Statement of
Amanda Vazquez
Government Relations Director
Great Plains Paralyzed Veterans of America
Before the
Senate Committee on Veterans' Affairs
Concerning
The Challenges of an Aging VA Medical Center
August 20, 2009
Senator Johanns, on behalf of Great Plains Paralyzed Veterans of America, I would like to thank you for the opportunity to present our views today on the VA facility in Omaha. We appreciate the effort of this Committee to look into the situation in Omaha to see whether the current
hospital is sufficient to meet the needs of Nebraska's veterans. The VA Nebraska-Western Iowa Health Care System, while it has improved immensely over the last 25 years, needs to be
examined and enhanced related to available space for an SCI Clinic and parking. We believe that there are options that would improve the functionality of the Omaha VA and improve overall quality of care for our veterans.
PVA would like to focus much of our discussion on the issues that our members face when visiting the VA facility in Omaha, and how these issues affect their overall care. We will then outline the SCI services that are provided at the Lincoln and Grand Island locations that would be better implemented from Omaha. We would like to impress upon you the importance of addressing these challenges in order to improve the care that Nebraska veterans receive.
Identifying Challenges with the Facility
Among our membership, parking has been identified as the number one problem with the Omaha VA. One of our PVA members commented, you have to get there two hours early [for an appointment] just to find a parking space." Another member commented "it's like a kamikaze
run" because you become so desperate to find an available parking space, you are willing to risk collision and even hitting people who are walking to and from their vehicles. Veterans do not want to, and often cannot, spend their day driving around a parking lot to try to find an available space, especially when they have had to wait a week or more to get their appointment. Veterans know that a missed appointment could result in another lengthy wait before their doctor would be able to see them again. Going to a doctor's appointment should not be an all-day event, especially if the individual is only actually in the hospital for a couple of hours. You and I would never stand for that if we were visiting our doctor's office. There is no reason why this should
be an acceptable practice for our veterans.
Further, handicapped parking is an even greater challenge. All of our members are qualified to park in handicapped parking spaces; however, these spaces are rarely unoccupied and so veterans must venture out into the main parking lot where spaces are extremely tight. Most of our members use wheelchairs and drive vans with ramps. Therefore, they require the van accessible spaces which allow for the ramp to be lowered into an access aisle. There are even fewer van accessible spaces than handicapped parking spaces, making it virtually impossible for our members to utilize these spaces when they visit the VA. If they park their van in a "regular" parking space, there is no room for the ramp to unfold, leaving no way for the individual to exit the van. This leaves only two options:
a. Drive around for hours waiting for a van accessible space to open up
b. Have someone drop the veteran off at the front of the hospital and then park the van in a regular parking space.
Option a is less than ideal since there is no way of knowing when someone will return to their van to leave the parking lot and free up the van accessible space. This option is completely unreliable and could potentially cause the veteran to miss his/her appointment. Option b is only an option if the person needing the use of the ramp is not driving, making it possible for the driver to drop them off and park the vehicle. Many of our members are very independent, and drive themselves to appointments and anywhere else they may need to go; thus, forcimg the veteran to rely on someone else to take the time to transport them to and from their appointment.
Since the Omaha VA is situated on uneven ground, there is a very steep hill leading up to the hospital from the main parking lot. If PVA members, or any other individual who uses a wheelchair, is forced to park in this lot, they are then also forced to climb this steep hill to get to the hospital. This hill is often referred to as "the death hill" by many veterans, because of the incredible slope and the amount of endurance and strength it takes for a person in a wheelchair to push up the hill. It becomes even more of a challenge in the winter months when there is ice and snow on the ground and the extreme cold air is inhaled. Many of our members and other disabled veterans are of the older generations, and do not have the physical capacity to climb this hill without risking their health and safety.
Delivery of Care for SCUD Patients
Veterans with Spinal Cord Injuries (SCI) require specialized care from the VA that should come from doctors and nurses who have been trained specifically in SCI. It is extremely important that SCI veterans meet with these doctors and nurses to ensure that they receive the best care possible. That being said, the VA in Nebraska has an SCI Primary Care Team which is located in Lincoln where the SCI Clinic is held. Therefore, the only SCI doctor in Nebraska is located 50+ miles away from the main acute care hospital. With the majority of the veteran population
 
in Nebraska living within a 50 mile radius of Omaha, it does not make sense to have this clinic based out of the Lincoln.
To my knowledge, Dr. Judge, who runs the SCI clinic in Lincoln, has tried for years without avail to schedule a couple days a month to come up to Omaha to meet with patients. He has not been successful because there is not any available space in Omaha to hold such a clinic, even for a day or two a month. This situation puts extreme limitations and hardships on PVA members, and has caused them to stop utilizing the SCI Clinic. It becomes very difficult for many of our members to travel to and from Lincoln to meet with the medical staff at the Clinic; therefore, they have simply stopped making the trip. Since Dr. Judge has not been approved to travel to Omaha to meet with patients, our members are forced to meet with doctors and nurses who are untrained in SCI and do not understand their specific disabilities. This can cause misdiagnosis of certain conditions, and could potentially be life-threatening.
One PVA member, Randy Squier of Glenwood, Iowa, said he had never even heard of an SCI Clinic in Lincoln. No one has ever told him about the SCI Clinic, or even talked to him about visiting a nearby SCI Center. He said, "I don't know what I'm missing out on." In response to whether or not the staff in Omaha (where he goes for a yearly checkup) understands his situation, Randy said, "I don't know that they fully understand SCI. Every time I go, I have to tell them my story all over again because it's always a different person." One staff person couldn't
believe Randy could move his arms because his chart had him classified as a quadriplegic. This lack of knowledge by staff that are treating SCI patients is deeply concerning and does not measure up to the quality of care that should be given in any VA hospital, let alone Nebraska.
The SCI Clinic doctor and nurse travel quarterly from Lincoln to Grand Island to meet with patients for a day. PVA member, Tamara Lawler from Kearney, expressed that the "SCI Clinic should be in Omaha" with the other clinics, since it is the main VA facility in the state. With the majority of veterans living in and around Omaha. it only makes sense to have this specialized clinic in Omaha as well. Ed Keuter, another PVA member who lives in Omaha, said "I think it would be a great thing for Omaha to have it" because many veterans are unable to use the Clinic since it is based in Lincoln. Mr. Keuter is one of these veterans. He used to travel to Lincoln to see Dr. Judge; however, he is no longer able to make that trip. He now uses the VA's community or home-based care. Mr. Keuter spoke very highly of this new program because it allows for a nurse to visit him in his house. He and his wife are extremely happy with this option as it alleviates the hardship of driving to the SCI Clinic. However, the nurses who visit him are not as knowledgeable in SCI because they have never been trained in that area.
None of the staff in Omaha has attended any SCI training, according to our National Service Officer, John Gogan. He says the staff may have SCI assigned as their specialty area, but it may be their 3rd or 4th priority. When asked if he thought he would be well-cared for at the Omaha hospital should he have to be admitted, Mr. Keuter said "it would make [him] nervous" to rely on the staff in Omaha to handle his care. He does not think the staff could adequately care for his specific needs relating to SCI because they have never had any formal training. When asked about the nurses and doctors in Omaha relating to SCI, Ms. Lawter said "They're horrible. They don't know anything about SCI. One nurse actually said to me 'Oh my god that's gross' when Ms. Lawter was explaining a method of care related to her injury. According to Mr. Gogan, if a
 
SCI patient is admitted at the Omaha hospital, the medical staff is resistant to calling Dr. Judge to see the patient. There seems to he a certain arrogance about these doctors that they feel they know how to handle SCI patients regardless of the fact that they have never been through SCI training.
Many of the concerns that I have outlined for you today could have been eliminated if there were space for a SCI Clinic to be housed in Omaha. Having trained medical professionals to treat spinal cord injured patients is essential in providing a higher standard of care, which the VA prides itself on. These concerns must be addressed. The level of care that many of our members are receiving is unacceptable. We believe part of the answer could he a new facility. If space becomes available in Omaha for the SCI Clinic to be relocated, Omaha will then have the ability to employ trained, skilled nurses and doctors to care for SCI patients. However, Omaha must increase the number of staff who are trained in SC1 to ensure that all SCI patients are cared for by knowledgeable, trained staff who can handle and best diagnose their unique situations.
Senator Johanns, Great Plains PVA would like to thank the Committee for looking into the situation with the Omaha VA. We all agree that the VA is the best source of care for our nation's veterans, especially when it comes to specialized services such as SCI. We look forward to working with the Committee to address these challenges and hope we can find a much needed solution. I would be happy to answer any questions that you might have.