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Thursday, May 29, 2014 12:01 am

In central Illinois, VA means delay

The national scandal hits home. An underfunded overworked health care system needs reform.

Ed Boblitt just before his deployment to Vietnam in 1968. To his left, his fiancee Janice. The couple broke their engagement in 1969 and were married in 2009, 40 years later.

 

The U.S. Department of Veterans Affairs scandal is starting to hit closer to home. It was late 2013 when Dr. Sam Foote filed a complaint with the VA Office of Inspector General and met with newspaper reporters alleging that patients died waiting for treatment at the Phoenix VA. VA staffers, Foote says, falsified records to meet internal standards. Early this month, U.S. Secretary of Veterans Affairs Eric Shinseki ordered audits of every VA facility in the nation. Recent reports from The American Legion claim that investigations are underway in as many as 19 states – including Illinois. U.S. Senator Mark Kirk has called for the resignation of Joan Ricard, director of the suburban Chicago Edward Hines, Jr. VA Hospital, after a social worker claimed administrators there cooked the books to obtain performance bonuses.

In central Illinois, 150,000 veterans have access to only a few medical facilities spread out over a 34-county area that includes part of Indiana. The nearest hospital is in Danville – 127 miles from Springfield.  Veterans who need medical care unavailable at their local clinic are asked to travel to the nearest facility where those services are provided – even if that facility is outside of the Illiana Health Care System. Not all clinics are created equal; some are larger and offer more specialized treatments. Live in Springfield but need glasses or an X-ray? You’re going to Peoria. Springfield veterans are often required to travel as far as St. Louis, Danville or Indianapolis. Travel reimbursement – 41.5 cents per mile, or about $100 for a round-trip drive to Danville – is usually available.

Ed Boblitt of Auburn has the system’s geography memorized. That’s because he’s often sent to Peoria, Danville, Decatur and other facilities. He’s grown accustomed to waiting weeks and even months for an appointment. The long waits, he says, have exacerbated a skin condition and even cost him sight in one eye.

There are plentiful stories of central Illinois veterans enduring long waits and long drives for access to free health care. They include a Jacksonville veteran who was denied local chemotherapy, a one-eyed man who drives to St. Louis for prosthesis, and a veteran who claims the VA has no idea which branch of the armed forces he served in.

The Springfield outpatient clinic at 5850 South Sixth Street is open during regular business hours and provides primary care, mental health care, social work and blood drawing services. Dr. Dexter Hazlewood of Peoria oversees the clinic and others in Decatur, Mattoon, Peoria and West Lafayette, Indiana. The clinics, anchored by the Danville hospital, comprise The Illiana Health Care System. Hazlewood says an eligible veteran makes an appointment by calling a scheduling center. Triage nurses “make appropriate inquiries and decide the appropriate response.” If they decide a veteran needs to be seen, they attempt to book an appointment “within 14 days of a desired date.”  

Scheduling complexities and travel requirements often seem burdensome to central Illinois veterans. In recent years, the VA started providing shuttle service. The shuttle departs the Springfield clinic every morning at 9:30 a.m. and goes to Danville before continuing on to Indiana and then making the return trip (which departs from Danville at 4:30 p.m.). If the shuttle is on time, veterans who departed Springfield at 9:30 a.m. will return at 6:30 p.m. A brochure, however, advises veterans to expect delays, stating that “evening shuttles departing from Danville…may be delayed waiting for the Indianapolis shuttle to return to Danville.”

Springfield resident Jack Jackson served in the United States Navy from 1964 to 1968. He lost an eye in a service-connected incident and now wears a prosthetic. Every two years, Jackson travels to a VA facility in St. Louis for routine prosthetics appointments. “Sometimes it can take four months before you are seen by the doctor,” says Jackson. He’s avoided the wait time – longer in the summer – by driving in the winter, but says a 210-mile round-trip drive twice in seven days (once for the required follow-up appointment) is too difficult with just one eye. Jackson, however, has maintained his humor about it all. Area residents may remember him as longtime host of WMAY’s the One-Eyed Jack show.

Today Jackson, 68, owns and operates the Dr. of BBQ food stand on the corner of Fifth and Stanford in Springfield. While limited access to care can be frustrating, he gives the VA high marks for quality. Jackson lived for several years with acute foot pain that never went away despite regular visits to a Springfield doctor, which Jackson financed personally. When that doctor died, Jackson finally gave in and drove himself to Danville for an appointment where a VA doctor fixed the chronic problem in one short appointment.

Living with a system that forces you to rely on a small local clinic or drive hundreds of miles simply changes the way veterans make their medical decisions. Although the VA claims its maximum wait time is 14 days, most veterans say it can take up to three months – especially if they’re unable to convince the triage nurse that their needs warrant an immediate appointment.  “If I have a severe cold, I know I’ m probably not going to get in to see a doctor before my cold has run its course,” Jackson says. “I’ll try to pump myself full of OTC meds or find someone with leftover medication that I can borrow.” 

Ed and Janice Boblitt today.
PHOTOS COURTESY ED AND JANICE BOBLITT

Those with acute problems face even more difficult dilemmas. A veteran who experiences serious  abdominal pain on a Sunday morning, for example, can either wait for the clinic to open on Monday, drive himself to Danville, or visit a local hospital Emergency Room and hope the VA picks up the tab. Illiana Health Care System director and CEO Japhet Rivera, who works out of the medical center in Danville, says the VA pays for veterans’ stays in the ER. “If they are eligible there should not be a problem,” he explains, while also acknowledging that there are sometimes “judgment situations” in which the veteran and the VA disagree about the necessity of the ER visit. The judgment call debate gets especially cloudy in light of reports that veterans in some states are resorting to the ER when standard appointments aren’t available.

Michael Leathers, spokesperson for Springfield’s Memorial Medical Center says his hospital sends the veteran a billing statement but works with the VA office to resolve the claim. A veteran sometimes receives a bill because the VA has determined a portion of the claim should be “self-pay.” Veterans who meet the guidelines, Leathers says, can also receive assistance through Memorial’s charity-care program, which may include a write-off of all or part of their balance due. Linda Teeter, manager of managed care for Hospital Sisters Health System (St. John’s) in Springfield says she’s also seen cases in which veterans receive at least part of an ER bill.

The national outcry over the VA has revolved around long delays and improper actions to make those delays appear less severe. But even when the system works, questions remain: Is the VA requiring too much of rural veterans who need routine medical services? Are travel requirements fair? Are there alternatives? Jackson believes each veteran should receive a photo ID entitling him to free medical care at any public or private facility nationwide. Pilot programs and other initiatives have explored similar strategies to varying levels of success, and in critical situations the VA will allow veterans to receive local “non-VA” care from outside providers.

Congresswoman Tammy Duckworth, D-Schaumburg, served as director of the Illinois Department of Veterans Affairs from 2006 to 2009. She says she wants “veterans to access the highest level of health care as quickly and as efficiently as possible, regardless of where they live.” A longtime supporter of VA’s expansion of services to veterans in all areas, Duckworth is “exploring options that allow veterans to access local health providers if the care is appropriate and VA services are not available.”

While the VA sometimes allows veterans to seek outside medical care, there are no rules or guidelines to determine a veteran’s eligibility for non-VA treatment. Director Rivera says the VA “decides on a one-by-one basis,” and tries to “avoid people, especially the elderly, traveling long distances.” When asked what age or distance makes a veteran eligible to receive care outside of the VA system, he says, “We don’t have any type of specific criteria, and in many cases we have to use our judgment and common sense to make sure we are providing compassionate care.” Clinic manager Dr. Hazlewood says relying on outside providers would ultimately be detrimental. “Everyone feels like they have a good reason [to receive outside care], but if we were to do that across the board, it would sink the system,” he explains. Veterans like Jackson disagree, wondering why the VA can reimburse about $100 for travel fees but not use the same amount of money to pay for negotiated group rates through local health care providers.

Jacksonville resident Steve Bartlett served in the United States Marine Corps from 1983 to 1987 and was a mechanic in the United States Army from 1993 to 1996. Many years after his discharge from the Army, doctors told him he developed Non-Hodgkin lymphoma, a cancer of the lymph tissue that can develop if a patient encounters certain chemicals like those Bartlett may have contacted in water wells during his time in the Army. Two years ago, Bartlett petitioned the VA for non-VA approval so he could receive chemotherapy near his home. The VA denied his request, asking him to drive 300 miles round-trip to Danville to receive radiation treatment once every three weeks for two years. Bartlett, a prison guard who will turn 50 in August, paid out of his own pocket for local care and is now cancer-free.

The Veterans Health Administration traces its origins back to the Civil War and federal facilities authorized by President Abraham Lincoln. Herbert Hoover created the VA in 1930, and Ronald Reagan renamed the agency as the Department of Veterans Affairs in 1989. Until the 1990s, veterans were required to access care at a VA hospital. In 1997, the department started enrolling almost all veterans into the VA and standardized eligibility criteria. They established a network of community-based clinics to improve rural access. Since 1998, most vets – not just those with service-connected disabilities – have been eligible for free medical care. There are still income and discharge requirements, but the change in the 1990s dramatically increased the number of patients who have access to free medical care through the VA. The increase also made delays inevitable.

The VA is the second largest bureaucracy in the federal government, behind the Department of Defense. President Obama’s 2015 budget includes $163.9 billion for the VA, and 35.4 percent of that total is tagged for medical programs. Finances are tight, demand is up, two wars are ending, and veterans are coming home in record numbers. The Phoenix VA Health Care System – the one in the eye of the wait-list storm – serves more than 80,000 patients with a budget of $438 million. The Illiana system serves about 33,000 veterans with $175 million. There’s simply not enough money to go around. That unavoidable fact leaves doctors and administrators like Rivera and Hazlewood repeating sad variations of a standard refrain: “We want our veterans to know that we’re trying to do the best we can with what we have.”   

One disabled veteran from central Illinois who spoke under the condition of anonymity says he often sees a different doctor at a different facility and is constantly repeating his medical history and then receiving random appointment times and inaccurate health care diagnoses. At one point, upon requesting his medical file, he discovered that his records list a serious disease that he’s never had and lists him in the wrong branch of service. Once, at a VA clinic, he casually mentioned feeling slightly depressed. Two weeks later, a strong anti-depressant – usually administered under careful supervision – arrived via United States Postal Service. The veteran says he often has appointments scheduled for him on days in which he is unavailable, has been sent notices for appointments that were supposed to have already occurred, and has even showed up for appointments in faraway cities only to be turned away because staffers claim he didn’t actually have an appointment. He also claims that triage nurses who schedule appointments over the phone have refused to book appointments for things ranging from flu-like symptoms to severe colds. Dr. Hazlewood says that should never happen. “You are seen even if you disagree with the triage nurse,” he says. “Our care is centered around the veteran. If a nurse refuses to make an appointment, the veteran needs to file a complaint.”

Ed Boblitt has so many afflictions he can’t even list them all. He served from 1966 to 1975 in the United States Navy and the Air National Guard. Now, he’s rated 90 percent disabled with a 10 percent unemployable rating. He’s had service-connected heart attacks, diabetes and PTSD. “I don’t even know what else,” he says. “I asked the VA for the whole list, and they told me it would take two years to put together.”

VA officials are promoting telemedicine to increase efficiencies and decrease costs, but Boblitt says his first experience with the technology has left him underwhelmed. Earlier this year, Boblitt scratched a sore on his leg that became infected. Three weeks later, a VA doctor examined his wound and provided medicine – but Boblitt was allergic to it. He claims the medication “was eating the skin” off of his leg. He called back for another appointment and was seen promptly. Since the Springfield VA clinic doesn’t have a dermatologist, the clinic’s medical staff photographed his wound and sent the images to a doctor in Indianapolis. When that doctor couldn’t make a diagnosis, the VA approved Boblitt for non-VA care. It took him two or three weeks to receive the authorization in the mail. When he did, Boblitt saw a local doctor who treated the wound immediately.

Boblitt says he goes to Peoria every three months and occasionally drives to Danville. He spent 120 days at the Phoenix VA hospital and another 45 days in a Des Moines facility. He’s learned he has to fight for every aspect of his care. “Oh, they could do a lot better than they’re doing,” he says. Even the little things are confusing. His medication – received in the mail – changed from green and white to orange without explanation.

Confusion over pills isn’t his biggest complaint. “The VA blinded me in one eye,” he says. Boblitt was hit by a car in his childhood and has experienced deteriorating vision throughout his adult life. When a doctor at the Danville hospital said he could help, Boblitt jumped at the chance. He says the VA botched a cataract surgery in 2012 by failing to notice a detached retina. Boblitt believes it may have been partially detached due to previous trauma but became fully detached during the procedure. All he knows is that after the procedure, he lost sight in the eye. “They sent me to appointments in Peoria, Decatur and Springfield, but I had to wait two weeks or more between each appointment,” he says. “When they finally got me to the right doctor who could reattach it, he told me that it was too late.” That was four months after his initial cataract surgery. Boblitt is now blind in one eye.

With federal audits of all national VA health systems underway, Danville’s Dr. Rivera is optimistic about the outcome and says his organization has nothing to hide. Requests for complaint and disciplinary information made under the Freedom of Information Act were not returned by Illinois Times’ print deadline. Whatever the results, funding and awareness will remain key issues. Rivera says that it’s often difficult to entice doctors to live in Danville. The Illiana System employs about 65 doctors and 19 nurse practitioners split between a hospital and five clinics. The average salary for a primary care physician at VA’s Illiana Health Care System is $116,000, excluding benefits like insurance and student loan forgiveness. Forbes reports that in 2013, average pay for a primary care doctor in the United States was $221,000. In the Springfield area, the average is closer to $160,000.

Until recently it was illegal for the VA to advertise its services, but with advertising and outreach regulations changing, the agency is just now learning how to coordinate marketing and outreach efforts. But could it handle more patients? Currently, the Illiana system is treating roughly 25 percent of its eligible veterans. The national average is 30 percent.

The state could  increase the number of vets who get help – if it had money to do so. Erica Borggren is the director of the Illinois State Department of Veterans’ Affairs. IDVA is not part of the VA, but augments federal programs and has Veteran Services Officers who assist veterans in need of programs and benefits. Borggren and her staff employ 71 VSOs in 80 of 102 counties across the state, and those VSOs help veterans access federal VA benefits. With hundreds of nonprofit organizations offering to help veterans, accessing supplemental care can seem overwhelming. That’s why the IDVA has created Illinois Joining Forces (illinoisjoiningforces.org), a public/private partnership that creates a “no wrong door system” by providing information about numerous benefits, services providers, and other resources in one location. Any service member, veteran or family member can access the website and search for help by type of need.

But when it comes to providing good care to veterans, the main issue Illinois faces is the budget, and how the state will grapple with the $1.8 billion hole caused by the expiration of income tax rates. Agencies are already preparing for dramatic cuts, and Borggren says IDVA is expecting $17 million in cuts to its state funding plus the associated federal resources. If the tax increase expires, as now appears likely, Borggren expects to close half of IDVA’s veterans’ services offices, two veteran homes and other critical services.

Ed Boblitt served his country and is now unable to work. Jack Jackson served in the military, lost an eye, and isn’t sure his bills will be paid if he has a serious medical concern when the Springfield clinic is closed. Steve Bartlett sacrificed for his nation and paid out of pocket for his own cancer treatment. We owe these men and women better. It’s time to reform the VA.

Zach Baliva is a filmmaker and journalist living in Chatham. Zachbaliva@gmail.com.

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