Patient volume squeezes VA care
By JEAN HELLER
Published January 29, 2007
Tampa Bay's two massive veterans hospitals last year treated 2.5-million patients, roughly the population of Kansas.
The James A. Haley VA Medical Center in Tampa is the busiest of all 140 VA medical facilities in the country. Bay Pines in St. Petersburg is sixth-busiest.
They are separated by only 36 miles.
But in recent years the two facilities have been tethered by more than proximity and heavy patient loads. Each has been touched by controversy, ranging from patient care to management.
As more veterans seek the hospitals' services, their size and missions are a growing challenge for staff and administrators, and ultimately for the veterans who rely on VA medical care.
"There are things we have to fix, and we will fix them," said John Pickens, spokesman for the VA region that covers all of Florida, South Georgia and Puerto Rico.
Pickens argues that care at VA hospitals gets high marks from veterans and outside medical investigators, and that the VA operates in more of a fishbowl of public scrutiny than private hospitals. Investigations by the VA's Inspector General and congressional oversight groups spotlight matters that might escape public notice if they happened in private facilities.
"I'm not saying the VA doesn't have problems or that they should be hidden from the public," Pickens said. "When it comes to the quality of patient care, it has to be the best, or we are failing in our mission on behalf of this nation's veterans."
VA patient loads are much higher than private and community hospitals.
The Bay Pines hospital, for example, covers nine counties and served more than 1-million patients last year. By comparison, Bayfront Medical Center in St. Petersburg serves primarily south Pinellas County and treated 218,000 patients.
While the Haley hospital in Tampa serves eight counties and treated 1.5-million patients last year, Tampa General Hospital serves Hillsborough County and treated 220,000.
VA officials acknowledged 10 years ago that the load on Haley was becoming too great when they announced plans for a new hospital in the Orlando area. But nothing was done until 2005, when plans were expanded significantly. Site selection is under way for the new facility, with operations expected to begin in 2011.
But until doctors are in the corridors and patients are in the beds, Orlando area veterans will continue to live in Haley's world.
The resulting pressure on the two hospitals leads to conflicting opinions about the quality of care.
"All my medical care comes through Bay Pines now, and it's a lot better service and a lot better care than I'd ever get through Medicare," said Kevin Kelly, 59, a former oil-rig worker and eight-year Navy veteran with emphysema. "I have no trouble seeing my doctors whenever I need to, and they're some of the top specialists in the country."
Kelly says he has heard complaints about the VA from other veterans, usually about the time it takes to get enrolled in the system and the long waits to see doctors in some specialized fields.
"It can take months to go through the evaluation process and get into the system, and once you're there, I've heard it can take months to see some specialists," Kelly said. "A dermatologist can be a six- or seven-month wait. But I can get in to see a pulmonary specialist right away."
Steve Dittbenner, 56, of Clearwater, a Vietnam-era Air Force veteran with Parkinson's disease, said he has used VA hospitals in Kansas City, Washington, D.C., and Tampa Bay and is always astonished by the credentials of his doctors.
"People who can't afford any kind of private medical care are getting access to some of the best minds in their fields," he said.
A Harvard Medical School study published this month found that federal hospitals, many of which are VA hospitals, provide the best care for some of the most common life-threatening illnesses, including heart attack, congestive heart failure and pneumonia.
And a recent issue of the medical journal Neurology declared the VA system "one of the most striking examples of American health care success."
"The VA has achieved remarkable improvements in patient care and health outcomes, and is a cost-effective and efficient organization," according to the journal.
Still, both Haley and Bay Pines have had problems in recent years.
- A Bay Pines doctor was suspended from research duties after sloppy paperwork and security procedures endangered the health and the privacy of 13 patients involved in research on stroke medication.
- The director of the Haley facilities was transferred from his job after a series of investigations raised questions about the quality of patient care and hospital management on his watch.
- The VA's Inspector General's office found a high mortality rate for cardiac patients at Haley.
- Bay Pines was the target of multiple federal inquiries in 2004 that led to a shakeup of hospital management.
But Bay Pines and Haley are not the only VA facilities that have had problems.
In the last month, the VA's Office of the Inspector General also issued reports critical of some administrative and patient care practices in Claremore, Okla.; Amarillo, Texas.; Detroit; Bath, N.Y.; Durham, N.C.; and Kansas City.
Seasonal residents add to pressures
Bay Pines and Haley, in some respects, are victims of the VA medical system's success.
VA services historically were limited to veterans with service-related injuries or illnesses. In 1995, Congress opened VA doors to all veterans.
The numbers have been rising since.
In eight counties served by Haley and its satellite facilities, nearly 440,000 veterans are enrolled for VA services. In Bay Pines' nine-county area, more than 350,000 veterans are enrolled.
Last year's combined patient load of 2.5-million doesn't include the tens of thousands who use Haley and Bay Pines solely for prescription medications at their pharmacies.
And pressure on Haley and Bay Pines increases every year when thousands of winter residents and vacationers arrive, many of them veterans needing medical care while they're here.
In addition, many large corporations such as the Big Three automakers are scaling back retiree benefits. Many of those retirees who also are veterans tend to look to the VA to pick up the slack.
Such trends have had significant impact on Haley and Bay Pines.
Congressional studies have shown that the ratio of enrolled veterans to patient visits in West Palm Beach is not nearly as great as in Central Florida, in part because the veteran population of southeastern Florida is wealthier. Although wealthy veterans qualify for most VA care, they tend to prefer private doctors and can afford them.
Many retirees along Florida's west coast come from Rust Belt cities and have retirement plans that make the VA costs attractive.
"Even if you have good retirement insurance, you're not going to have a good prescription drug plan," Pickens said. "Our resources became so strained that Washington began setting priorities. At the top are the veterans with the severest service-connected problems. At the bottom are those that don't have any service-connected injuries or illness and do have the means to pay. They can no longer receive care."
Most of those who can enroll are glad of it.
"I get excellent service at Haley," said George Hilton of Apollo Beach, 57 and an Army veteran of Vietnam, Panama and Persian Gulf War. "I hear people complain about VA care from time to time, but some people just like to hear themselves talk. I've got no complaints."