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To reduce the backlog, a rule change will give priority to veterans with disabilities considered to be service related.
By ALICIA CALDWELL, Times Staff Writer
© St. Petersburg Times, published September 29, 2002
He did three tours of duty in Vietnam as a U.S. Marine. His body was damaged by Agent Orange, and his mind scarred by what he saw.
At 58, William Madigan Jr. of Sun City Center has a host of medical problems, many of them directly related to his military service. He takes a dozen prescription drugs, and recent triple bypass surgery left him with a sternum that hasn't healed properly.
Madigan had been trying since April to get a doctor's appointment at a VA clinic and finally got one -- for December. Madigan is just one in what has become a crush of people who are overwhelming the federal health care system for veterans.
Nearly 15,000 veterans are trying to get into James A. Haley VA Medical Center in Tampa or its seven associated clinics. An additional 5,500 are waiting for appointments at Bay Pines VA Medical Center in St. Petersburg or its clinics.
"It's not uncommon for those folks to sit out there for nine months or a year and a half," said Ken Thie, state service officer for the Veterans of Foreign Wars. "That's what I hear from folks every day."
While the situation is particularly dire in Florida, which has the second-largest veterans population in the country, it is a problem nationwide, with 300,000 veterans trying to get into the system.
The crisis prompted Anthony J. Principi, secretary of the U.S. Department of Veterans Affairs, to order new guidelines for appointment priority. Now, veterans whose disabilities are largely service-connected will get appointments first.
The change will help the veterans who made the biggest sacrifices: those injured in the line of duty. And it will push to the back of the line those aging veterans, struggling to pay for rapidly rising prescription drug costs, who have overwhelmed the system in recent years as they've sought low-cost prescriptions from the VA.
"I take 19 different drugs a day," said Sam Farina, a 73-year-old Army veteran from Clearwater who depends upon the VA for prescription drugs. "I could never manage on the outside."
They troop into Fred Harrop's office on a regular basis: aging veterans who have no prescription drug plan and desperately need to get into the VA system.
Some already have regular doctors through Medicare, but no prescription drug coverage because Medicare offers no such benefit. The VA charge of $7 or less for a month's supply is the only alternative for many seniors, said Harrop, director of veterans services in Pasco County.
"Getting into the VA is critical for them," he said.
The failure of Congress to pass a prescription drug plan this summer, despite months of intense debates, has made the VA prescription option all the more important for older retirees who are not enrolled in a private health care plan.
Some of the most popular prescription drugs for seniors rose an average of three times the rate of inflation last year, according to Families USA, a nonprofit group that advocates affordable health care.
Laurence Christman, special assistant to the director at Bay Pines VA Medical Center, said the savings veterans realize by going through the VA can mean the difference between receiving appropriate medication and doing without.
For instance, the VA pays $30.54 a pill for a 6 milligram tablet of Zyvox, a popular, wide-spectrum antibiotic, Christman said. Through the VA, a veteran can get a 30-day supply for no more than $7.
However, the patient first must see a VA doctor, even if their Medicare physician already has diagnosed a condition and prescribed a particular drug.
At both Bay Pines and Haley, about 80 percent of those waiting for an appointment are seeking prescriptions, said representatives of each institution.
"This current year is the worst," said Christman, of Bay Pines. "We're just inundated."
Last month, Principi, veterans affairs secretary, announced the need for a type of triage so that veterans injured in military duty would get preference in health care.
In a taped message to VA employees, Principi said he had sent an assistant secretary of the department to eight VA medical centers to ask for an appointment.
Gordon H. Mansfield, the assistant secretary, was paralyzed after being shot in the spine in Vietnam. He uses a wheelchair. Mansfield reported that six of the eight centers were overbooked and could not schedule an appointment for him.
The secretary cited Mansfield's experiences in justifying the restructuring of appointment scheduling to return to the VA's "core commitment" to veterans injured during military service.
Since 1996, the VA's patient load has almost doubled. That's when Congress opened the veterans health care system to all veterans, not just those who were injured in service.
"Congress may have made every veteran eligible for care, but they did not change the fact that we can treat only those whose care can be funded by the appropriations available to us," Principi said.
The veteran's health care system has a medical care budget of nearly $23-billion and a staff of 180,000.
U.S. Rep. C.W. Bill Young, a Largo Republican, said he considers it "shameful" that the backlog has gotten so bad. He blames it on two previous veterans affairs administrators. He pledged to continue supporting increased veterans health care funding, which he said has increased $4-billion during his three years at the helm of the House Appropriations Committee.
"This is one of the great needs," Young said. "It's not insurmountable, but we got off to a late start. There's no real complication to this. It's actually pretty basic. When we have the medical professionals and the money, this is a problem that will be solved."
Young said he supports the restructuring that Principi has proposed. Those changes will take effect Tuesday.
Veterans who were disabled in the line of duty are what the VA calls service-connected disabled. If 50 percent or more of the condition causing the disability is attributable to military service, that veteran will get outpatient appointments within 30 days, according to the new rule.
Those who already are in the system will not be affected by the change. And those veterans whose conditions are deemed emergencies will be treated immediately.
Many veterans, even those whose conditions are not connected to their military service, say they support the new ranking.
"I just feel that anybody who got wounded in the service of this country, I really think they ought to get preference," said John Glabere, 75, a World War II veteran from Venice who receives health care and prescriptions at Bay Pines. His health problems are not related to his military service. "What's fair is fair."
At Haley, the phone calls have begun.
Carolyn Clark, spokeswoman for the Tampa veterans hospital, said anyone on their waiting list who meets the new standard for priority appointments will get a phone call from Haley offering them an appointment within 30 days.
Veterans who are in that category and haven't heard from Haley ought to call and request an expedited appointment, she said.
At Bay Pines, the process is similar, said Christman, special assistant to the director. The hospital is identifying and contacting the people who qualify.
The Bay Pines administrators have devised other ways of attempting to deal with the crush of patients.
Pramod Mohanty, Bay Pines medical director, said the hospital will begin conducting group visits for patients who are coming into the system, allowing the outpatient clinic to see a dozen patients in two hours instead of 12 hours.
Mohanty emphasized that no one's medical condition would be discussed in a group. The initial visit for a veteran includes an orientation of sorts, with the hospital's nurses, pharmacy representatives and others. Instead of hearing that information alone, they would hear it together.
Then, a doctor will see patients individually, in private, Mohanty said.
The hospital's trial run in conducting group visits were "highly positive," Mohanty said. The hope is that this will help reduce the hospital's backlog.
"We are trying to do the best we can in a creative way to deal with this massive influx of patients," Mohanty said.
Nick Contomarinos, commander of the Amvets Post 98 in the Pasco County community of Holiday, said he's not sure how the changes will affect the people who come to him, worried about wait times. Many have serious medical conditions and need prescriptions, but many do not have service-connected disabilities. For them, the wait times will remain unthinkably long.
"They're told it'll probably take a year to get in," Contomarinos said. "They guys say "Geez, I'm 80 years old. I'll probably be dead.' It's a shame."