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The following items are
topics for discussion with Secretary Principi and General Schellhase
reference the VA Medical Health Care at the Kerrville VA Hospital.
1. Can you tell us anything about the status of the new STVHCS director
and the new VISN 17 director? We understand from the grape vine that Mr.
Coronado will not be selected for the VISN 17 director and that it is rare
for a deputy to be moved up to director. Is this true? If so, where does
this leave Mr. Tim Shea?
Secretary Principi: Under Secretary for Medical Health Care Mr.
Garthwaithe has resigned and I have placed three candidates on President
Bush's desk with my recommendation. The President should make that
announcement with in the next week. I would like to give the new Under
Secretary the opportunity to review the candidates for the VISN director's
job and in turn let him review the STVHCS director's job. I will tell you
that Mr. Coronado in not on the list for the VISN director's job.
General Schellhase: Does that mean that Coronado will return as the STVHCS
director and Tim Shea will revert to his old job?
Secretary Principi: I cannot answer that at this time. I will tell you
that Jose is a close friend of mine. I will also tell you that I have not
agreed with him on many of the decisions he has made in San Antonio.
2. Congressmen Smith made a public announcement in Kerrville last March
that the Kerrville hospital will receive the funding to complete the Adult
Day Care Facility. Was this an error on Congressmen Smith's part or is
this still in the works?
Secretary Principi: I have no idea why he would make such an announcement
without having full knowledge if it were not true. I am not aware of the
situation. Chris (the secretaries legal counsel) do you know anything
about this?
Chris: No Mr. Secretary.
Secretary Principi: Chris, make a note, I want this followed up on. There
is no reason this should have happened. I will touch base with Congressman
Smith.
3. There is still a serious shortage of nurses. I understand this problem
is VA wide. My discussion with Dr. Dan Bacon, Chief Medical Officer at
Kerrville VA Hospital, he stated he has a hiring freeze in effect. This
being the middle of the fiscal year, why a hiring freeze?
Secretary Principi: This is a nation wide issue and I do not believe
nurses would be included in a freeze. It is just we cannot find nurses
that want to come to work for the VA.
General Schellhase: Not true. Members of the HCVC have referred qualified
nurses' to the hospital and they were not hired because of the freeze.
This has been discussed with Dr. Bacon and Tim Shea. Is there anything
HCVC can do at the local level to fix this problem?
Secretary Principi: I will have to let you know but we will check into the
issue.
4. We are all having difficultly understanding the VISN 17 budget process.
Four VISNs in the system overspent their budget. Those that stayed within
their budget were forced by the VA Central Office to make up for this poor
management. Why should the well-managed Divisions have to pay for the
poorly managed Divisions at the expenses of the Veteran? Any time we ask
why something is being discontinued or delayed, the answer is always
budget. The current issue is where Veterans are being delayed in being
fitted for prosthetics due to budget, Veterans must now purchase all over
the counter items from local outlets - VA no longer provides some drugs
prescribed by VA doctors and must now be purchased by the Veteran at local
outlets - such as the drug "Clariton". What can the HCVC do to
help correct this problem?
Secretary Principi: You are correct. There were four VISNs that were not
well managed and the other VISNs had to help correct the problem. It is
the issue of trying to do more with less. You have my word, " it will
not happen again on my watch". We will have to hold more funds back
here in headquarters to insure there are funds to assist those VISNs that
have a particular emergency. I am not aware of the over the counter drug
issue. If we prescribe, we should supply. I will have to check into that.
5. While the Veteran population (the customers of the VA hospitals) is
saying we need more hospital beds. Audie Murphy is closing 22 more beds in
the oncology clinic. Kerrville is now down to 20 beds and 5 ICU beds (a
former 422 bed hospital).
Is the VA overall plan to continue to close down hospital beds ?
Secretary Principi: As you know this is a national trend. However, we
should keep beds where there is a known need. This is a good issue. I will
have to check how this is being done.
6. Kerrville is still in need of the following:
a. Pain Clinic - contracts with U of T San Antonio is of no benefit to
sick Veterans in Kerrville
b. Audiology Clinic with staff more than once every two weeks (there is a
six month back log)
c. Cardiology Clinic in Kerrville planned for September has been delayed
due to budget.
d. Orthopedic Clinic - Kerrville has an aged Veteran population, as does
most of the nation. This clinic is needed now.
e. Urologist - 65 days waiting time is entirely too long to wait for an
appointment, especially when the population is aged like it is in the Hill
Country, a retirement community. One Audie Murphy physician comes to
Kerrville twice a month for one day. This is unacceptable.
Secretary Principi: I hear what you are saying, but don't know the answer.
My first guess would be budget. You have a good point about the age of our
Veterans and the issue of travel as well as the difficulty of getting an
appointment.
7. Waiting time to get an appointment is still an issue. The VA has been
working to correct this problem for the past 50 years. Will there ever be
a solution or is this just the way it is going to be for our Veterans? The
reported time for a new enrollee for an initial appointment is 23 days.
This is true, but this initial appointment will be rescheduled in most
cases more than once making a true waiting time of over 45 days and many
times as much as 6 months.
Secretary Principi: This should not be. We should have accurate numbers.
If appointments are rescheduled our numbers should reflect that. I will
personally check out those numbers.
General Schellhase: If needed, HCVC can provide specific names and exact
dates.
8. Waiting time to see the doctor after an appointment has been made is
still an issue. If the Veteran is not the first or second
appointment in the morning some times they have to wait as much as three
hours Will larger budgets fix this problem?
Secretary Principi: Again, I will personally check this out. It should not
be happening.
9. The lack of follow-up between the care provider and the specialist is
non-existent. It seems this is true throughout the VA system. Once
referred to a specialist the, primary care provider is given no feed back.
This needs to be fixed
Secretary Principi: This will be fixed. I am aware of this issue on a
personal level and I can assure you it has my attention.
10. The substance abuse rehab program has been moved from Kerrville to San
Antonio. In San Antonio we now have what is being tagged as a
walk-in/walk-out program. It operates only in the morning, if you like it
- stay, if not - leave. We understand this is a national trend. It is kind
of like an out patient program. According to our members, it is not
working. In fact at the most recent national convention of the substance
abuse folks it was agreed - lock down is the only thing that really works.
The HCVC has members that are success stories from the old lock down
program. We have none from the current program. Today the abusers just
drift from one open clinic to the next and they have no long term plans to
stop their abuse. What can we do to get this turned around?
Secretary Principi: Point well made and I hear what you are saying. I also
know this is the national trend and was not aware of this recent
development at this national convention, but will look into the issue.
11. We find there are no pictures of the chain of command in the VA
Hospitals (Audie Murphy & Kerrville). It has been reported twice that
the pictures came in damaged and have not yet been received. Can this be
corrected before you leave office?
Secretary Principi: If this is not corrected within 20 days, I want you to
give me a personal call. It will be fixed.
12. We find there is a big gap between the medical and administration
people as to what is going on at both Kerrville and Audie Murphy. Is it
possible to get hospital directors that are both medical and administers?
Secretary Principi: You are asking for the impossible. There are very few
doctors that are administrators. When you find one let us know. Like wise,
when you find an excellent administrator with good medical credentials,
let us know. We know what you are saying and we are fully aware of the
issue.
13. The issue of Teaching vs. Veterans Medical Care has become a serious
issue in the past several months. It seems the teaching side of the house
says, "you (Veterans) are here for our benefit". The interns
have stated this feeling to more than one Veteran. This needs to be fixed.
Secretary Principi: Don't get me started. This is one of my hot buttons
and I am working on the issue. We spent several billion - I said billions
- with our Universities and I am not sure we are getting our buck's worth.
You will see more on this in the near future.
14. The HCVC raised the issue of the possibility of having the Kerrville
VA Hospital serve as a full-fledged diagnostic facility for the VA system,
especially in South Texas. You indicated your wiliness to pursue this
issue with further dialog with HCVC. Can we do this during this meeting?
Secretary Principi: This is a good issue. Many major hospitals do just
that, such as Mayo. We will continue to investigate the possibility.
15. There are a lot of good things going on at our VA Hospitals, but all
we hear are the negatives. We need some way to get the VA Public Relations
people to do more to shed light on the good things that are happening. How
can the HCVC make this happen?
Secretary Principi: I don't know about HCVC, but I do know about the
workings of this department and you can rest assured we will address the
issue. You may or may not know that our PR people will be having a
national convention in Florida next month. This will be an issue of
discussion now that you have brought it up. We may call on HCVC to give us
a hand. This is truly a worthwhile issue and we should be doing it daily.
NEW ISSUES THAT CAME
UP
General Schellhase: I
notice from your visit to El Paso and to the ROA convention where you are
making your project the backlog of claims. You are setting aside several
million to hire and train 900 new processors. My opinion is you don't need
to hire 900 new people; you need to train the ones you have to process the
claims the first time around. Stop turning the claims back for such minor
issues as spelling, wrong lines used, some minor numbers missing, etc.
Secretary Principi: The President has directed this issue be fixed. We are
creating a "TIGER TEAM NETWORK". There will be nine teams
initially. These teams will be set up regionally. We currently have 63,000
claims that are from Veterans over 70 years of age and the claim is within
at least one year old or older. In this 63,000 there are 53,000 that are
over one year old. These will be our target claims to start cleaning up
this backlog. We have an estimated 638,000 claims to process. Many are
appeals because of the issues you raise. These will be addressed. This
issue has the President's attention.
General Schellhase: The VA needs to get the decision makers out of the DC
and regional offices and down where the Veteran is getting his care. You
need to learn about these issues first hand. Many of the doctors and
nurses are reluctant to surface these issues. As you know the whistle
blowers never win. Therefore, the HCVC has become a sounding board for
these employees. The mission of the HCVC is to stay out of the
administrative side of the hospital. But when the service to the Veteran
becomes an issue, we become an active group of Veterans to try and make it
better for our own.
Secretary Principi: I will be in San Antonio next week for the American
Legion convention, I may just make a trip over to Kerrville. Should it be
a surprise or announced visit?
General Schellhase: Announced visit and I can assure you, you will see one
of the finest old hospitals in your system that looks new and is servicing
the Veterans with all it has to offer. You will see some of your most
dedicated employees that love what they do. However, they need some one to
tell them they are appreciated. A pat on the back never hurts
Secretary Principi: Give them a heads up; I may just do that. Thanks for
coming.
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