Under the recommendations made by the VA, the Topeka VA medical center would cease emergency, inpatient medical and outpatient surgical services. The facility in Leavenworth would also see a reduction from a 23-bed inpatients facility to a 12-bed observational hospital. (Noah Taborda/Kansas Reflector)
TOPEKA — When retired U.S. Army Col. Lynn Rolf enlisted and went to war, the federal government made a promise it would take care of his medical needs.
Rolf, who began his 31 years of military service in 1970 in Vietnam, says he is still fighting the battle to ensure that commitment is fulfilled and veterans’ medical services remain in place. Recent recommendations from the Department of Veteran Affairs to the Asset and Infrastructure Review Commission suggesting an overhaul of its health network are the equivalent of reneging on that promise, Rolf said.
“In my personal experience, VA care is pretty darn good,” Rolf said. “But I’m used to fighting bureaucracies and and it’s easy for me to when someone tells me ‘No, you can’t do this can’t do that’ I don’t take that as an answer.”
On Monday, Rolf and fellow veterans opposing these changes gained a key victory after a bipartisan group of U.S. senators, including the chairman of the Senate Veterans’ Affairs Committee, announced plans to block the AIR Commission, citing a flawed process. A 2018 law signed by President Donald Trump requires the VA to submit plans to the commission, after which AIR would forward recommendations to Congress for consideration.
A dozen senators said they will not approve the commission’s creation by refusing to approve President Joe Biden’s nominations to the panel, in part because of “unworkable” and controversial recommendations. The VA proposal sought to close 172 of more than 800 clinics nationwide and, among changes in Kansas, reduce capacity or stop certain emergency services in several locations.
In the northeast part of the state, where most of the approximately 221,000 veterans living in the state reside, the plan would discontinue emergency inpatient medical and outpatient surgical services at the Topeka medical center. In Leavenworth, a 23-bed inpatient center would become a 12-bed observational hospital, while a new outpatient facility would be built on campus.
This is not the first time someone has proposed ceasing inpatient emergency services at these facilities, but Rolf said it presented another serious challenge. Just recently, he needed a boil removed, but his primary care physician was not licensed for the same services as his local VA facility.
Without veteran-oriented emergency services, many would need to find treatment at conventional medical centers and hospitals, often racking up expenses.
“Most of our veterans that don’t have the financial capabilities just go without treatment, and that just makes it worse,” Rolf said. “All of a sudden, now they got to go to a lifesaving procedure, or they don’t receive any treatment at all and end up dying, which is even worse.”
The U.S. Senators’ move all but ends five years of efforts to cut back the VA footprint across the country. Those in on the deal to block the commission could still change their mind but for now, the recommendations will not move forward in the process.
In the report, the VA said the overhaul would help address recruitment challenges and lower demand for services in some areas.
“Currently, most ED visits occur on weekdays during the hours of 8:00 a.m. and 10:00 p.m., and most are low to moderate complexity with only 7,638 visits in FY 2019,” the VA recommendations said of the Leavenworth facility.
“Maintaining ED services at the Topeka VAMC is no longer sustainable due to small and decreasing demand and provider recruitment challenges,” the report continued. “Replacing the ED with an urgent care center will provide the appropriate level of care for the Veteran population.”
According to the VA recommendations, neither the Leavenworth nor the Topeka medical centers meet current design standards, and facility condition assessment deficiencies are about $199 million and $141 million, respectively.
But national and state legislators said these suggested changes were skewed against rural states. Rep. Pat Proctor, a Fort Leavenworth Republican and Army veteran who led teams in Iraq and Afghanistan, said recommendations based on data leave out real-life effects on those who need those services.
“I feel like the rug was pulled out from under us,” Proctor said earlier this month. “Weigh the recommendations against the violence it will do to people’s lives. I hope that they will come back and talk to us before they rip vital health care services out of our community.”
Proctor noted the recommendations could also harm a planned veterans’ home in northeast Kansas. A bill providing further funding for the facility passed the Legislature and received the governor’s approval earlier this year, but he said the decision was predicated on the current level of VA services being available in the region.
“The Veterans’ Home for Northeast Kansas — funding for which I was able to finally get passed last session after years of empty promises — will be a long-term care facility for our most medically vulnerable veterans,” Proctor said. “It will be dependent on regional VA health care facilities to deal with emergent medical needs. Removing these hospital beds from our community puts those veterans at risk.”
The overhaul prompted protests in New York, Massachusetts, Ohio, Pennsylvania, South Dakota and West Virginia. Earlier this month, veterans and members of the American Federation of Government Employees District 9 union gathered at the Heartland VA Network in Kansas City, Missouri, to protest changes in the region.
Sen. Brenda Dietrich, a Topeka Republican, echoed the same concerns Proctor had for her veteran constituents. Dietrich, who served on the Veterans and Military Committee while in the Statehouse, said she frequently heard from veterans that they needed care in an environment where they were the top priority.
“I think all of our veterans want to be valued,” Dietrich said. “From an efficiency standpoint, it probably makes sense if you are looking at the data. But from a care standpoint, I think it’s going to be very controversial and not well received by our community.”
However, additional recommendations may have provided increased services in other areas of the state, such as Wichita, where the VA suggested a strategic collaboration with the University of Kansas and affiliated community hospitals to add inpatient mental health services. Currently, the nearest facility offering these services is in Topeka, two hours away.
“The Wichita VAMC has reported holding four to six mental health patients in the inpatient medical and surgical unit at any given time, while waiting for community inpatient mental health beds to become available,” the VA report reads.
In addition, the VA recommended opening community-based outpatient clinics in Derby, Iola and West Wichita. But with those new clinics, the VA suggested closing CBOCs in Fort Scott, Chanute and Garnett because of proximity to new or existing facilities.
If the recommendations should resurface the capacity available would be able to support 100% of projected enrollee demand, per the VA. About 173,500 veterans would be within 30 minutes of primary care via the VA or a community provider, and an additional 600 would be within an hour’s drive.
Sen. Tom Hawk, a Manhattan Democrat, said some give and take is always likely when trying to meet the needs of all patients. Some veterans he has spoken with in his community have expressed concerns about traveling long distances for services, which the new clinics could help mitigate.
“There is always a recognition that most people don’t like change, but it’s inevitable. I don’t think we should be afraid of change,” Hawk said. “But I do think part of our democratic process should be listening to all the people who are impacted by change.”
“So, how do you find that balance between offering the kind of service that’s efficient, affordable and effective?” he said.
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