still in the works?

Secretary Principi: I have no idea why he would make such an announcement without having full knowledge if it were not true. I am not aware of the situation. Chris (the secretaries legal counsel) do you know anything about this? 

Chris: No Mr. Secretary.

Secretary Principi: Chris, make a note, I want this followed up on. There is no reason this should have happened. I will touch base with Congressman Smith.

3. There is still a serious shortage of nurses. I understand this problem is VA wide. My discussion with Dr. Dan Bacon, Chief Medical Officer at Kerrville VA Hospital, he stated he has a hiring freeze in effect. This being the middle of the fiscal year, why a hiring freeze? 

Secretary Principi: This is a nation wide issue and I do not believe nurses would be included in a freeze. It is just we cannot find nurses that want to come to work for the VA.

General Schellhase: Not true. Members of the HCVC have referred qualified nurses' to the hospital and they were not hired because of the freeze. This has been discussed with Dr. Bacon and Tim Shea. Is there anything HCVC can do at the local level to fix this problem?

Secretary Principi: I will have to let you know but we will check into the issue.

4. We are all having difficultly understanding the VISN 17 budget process. Four VISNs in the system overspent their budget. Those that stayed within their budget were forced by the VA Central Office to make up for this poor management. Why should the well-managed Divisions have to pay for the poorly managed Divisions at the expenses of the Veteran? Any time we ask why something is being discontinued or delayed, the answer is always budget. The current issue is where Veterans are being delayed in being fitted for prosthetics due to budget, Veterans must now purchase all over the counter items from local outlets - VA no longer provides some drugs prescribed by VA doctors and must now be purchased by the Veteran at local outlets - such as the drug "Clariton". What can the HCVC do to help correct this problem? 

Secretary Principi: You are correct. There were four VISNs that were not well managed and the other VISNs had to help correct the problem. It is the issue of trying to do more with less. You have my word, " it will not happen again on my watch". We will have to hold more funds back here in headquarters to insure there are funds to assist those VISNs that have a particular emergency. I am not aware of the over the counter drug issue. If we prescribe, we should supply. I will have to check into that. 

5. While the Veteran population (the customers of the VA hospitals) is saying we need more hospital beds. Audie Murphy is closing 22 more beds in the oncology clinic. Kerrville is now down to 20 beds and 5 ICU beds (a former 422 bed hospital).
Is the VA overall plan to continue to close down hospital beds ? 

Secretary Principi: As you know this is a national trend. However, we should keep beds where there is a known need. This is a good issue. I will have to check how this is being done.

6. Kerrville is still in need of the following:

a. Pain Clinic - contracts with U of T San Antonio is of no benefit to sick Veterans in Kerrville
b. Audiology Clinic with staff more than once every two weeks (there is a six month back log)
c. Cardiology Clinic in Kerrville planned for September has been delayed due to budget.
d. Orthopedic Clinic - Kerrville has an aged Veteran population, as does most of the nation. This clinic is needed now. 
e. Urologist - 65 days waiting time is entirely too long to wait for an appointment, especially when the population is aged like it is in the Hill Country, a retirement community. One Audie Murphy physician comes to Kerrville twice a month for one day. This is unacceptable. 

Secretary Principi: I hear what you are saying, but don't know the answer. My first guess would be budget. You have a good point about the age of our Veterans and the issue of travel as well as the difficulty of getting an appointment.

7. Waiting time to get an appointment is still an issue. The VA has been working to correct this problem for the past 50 years. Will there ever be a solution or is this just the way it is going to be for our Veterans? The reported time for a new enrollee for an initial appointment is 23 days. This is true, but this initial appointment will be rescheduled in most cases more than once making a true waiting time of over 45 days and many times as much as 6 months.

Secretary Principi: This should not be. We should have accurate numbers. If appointments are rescheduled our numbers should reflect that. I will personally check out those numbers.

General Schellhase: If needed, HCVC can provide specific names and exact dates.

8. Waiting time to see the doctor after an appointment has been made is still an issue. If  the Veteran is not the first or second appointment in the morning sometimes they have to wait as much as three hours Will larger budgets fix this problem? 

Secretary Principi: Again, I will personally check this out. It should not be happening. 

9. The lack of follow-up between the care provider and the specialist is non-existent. It seems this is true throughout the VA system. Once referred to a specialist the, primary care provider is given no feedback. This needs to be fixed

Secretary Principi: This will be fixed. I am aware of this issue on a personal level and I can assure you it has my attention.

10. The substance abuse rehab program has been moved from Kerrville to San Antonio. In San Antonio we now have what is being tagged as a walk-in/walk-out program. It operates only in the morning, if you like it - stay, if not - leave. We understand this is a national trend. It is kind of like an out patient program. According to our members, it is not working. In fact at the most recent national convention of the substance abuse folks it was agreed - lock down is the only thing that really works. The HCVC has members that are success stories from the old lock down program. We have none from the current program. Today the abusers just drift from one open clinic to the next and they have no long term plans to stop their abuse. What can we do to get this turned around? 

Secretary Principi: Point well made and I hear what you are saying. I also know this is the national trend and was not aware of this recent development at this national convention, but will look into the issue.

11. We find there are no pictures of the chain of command in the VA Hospitals (Audie Murphy & Kerrville). It has been reported twice that the pictures came in damaged and have not yet been received. Can this be corrected before you leave office?

Secretary Principi: If this is not corrected within 20 days, I want you to give me a personal call. It will be fixed. 

12. We find there is a big gap between the medical and administration  people as to what is going on at both Kerrville and Audie Murphy. Is it possible to get hospital directors that are both medical and administers? 

Secretary Principi: You are asking for the impossible. There are very few doctors that are administrators. When you find one let us know. Like wise, when you find an excellent administrator with good medical credentials, let us know. We know what you are saying and we are fully aware of the issue.

13. The issue of Teaching vs. Veterans Medical Care has become a serious issue in the past several months. It seems the teaching side of the house says, "you (Veterans) are here for our benefit". The interns have stated this feeling to more than one Veteran. This needs to be fixed.

Secretary Principi: Don't get me started. This is one of my hot buttons and I am working on the issue. We spent several billion - I said billions - with our Universities and I am not sure we are getting our buck's worth. You will see more on this in the near future.

14. The HCVC raised the issue of the possibility of having the Kerrville VA Hospital serve as a full-fledged diagnostic facility for the VA system, especially in South Texas. You indicated your wiliness to pursue this issue with further dialog with HCVC. Can we do this during this meeting?

Secretary Principi: This is a good issue. Many major hospitals do just that, such as Mayo. We will continue to investigate the possibility.

15. There are a lot of good things going on at our VA Hospitals, but all we hear are the negatives. We need some way to get the VA Public Relations people to do more to shed light on the good things that are happening. How can the HCVC make this happen?

Secretary Principi: I don't know about HCVC, but I do know about the workings of this department and you can rest assured we will address the issue. You may or may not know that our PR people will be having a national convention in Florida next month. This will be an issue of discussion now that you have brought it up. We may call on HCVC to give us a hand. This is truly a worthwhile issue and we should be doing it daily.

NEW ISSUES THAT CAME UP


General Schellhase: I notice from your visit to El Paso and to the ROA convention where you are making your project the backlog of claims. You are setting aside several million to hire and train 900 new processors. My opinion is you don't need to hire 900 new people; you need to train the ones you have to process the claims the first time around. Stop turning the claims back for such minor issues as spelling, wrong lines used, some minor numbers missing, etc.

Secretary Principi: The President has directed this issue be fixed. We are creating a "TIGER TEAM NETWORK". There will be nine teams initially. These teams will be set up regionally. We currently have 63,000 claims that are from Veterans over 70 years of age and the claim is within at least one year old or older. In this 63,000 there are 53,000 that are over one year old. These will be our target claims to start cleaning up this backlog. We have an estimated 638,000 claims to process. Many are appeals because of the issues you raise. These will be addressed. This issue has the President's attention.

General Schellhase: The VA needs to get the decision makers out of the DC and regional offices and down where the Veteran is getting his care. You need to learn about these issues first hand. Many of the doctors and nurses are reluctant to surface these issues. As you know the whistle blowers never win. Therefore, the HCVC has become a sounding board for these employees. The mission of the HCVC is to stay out of the administrative side of the hospital. But when the service to the Veteran becomes an issue, we become an active group of Veterans to try and make it better for our own.

Secretary Principi: I will be in San Antonio next week for the American Legion convention, I may just make a trip over to Kerrville. Should it be a surprise or announced visit?

General Schellhase: Announced visit and I can assure you, you will see one of the finest old hospitals in your system that looks new and is servicing the Veterans with all it has to offer. You will see some of your most dedicated employees that love what they do. However, they need someone to tell them they are appreciated. A pat on the back never hurts

Secretary Principi: Give them a heads up; I may just do that. Thanks for coming. 


'Worm' Immobilizes Tricare Website


With Tricare for Life taking effect on October 1 for Medicare-eligible Military retirees who have Medicare Part B, answers to questions about the program are supposed to be on tap at the Tricare Website (http://www.tricare.osd.mil). But the threat of the "Code Red Worm" has shut down the site for those who use commercial Internet Service Providers. The block was originally set on August 1 for all Defense Information Systems Agency gateways. It was partially lifted on August 2 but was imposed again on August 7. Another method to reach TFL is by phone at 1-888-DoD-Life. The Tricare Senior Pharmacy service (also at the blocked Website) can be reached at 1-877-DoD-Med.
 

ISSUES PAPER
22 August 2001

The following items are topics for discussion with Secretary Principi and General Schellhase reference the VA Medical Health Care at the Kerrville VA Hospital.

1. Can you tell us anything about the status of the new STVHCS director and the new VISN 17 director? We understand from the grape vine that Mr. Coronado will not be selected for the VISN 17 director and that it is rare for a deputy to be moved up to director. Is this true? If so, where does this leave Mr. Tim Shea?

Secretary Principi: Under Secretary for Medical Health Care Mr. Garthwaithe has resigned and I have placed three candidates on President Bush's desk with my recommendation. The President should make that announcement with in the next week. I would like to give the new Under Secretary the opportunity to review the candidates for the VISN director's job and in turn let him review the STVHCS director's job. I will tell you that Mr. Coronado in not on the list for the VISN director's job. 

General Schellhase: Does that mean that Coronado will return as the STVHCS director and Tim Shea will revert to his old job?

Secretary Principi: I cannot answer that at this time. I will tell you that Jose is a close friend of mine. I will also tell you that I have not agreed with him on many of the decisions he has made in San Antonio.

2. Congressmen Smith made a public announcement in Kerrville last March that the Kerrville hospital will receive the funding to complete the Adult Day Care Facility. Was this an error on Congressmen Smith's part or is this still in the works?

Secretary Principi: I have no idea why he would make such an announcement without having full knowledge if it were not true. I am not aware of the situation. Chris (the secretaries legal counsel) do you know anything about this? 

Chris: No Mr. Secretary.

Secretary Principi: Chris, make a note, I want this followed up on. There is no reason this should have happened. I will touch base with Congressman Smith.

3. There is still a serious shortage of nurses. I understand this problem is VA wide. My discussion with Dr. Dan Bacon, Chief Medical Officer at Kerrville VA Hospital, he stated he has a hiring freeze in effect. This being the middle of the fiscal year, why a hiring freeze? 

Secretary Principi: This is a nation wide issue and I do not believe nurses would be included in a freeze. It is just we cannot find nurses that want to come to work for the VA.

General Schellhase: Not true. Members of the HCVC have referred qualified nurses' to the hospital and they were not hired because of the freeze. This has been discussed with Dr. Bacon and Tim Shea. Is there anything HCVC can do at the local level to fix this problem?

Secretary Principi: I will have to let you know but we will check into the issue.

4. We are all having difficultly understanding the VISN 17 budget process. Four VISNs in the system overspent their budget. Those that stayed within their budget were forced by the VA Central Office to make up for this poor management. Why should the well-managed Divisions have to pay for the poorly managed Divisions at the expenses of the Veteran? Any time we ask why something is being discontinued or delayed, the answer is always budget. The current issue is where Veterans are being delayed in being fitted for prosthetics due to budget, Veterans must now purchase all over the counter items from local outlets - VA no longer provides some drugs prescribed by VA doctors and must now be purchased by the Veteran at local outlets - such as the drug "Clariton". What can the HCVC do to help correct this problem? 

Secretary Principi: You are correct. There were four VISNs that were not well managed and the other VISNs had to help correct the problem. It is the issue of trying to do more with less. You have my word, " it will not happen again on my watch". We will have to hold more funds back here in headquarters to insure there are funds to assist those VISNs that have a particular emergency. I am not aware of the over the counter drug issue. If we prescribe, we should supply. I will have to check into that. 

5. While the Veteran population (the customers of the VA hospitals) is saying we need more hospital beds. Audie Murphy is closing 22 more beds in the oncology clinic. Kerrville is now down to 20 beds and 5 ICU beds (a former 422 bed hospital).
Is the VA overall plan to continue to close down hospital beds ? 

Secretary Principi: As you know this is a national trend. However, we should keep beds where there is a known need. This is a good issue. I will have to check how this is being done.

6. Kerrville is still in need of the following:

a. Pain Clinic - contracts with U of T San Antonio is of no benefit to sick Veterans in Kerrville
b. Audiology Clinic with staff more than once every two weeks (there is a six month back log)
c. Cardiology Clinic in Kerrville planned for September has been delayed due to budget.
d. Orthopedic Clinic - Kerrville has an aged Veteran population, as does most of the nation. This clinic is needed now. 
e. Urologist - 65 days waiting time is entirely too long to wait for an appointment, especially when the population is aged like it is in the Hill Country, a retirement community. One Audie Murphy physician comes to Kerrville twice a month for one day. This is unacceptable. 

Secretary Principi: I hear what you are saying, but don't know the answer. My first guess would be budget. You have a good point about the age of our Veterans and the issue of travel as well as the difficulty of getting an appointment.

7. Waiting time to get an appointment is still an issue. The VA has been working to correct this problem for the past 50 years. Will there ever be a solution or is this just the way it is going to be for our Veterans? The reported time for a new enrollee for an initial appointment is 23 days. This is true, but this initial appointment will be rescheduled in most cases more than once making a true waiting time of over 45 days and many times as much as 6 months.

Secretary Principi: This should not be. We should have accurate numbers. If appointments are rescheduled our numbers should reflect that. I will personally check out those numbers.

General Schellhase: If needed, HCVC can provide specific names and exact dates.

8. Waiting time to see the doctor after an appointment has been made is still an issue. If  the Veteran is not the first or second appointment in the morning some times they have to wait as much as three hours Will larger budgets fix this problem? 

Secretary Principi: Again, I will personally check this out. It should not be happening. 

9. The lack of follow-up between the care provider and the specialist is non-existent. It seems this is true throughout the VA system. Once referred to a specialist the, primary care provider is given no feed back. This needs to be fixed

Secretary Principi: This will be fixed. I am aware of this issue on a personal level and I can assure you it has my attention.

10. The substance abuse rehab program has been moved from Kerrville to San Antonio. In San Antonio we now have what is being tagged as a walk-in/walk-out program. It operates only in the morning, if you like it - stay, if not - leave. We understand this is a national trend. It is kind of like an out patient program. According to our members, it is not working. In fact at the most recent national convention of the substance abuse folks it was agreed - lock down is the only thing that really works. The HCVC has members that are success stories from the old lock down program. We have none from the current program. Today the abusers just drift from one open clinic to the next and they have no long term plans to stop their abuse. What can we do to get this turned around? 

Secretary Principi: Point well made and I hear what you are saying. I also know this is the national trend and was not aware of this recent development at this national convention, but will look into the issue.

11. We find there are no pictures of the chain of command in the VA Hospitals (Audie Murphy & Kerrville). It has been reported twice that the pictures came in damaged and have not yet been received. Can this be corrected before you leave office?

Secretary Principi: If this is not corrected within 20 days, I want you to give me a personal call. It will be fixed. 

12. We find there is a big gap between the medical and administration  people as to what is going on at both Kerrville and Audie Murphy. Is it possible to get hospital directors that are both medical and administers? 

Secretary Principi: You are asking for the impossible. There are very few doctors that are administrators. When you find one let us know. Like wise, when you find an excellent administrator with good medical credentials, let us know. We know what you are saying and we are fully aware of the issue.

13. The issue of Teaching vs. Veterans Medical Care has become a serious issue in the past several months. It seems the teaching side of the house says, "you (Veterans) are here for our benefit". The interns have stated this feeling to more than one Veteran. This needs to be fixed.

Secretary Principi: Don't get me started. This is one of my hot buttons and I am working on the issue. We spent several billion - I said billions - with our Universities and I am not sure we are getting our buck's worth. You will see more on this in the near future.

14. The HCVC raised the issue of the possibility of having the Kerrville VA Hospital serve as a full-fledged diagnostic facility for the VA system, especially in South Texas. You indicated your wiliness to pursue this issue with further dialog with HCVC. Can we do this during this meeting?

Secretary Principi: This is a good issue. Many major hospitals do just that, such as Mayo. We will continue to investigate the possibility.

15. There are a lot of good things going on at our VA Hospitals, but all we hear are the negatives. We need some way to get the VA Public Relations people to do more to shed light on the good things that are happening. How can the HCVC make this happen?

Secretary Principi: I don't know about HCVC, but I do know about the workings of this department and you can rest assured we will address the issue. You may or may not know that our PR people will be having a national convention in Florida next month. This will be an issue of discussion now that you have brought it up. We may call on HCVC to give us a hand. This is truly a worthwhile issue and we should be doing it daily.

NEW ISSUES THAT CAME UP

General Schellhase: I notice from your visit to El Paso and to the ROA convention where you are making your project the backlog of claims. You are setting aside several million to hire and train 900 new processors. My opinion is you don't need to hire 900 new people; you need to train the ones you have to process the claims the first time around. Stop turning the claims back for such minor issues as spelling, wrong lines used, some minor numbers missing, etc.

Secretary Principi: The President has directed this issue be fixed. We are creating a "TIGER TEAM NETWORK". There will be nine teams initially. These teams will be set up regionally. We currently have 63,000 claims that are from Veterans over 70 years of age and the claim is within at least one year old or older. In this 63,000 there are 53,000 that are over one year old. These will be our target claims to start cleaning up this backlog. We have an estimated 638,000 claims to process. Many are appeals because of the issues you raise. These will be addressed. This issue has the President's attention.

General Schellhase: The VA needs to get the decision makers out of the DC and regional offices and down where the Veteran is getting his care. You need to learn about these issues first hand. Many of the doctors and nurses are reluctant to surface these issues. As you know the whistle blowers never win. Therefore, the HCVC has become a sounding board for these employees. The mission of the HCVC is to stay out of the administrative side of the hospital. But when the service to the Veteran becomes an issue, we become an active group of Veterans to try and make it better for our own.

Secretary Principi: I will be in San Antonio next week for the American Legion convention, I may just make a trip over to Kerrville. Should it be a surprise or announced visit?

General Schellhase: Announced visit and I can assure you, you will see one of the finest old hospitals in your system that looks new and is servicing the Veterans with all it has to offer. You will see some of your most dedicated employees that love what they do. However, they need some one to tell them they are appreciated. A pat on the back never hurts

Secretary Principi: Give them a heads up; I may just do that. Thanks for coming. 


VA PRIORITIZING OLDER VETERAN'S APPLICATIONS
August 31

Secretary of Veterans Affairs Anthony J. Principi has announced that the VA's 57 regional claims offices will pull an estimated 6,000 applications of veterans age 70 or older that have been pending for more than a year. A special team in Cleveland will tackle that workload as a top national priority, then will move to 17,000 of the longest-pending claims of other veterans whose claims have been pending more than a year. VA also is focusing at nine centers on 58,000 more claims from other veterans who have waited more than a year for a decision. Even after the backlog of the long-pending claims of older veterans is reduced, VA will keep in place new rules to raise the priority of all applications of veterans who are age 70 or older.

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