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Director: Improving regional VA’s failing grade a priority

Veteran: “I am scared to death about my health care.”

Veterans speak out at Gulf Coast Veterans Health Care Systems town hall meeting in Biloxi. The forum allowed veterans to speak about problems they have encountered and offered people to help them find solutions.
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Veterans speak out at Gulf Coast Veterans Health Care Systems town hall meeting in Biloxi. The forum allowed veterans to speak about problems they have encountered and offered people to help them find solutions.

There is a new (albeit interim) sheriff in town at the Gulf Coast Veterans Health Care System, and he wants the region to know that changes are already in the works to improve the care veterans from Biloxi to Panama City receive at Department of Veterans Affairs medical facilities.

Following the departure in May of former director Anthony Dawson, Dr. M. Christopher Saslo was named the acting director of the GCVHCS, which includes the hospital in Biloxi and outpatient clinics across the Gulf Coast. Saslo, whose title changed last week from acting to interim director, recently addressed the news that the GCVHCS is one of 14 VA medical systems across the country that earned just one out of a possible five stars on a quarterly quality rating scale.

The Strategic Analytics for Improvement and Learning (SAIL) report measures the quality of care that a VA health care system provides. Organizations like the GCVHCS are graded on 30 different areas, including subjective surveys of patient and employee satisfaction, and objective measures like mortality rates and the number of readmissions after patients are discharged from the hospital.

“What we’re talking about basically is a scorecard,” Saslo said. “It helps us to identify the areas where we’re doing well, and where we need to improve.”

The most recent SAIL report, which covers the first quarter of fiscal year 2017, gave the GCVHCS good marks for areas like the number of central line-related infections patients in the hospital in Biloxi experienced (zero), and the number of ventilator-associated events (also zero).

But in areas like employee satisfaction and patient access to primary and specialist care, the system received unsatisfactory scores.

“The different areas have different weights,” Saslo said. “It’s a bit deceiving, because some of the data, like the employee satisfaction survey, is pretty old. The issues that were in place at the time of the survey may have already improved by the time the ratings come out.”

Saslo said the agency has already begun to address issues like high nurse turnover by offering higher salaries and recruitment incentives. He’s also looking at “right-sizing” the agency’s other services in order to use the organization’s limited resources in the most efficient manner possible.

“We don’t have an unlimited pool of resources,” he said. “But we’re trying to do a better job of matching our resources to the demands of our patients.”

Calls for reform

Since 2014, when scandals surrounding long wait times, cover-ups and other deficiencies at some VA clinics first gained national attention, elected officials made several high-profile calls for reform of the system. But despite the resignation of then-Veterans Affairs Secretary Eric Shinseki and the hiring of his replacement, Robert McDonald, change was slow in coming.

In August of last year, then-director Anthony Dawson found out how unhappy some local veterans were when he hosted a town hall meeting at the Eglin Air Force Base outpatient clinic in Pensacola. Several veterans and their family members spoke about the problems many had with receiving behavioral health services.

“We witnessed veteran after veteran speak about having appointments canceled and rescheduled for months out, with some of those appointments even being canceled and rescheduled,” said Crestview resident Rebecca Winkler, whose son Drew, an Air Force veteran struggling with post-traumatic stress disorder, took his own life on Memorial Day 2016. “We listened to multiple stories just like ours, with patients listening to the doctor’s problems during appointments and being given meds they didn’t want.

“At the time of the town hall meeting, (the clinic had) one psychiatrist and possibly one counselor — maybe none. The regional director from Biloxi stated they had a hard time getting and keeping individuals because of what they could pay them. He even went so far as to say if any of us in the audience knew of anyone qualified, we should give them his info.”

Saslo acknowledged that access to care — particularly mental health care — is a challenge for the system, but points to recent hires in that area as a victory of sorts.

“The Eglin clinic has really taken a hit over the past year and a half in the behavioral health department,” he said. “To be honest, it’s a tough recruit in the panhandle of Florida for behavioral health professionals, but we made new hires at both Eglin and the Panama City Beach clinics.”

According to GCVHCS spokesman Jerron Barnett, the Eglin clinic’s behavioral health team is comprised of one program manager, two psychiatrists, two nurse practitioners, two registered nurses, two social workers and four psychologists — one of whom is scheduled to come on board in July.

“Once that person starts, there will be no more vacancies there,” Barnett said.

Perceptions and realities

Niceville resident Sam Houston, a Vietnam War veteran, uses the Eglin clinic frequently for his primary care, and occasionally goes to Pensacola to see a specialist. He thinks the one-star rating for the GCVHCS is a bit unfair, given the quality of treatment he has received locally.

“I would give them a high score in some areas, and a lower score in others,” he said. “For example, the hours are very limited. They’re open from 8 to 4 every day — that’s it. If a vet needs help outside those hours, he has to go to a private provider.”

Like Houston, Fort Walton Beach resident Carl Williams visits the Eglin clinic for his primary care. One or two times a month, however, he travels to Pensacola to see a neurologist.

Williams, who suffered a stroke while working in South Carolina over a year ago, uses a wheelchair and has to take a shuttle bus to his appointments in Pensacola. On Thursday, the Army veteran’s scheduled 10 a.m. appointment was canceled at 8:44 a.m.

Despite the inconvenience of having to go out of town to see a specialist, Williams said he thinks the GCVHCS deserves a higher rating than one star.

“Overall, I’d give them a three,” he said. “I’d give my doctor in Pensacola a four.”

Houston is hopeful that the ongoing expansion of the Eglin clinic will help improve the access issues that many of his fellow veterans face when they try to schedule an appointment.

“It’s almost impossible to get in to see someone the day of,” Houston said. “You can’t just walk in there with the flu and expect to be seen that day.”

Saslo said that perception — that veterans can’t get the help they need when they want it — is the biggest challenge he faces.

“Until the veterans feel that access is improved, the perception will be the reality,” he said. “One thing we’re trying to clarify is that same-day access doesn’t necessarily have to mean seeing a doctor that day. We want our other staff members to practice at the top of what their licensure and training allows. That means that in some instances, a registered nurse can help with a medication refill, or a nurse practitioner can see a patient with a less complicated condition.”

‘They deserve our very best’

David Shulkin, the current secretary of Veterans Affairs, has publicly addressed the 14 healthcare systems that received a one-star rating, telling USA Today he has assembled teams to help improve the care at those locations.

“Veterans shouldn’t have to accept low quality care,” he said. “They deserve our very best.”

U.S. Rep. Matt Gaetz, whose congressional district falls within the GCVHCS’s footprint, has pointed to the recent passage of the Veterans Accountability Act as a step in the right direction toward reforming the behemoth that is the VA health care system.

“I believe that the care of our veterans is of the utmost importance, and I am always disheartened when I learn of any substandard treatment of them,” he said. “This is why we work hard every day to fight for those who have fought for us. I am very hopeful that with the recent passage of the Veterans Accountability Act we will see large-scale improvements across the board as it relates to the care of our veterans.”

One of the reforms that Gaetz touts about the Veterans Accountability Act is the increased ability it gives to fire incompetent or corrupt employees within the VA. But in the case of administrators like Dawson, who led the GCVHCS for five years, it’s hard to determine if low ratings led to a promotion, a demotion or a lateral transfer.

Dawson, who accepted a position as the associate director of the Michael E. DeBakey VA Medical Center in Houston, Texas, has been with the VA for more than 30 years. The VA has stated that it is implementing a search for Dawson’s replacement, but repeated attempts to have an official from VA headquarters clarify whether he was forced out of his leadership role at the GCVHCS were not answered.

“It wasn’t categorized as a promotion or a demotion to us,” said Barnett, the GCVHCS spokesman. “He just told us that he had family and other ties in Houston, and this was an opportunity to go back there.”

Whatever the reason for Dawson’s transfer, Saslo said he is determined to address the issues that continue to plague the GCVHCS.

“We realize that there are areas where we need to improve, and we’re already taking steps in that direction,” Saslo said. “But it’s not an overnight process. We didn’t get broken in a day, and we won’t be fixed in a day. The one thing I want people to know is that the employees of this system take their work very seriously and very personally. Around 40 percent of our employees are veterans themselves, and those of us who aren’t veterans usually have loved ones who are. We want to give our veterans the best possible care.”

In the meantime, people like Rebecca Winkler will continue to keep a watchful eye on the agency.

“They have to improve,” she said. “Our veterans deserve so much more than being treated as speed bumps in a revolving door.”