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July 16, 2003 |
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I am Walter Schellhase, President of the Hill Country Veterans Council. The Council represents over 16,000 veterans in the Texas Hill Country. Thank you for the opportunity to speak to you reference the CARES initiative as the process relates to the Kerrville Division of the STVHCS. Members of your team have visited the Kerrville facility on at least two occasions. Therefore, you know the excellent condition of these facilities, the truly dedicated professional staff providing care to our veterans and the timeliness of service the veteran receives. Therefore, I will not go into telling you about the excellent facility we have in Kerrville. However, I will tell you about the desire of veterans through out South Texas choosing to make use of this facility as opposed to all others in the system. It is a well know fact that Veterans in South Texas will go the extra mile to obtain their medical health care in Kerrville when allowed to do so. Up until a few years ago, Kerrville was known as the very best in VA health care service. There had to been a reason for such desire on the part of the veteran to come to Kerrville. Several years ago bad decisions were made reference acute beds, specialty services, surgery, and who will and who will not be entitled to VA service. The VA has a unique way of making the stagtistics reflect the numbers the system wants to see. As an example, this year you want the numbers to reflect usages. Therefore, service is extended to all categories of veterans. Next year you want to reflect a lack of usages. Therefore, you cut off service to a particular category. Lets face it, the VA is not providing the veterans with the service our veterans deserve and yet you cut or, in the case we are here today to discuss, enhanced realignment. Enhanced Realignment is NOT a bad term to use when you are trying to sale a product to congress. However, in real terms, it means reduced service to our Kerrville veterans, regardless of what you say. In fact at a recent briefing by one of your team members the statement was made, “we are not trying to close down anything, we are trying to justify keeping the small rural hospitals open”. We do not consider Kerrville a small rural hospital. The fact that the VA has selected to discontinue much of the services provided in the past, in the desire to achieve budget goals, does not mean these services are not still needed, it just means they are no longer available to the needing veteran in this particular area. Lets look at the Kerrville hospital. Ten years ago there was over 300 active beds, specialist for most needs, surgery and an excellent team approach to veterans health care. Today we have 5 ICU and 20 acute beds. Now you propose to change the 20 beds remaining from acute to transitional. Has anyone in the VA bureaucracy ever wondered where those 280 veterans, needing acute beds, have gone for medical care? In the STVHCS stagtistics plan presented to the Council last December there was projected a continuing decrease in veterans count from now until 2022. As a veterans group we challenged these numbers as being grossly in accurate. I see in the data provided for this meeting today, VISN 17 show a substantial increase in requirements for primary care in South Texas from a 2001 base line of over 212,000 to nearly 278,000 in 2012 and then a slight decreasing to a little over 256,000 in 2022. At the same time, specialty care is expected to continue to increase over the years by 53% in the year 2022. I am not for sure why 17’s figures differ so much from those used by STVHCS in December. The interesting thing however is, how can STVHCS justify recommendation of Alternative A (Status Quo) with a projected decrease in patient load where VISN 17 recommends Alternative D with a substantial increase in patient count. VA started closing beds in our area (both Kerrville and Audie Murphy) several years ago and opening clinics. Opening clinics through the catchment area of each VA facility provided a tremendous service for the veteran. Many veterans that have never used a VA facility started to receive medical care at one of these clinics. It is a well-known fact that local clinics provide an additional input to the requirements of acute beds. For roughly every 20 outpatients seen in a clinic at least one patient will require an acute bed. However, when that veteran is referenced to the hospital for an acute bed, the bed is not available. You can provide all the clinics you want, but if you do not maintain the hospitals to support the clinics, you have provided the veteran a disservice. STVHCS director has stated on more than one occasion that we have gone too far in closing acute beds. And now, if I read this proposal correctly, you want to open more clinics in the San Antonio area adding additional needs for acute beds and at the same time, provide for the 20 Kerrville beds in San Antonio. Based on data presented and being reviewed here today, it is obvious there is a need for more acute beds not less in the South Texas area. So the question I have to ask is, “why change acute to transitional in Kerrville”? This is where it becomes difficult to understand VISN 17’s recommendation. At the current time, when Audie Murphy’s acute beds are full, the patient is sent to Kerrville and this is not unusual. When Kerrville acute beds are full, which is about 50% of the time, patients are sent to Audie Murphy. However, on at least three occasions in the past 60 days three patients were referred to Audie Murphy but no beds were available. One went to the local hospital at his own expense, one was sent to Methodist and the other was held at Kerrville until a bed opened up at Audie. When you look at VISN 17’s recommendation under the comments column it notes: “Implement in coordination with San Antonio”. To date, it appears no one knows exactly what this means. Does it mean Audie Murphy is going to open up more acute beds to accept the Kerrville’s beds? Does it mean there is a building or expansion program planned for San Antonio? Does it mean long range more parking is going to be provided? Does it mean another large building project? “Implement In coordination with San Antonio” – just what does that mean: how does it effect Kerrville and how can we find out? It would be a shame for the VA to consider any sort of expansion in San Antonio where the facility is land locked, parking a serious problem now and gets worst every day, and cost/BDOC is extremely high. This would truly be an injustice to the American taxpayer, especially when you have a facility in Kerrville with over 70 acres available for expansion, unlimited parking capability, an operation cost/BDOC of only $870, a staff that is recognized as one of the best throughout the area, and a facility that the veteran is willing to drive through San Antonio, by passing Audie, to be treated at the Kerrville facility. How can you possibly not recommend an increase of at least 40 more acute beds in Kerrville to relieve the pressure at Audie, save hundreds of thousands of dollars in construction cost, provide the American taxpayer a break they deserve, make complete use of an excellent existing facility, added back the needed specialist such as surgery (now must go to Audie), urologist (waiting of over 67 days), Orthopedic (now must go to Audie) and podiatry (appointments made February will be kept in September). There are a lot of changes that need to be made in Kerrville, but acute beds to transitional beds is not one of them. Thank you. |
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