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Crunch has vets waiting for health care

An influx of veterans and a prescription drug benefit overwhelm the local VA clinic.

By JIM ROSS, Times Staff Writer
© St. Petersburg Times
published March 17, 2002

INVERNESS -- The Inverness VA Outpatient Clinic is so busy that some new patients are waiting at least nine months before they can undergo a basic exam.

The clinic at 401 N Central Ave. provides primary health care for members of Citrus County's veterans community. It opened in summer 2000 and was designed to serve the people who had served the nation through military service.

But patient volume, the ebb and flow of personnel and the peculiarities of the health insurance system have put the clinic in a tough position: It simply can't keep up with the patient load.

That's disturbing news for the 25,000 or so veterans who call Citrus County home.

The clinic is supposed to be a place where veterans can obtain primary care locally, instead of traveling to large VA facilities in Gainesville or Tampa.

The patient glut has made that difficult, and not just here: A similar VA clinic in Hernando County is so overwhelmed that it isn't accepting new patients. If Brooksville Regional Hospital vacates its building, government leaders hope to convert it to a VA clinic.

In July, the Citrus clinic had 1,693 "unique patients." A unique patient is a patient who has been assigned to receive care at the clinic and has received services, according to John Pickens, a spokesman for the federal Department of Veterans Affairs.

That high volume inspired the VA in 2001 to add a second doctor to the clinic's medical staff. The clinic also added a second registered nurse and, later, a second medical administration specialist. The clinic also employed a nurse practitioner and a health technician.

Less than one year later, the number of unique patients has increased 34 percent to 2,262, Pickens said.

Staffing, however, has decreased.

The clinic now has only one doctor because the other is on maternity leave. Pickens said the VA soon will bring another doctor to cover until the doctor on leave returns.

The clinic also is without its nurse practitioner. It still has its two medical administration specialists, one registered nurse and two licensed practical nurses.

The time gap that veterans face between enrollment and receiving care is "largely due to budget restrictions," Pickens said. (Pickens reminded veterans that, once they are enrolled in the VA medical system, they are eligible to receive urgent care at the VA facilities in Gainesville or Lake City.)

Pickens said the VA hopes the 2003 budget will "give us a little more room" for helping ease the crunch. But the agency is committed to maintaining reasonable ratios, Pickens said, and it won't overload providers with too many patients.

He noted that money for the VA health system is allocated nationwide according to the location of veterans who are seeking service. In recent times, one of every five veterans enrolling for VA health care has done so in Florida or Puerto Rico.

"Florida is one of those areas veterans are flocking to," he said.

But the money trickles in two years after the counts are completed, Pickens said, so the current budget doesn't match the strong rate of patient growth.

Population isn't the only explanation. The value of VA benefits also is contributing to the high patient load.

Most veterans seeking medical service are age 65 or older and thus are enrolled in Medicare, which does not have a prescription drug program. The VA provides prescription services through its mail-order pharmacy and other outlets, but only if the prescription comes from a VA provider.

The result, according to Citrus veterans service officer J.J. Kenney, is that veterans who otherwise wouldn't seek VA assistance are doing so because of the prescription benefit.

And why not? Without the benefit, Kenney said, a patient might pay $90 for a prescription; with the benefit, the copay for the same script might be $7.

"The biggest thing is the medications," Kenney said. "They've opened the floodgates, so to speak."

Kenney said the Inverness back load probably would dissipate if Congress allowed the VA pharmacies to accept prescriptions from civilian doctors.

Robert Corcoran, 82, certainly hopes the Inverness clinic can solve its woes. But he couldn't wait around while the line was so long.

A retired Air Force tech sergeant who served overseas during World War II, Corcoran moved to Citrus Hills in October. Before that, he lived in Pasco County.

Corcoran enrolled in the VA health system and learned he would wait up to six months to get an appointment. He complained and wrote letters.

Eventually, the VA clinic in Gainesville called. A patient had canceled and an appointment was open on Dec. 31.

"I said, 'Fine.' I took it and am very happy. I don't mind the drive over there. It takes an hour and a half," Corcoran said.

Warren Auer isn't as understanding.

Auer, from Beverly Hills, is a Navy veteran. So is his wife, Gloria. Both are 80.

Warren Auer has been upset about the waiting time for veterans and has been spreading information about the problem to fellow vets.

After hearing from Auer, the County Commission last week passed a resolution asking Congress to expand services at the clinic.

"I'm extremely satisfied" with that response, he said. "They are going to reach out to some of those places that I could never reach."

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