NEW HAMPSHIRE VETERANS TRAVEL FAR FOR VA

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NEW HAMPSHIRE VETERANS TRAVEL FAR FOR VA
Terry Date



Lewis Hadley of Danville tended to the sick and injured as a Navy corpsman in World War II. Today the thin 84-year-old receives medical care from the Department of Veterans Affairs for failing eyesight and seizures.

Hadley praises his doctors, but not the travel he makes for his care, having logged some 30,000 miles in out-of-state medical trips with his son, Bill, driving.

On Wednesday, Hadley was examined for glaucoma and diabetes in Jamaica Plain, Mass. Usually the trip makes for a 10-hour day, but they beat traffic and made it home after about seven hours.

“Yeah,” Lewis said, when asked if he wishes the veterans hospital in Manchester was full service again.

Each year thousands of sick veterans in New Hampshire, many of them elderly, file onto shuttle buses or enlist relatives for rides to out-of-state appointments that can represent 12- to 15-hour days rife with waiting.

Some patients and their advocates say many of the hurry-up-and-wait experiences veterans endure at facilities in Jamaica Plain and West Roxbury, Mass., and White River Junction, Vt., could be eliminated.

Make the VA Medical Center on the grassy hill in Manchester a full-service hospital as it was seven years ago, they say, and the Granite State soldiers, sailors, marines and airmen will get the treatment they earned and deserve.

These patients and their advocates have gained the support of scores of state representatives and veterans group officers, as well as a Republican gubernatorial candidate.

But others, including the chief of staff and the director of the Manchester VA Medical Center, say it is highly unlikely that Congress will restore the facility’s inpatient status, surgical services and intensive care unit. The demand for such care in the state is too low, the market for skilled professionals too competitive, and the cost of health care too high, they say.

Report release pending

The VA has adopted a regional health care approach, with lesser needs to be taken care of at small clinics in less populated locales and larger needs at medical centers in more urban settings.

New Hampshire is part of the VA New England health care system, VISN 1, serving 233,000 of the region’s 1.2 million veterans.

A debate between advocates and movers and shakers in the nation’s capital is likely to unfold after the September release of a report on VA health care in the state. The report is being crafted by the New Hampshire Cares Task Force, a legislative group headed by state Sen. Joseph Kenney, R-Wakefield.

Formed earlier this year, the group has visited medical facilities and is gathering information from those who receive and provide the health care.

Kenney, a U.S. Marine Corps reservist who served in Iraq, said veterans complain most frequently about difficulty finding rides, long waits for medical attention and the scant mileage reimbursement they get for their travels — about 10 cents a mile.

The VA either has to ease the travel burden or restore Manchester to hospital status, Kenney says.

“We’ve pulled back from full service with a veteran population (in the state) of over 120,000,” he said.

Manchester has seen improvement but more work needs to be done, says Bob Blais of the New Hampshire American Legion Veterans Affairs and Rehabilitation group, an advocacy panel that meets monthly with the Manchester center’s director, Marc Levenson, and his staff.

Manchester is offering services such as magnetic resonance imaging on the weekends, but arduous trips for older veterans remain.

A veteran can travel on a van to West Roxbury for a 10-minute appointment, but end up staying there all day because he is riding with eight or 10 other people who also need care, Blais said. And somebody from northern New Hampshire has an additional two-hour trip to Manchester to catch the van, he added.

On the plus side, the number of van or bus trips to the Boston Health Care System has been reduced as more care is outsourced to local hospitals. Manchester has an agreement with Catholic Medical Center, also in Manchester, for instance. Heart patients are among those seen at the Catholic center.

Yet that didn’t happen without people making noise.

State Veterans Advisory Committee member Brian Matchett, a doctor of psychology, and others told federal officials that in fiscal 2004, 7,605 New Hampshire veterans rode buses to treatment in the Boston Health Care System. That meant more N.H. veterans rode buses for such treatment than in all the remaining New England states combined.

The New Hampshire number was cut to 3,137 in the following fiscal year.

Today the number of veterans on buses is about 20 a day, or 1,800 annually, said Levenson, the director of the Manchester Medical Center.

New Hampshire stands alone

Still, Matchett, a U.S. Marine Corps veteran who lives in Rochester, says more needs to be done.

New Hampshire is the only state in the continental United States without a full-service veterans hospital, he said. And people from outside the state are setting the treatment agenda for its veterans.

Matchett and others say the need for veteran care in the state will remain high with the state’s high per capita rate of veterans, the higher survival rate of wounded soldiers due to advances in treatment of battlefield wounds, and the post-traumatic stress disorder experienced by military men and women serving in Iraq and Afghanistan.

Traumatic brain injuries, sustained by many military men and women who are victims of roadside bombs in Iraq and elsewhere, can require psychological and rehabilitative care. Therapy can last anywhere from three months to years, Levenson said.

In any event, soldiers surviving serious wounds often need lengthy and, in some cases, lifelong treatment.

And some service-connected conditions like post-traumatic stress disorder can crop up later in life but still require treatment. Matchett says the rate of those suffering from PTSD is 4 percent when they return from combat, but from one to 20 years thereafter the rate climbs to as high as 40 percent.

But Levenson said Manchester is answering the siren of veteran psychological needs.

Levenson said the Manchester center has added nine mental health positions for a total of 20 psychiatric doctors and psychologists. Eighteen of the positions are filled, he said.

The center has a full-time medical staff of 30 physicians and 15 nurse practitioners and physician’s assistants, and a part-time staff of 50 to 70 contracted physicians, Levenson said. It also houses 51 nursing home residents.

The director said the VA decided in 1999 to reduce the hospital’s medical services because the daily average of 20 patients receiving acute care did not reach the threshold to maintain the services.

The number of veterans sent out of state for medical services has remained stable over the past two to three years, with 240 to 320 a year sent to Catholic Medical Center and 160 to 240 sent to out-of-state facilities, he said.

Manchester and the state’s four outpatient clinics in Portsmouth, Tilton, North Conway and Somersworth served 20,000 veterans in fiscal 2006. This fiscal year, which ends Sept. 30, is tracking at a 3 percent increase, said Levenson, who is a medical doctor and has a master’s degree in business administration.

Squeaky wheels?

Levenson contends that a vocal minority of veterans are clamoring for Manchester to return to a full-service hospital. And he’s not the only one with this perspective.

Prostate cancer survivor Gene Pawlik of Derry said he traveled to the Jamaica Plain veterans hospital 25 times in two months for treatment. An Army veteran, he said that from a management perspective, the travel is necessary to avoid the costly duplication of services.

“I understand everything they are going through with the travel, but ultimately they are getting the services,” said Pawlik, a volunteer a the Manchester medical center.

Tell that to veterans Frank Emiro and Al Baldasaro, two Republican state representatives from Londonderry, or to veterans advocate Paul O’Donnell, and you are likely to get a heated response.

“The VA has aligned itself with outside contractors,” said O’Donnell, a Marine Corps veteran. “The tail is wagging the dog.”

Emiro, on the board of the National Vietnam and Gulf War Coalition, said out-of-state travel puts a heavy burden on the families of veterans, too.

He knew a highly decorated Korean War veteran who suffered a stroke and was sent from the Elliot Medical Center in Manchester to the Catholic Medical Center, then to the veterans facility in White River Junction, Vt.

He died there on Easter Sunday after a week and a half. His family could have spent more time with him in his last days if he was closer to home.

“It could have been right here” if Manchester was a full-service hospital, said the Army veteran.

In regard to outsourcing patients to hospitals outside the VA system, Baldasaro, a disabled veteran who served in the Gulf War, says many veterans are uncomfortable in this setting. And Andrew Breuder, chief of staff at the Manchester veterans medical center, said there is some truth to that assessment.

The veteran population is different, older and sicker, than the regular hospital population, said Breuder, a retired Air Force colonel rated as a chief flight surgeon.

Levenson wouldn’t say the transformation is impossible. Unlikely, yes, but not impossible. It would require the will of the VA and congressional approval.

“Things change, who knows what the next five years will bring?” he said.

Kenney says the action would take a public outcry, like the one that saved the Portsmouth Naval Shipyard two years ago.

Fran Byron, adjutant for the American Legion Post 115 in Danville, said the restoration of Manchester to full service would take still something else: common sense.

“These veterans have war-time injuries,” said the Naval Nurse Corps veteran. “These people have been doing the country’s business.”