August 12, 2005

Senator Ken Salazar
Western Slope/I 70 Corridor Region
225 North 5th Street Suite 511
Grand Junction, CO 81501

Dear Senator Salazar:

You have requested my biography and testimony as it relates to your investigation of veterans' health care in rural communities. 

Biography

Shortly after graduating from high school in Brandon, Florida, I joined the Army.  I was stationed in Europe and then the Kuwait during the Persian Gulf War.  After serving three years, I returned home to Florida where I attended college and earned a Bachelors of Arts majoring in Interdisciplinary Natural Sciences with an Emphasis of Biology from the University of South Florida in 1998.  I received my Masters of Business Administration-Technology Management in 2002 from the University of Phoenix at their Tampa campus.  Gaining an interest in accounting from my MBA program, I returned to the University of South Florida for enough accounting to earn me the ability to sit for the Certified Public Accountant examination, which I passed in 2003. 

I currently work for the National Credit Union Administration (NCUA) as a Credit Union Examiner and examine credit unions in Colorado and Wyoming. 

Testimony

I was diagnosed with a service-connected illness called Scleroderma shortly after separating from the Army.  From 1992 until 2000, I used the VA hospital in Tampa and was approved for fee-basis care as Scleroderma is an illness that is best followed by one Rheumatologist.  I was concerned in Tampa that I was being seen by a different specialist on most visits.  The Tampa VA is a teaching hospital associated with the University of South Florida Medical School and the large number of interns, residents, and fellows made it difficult to maintain continuity of care.  Therefore, I requested and was granted the ability to consult a Tampa Rheumatologist under the fee basis program so that I would see the same doctor each visit. 

In 2002, I moved to Grand Junction.  A large part of my decision to move to Grand Junction included my access to care and the fact that there was a large VA hospital here.  It was quite a disappointment to learn the VA hospital has not contracted with a Rheumatologist in Grand Junction to see patients.  Instead, they expect patients to travel to Denver or Salt Lake City for Rheumatology care.  I have traveled to Denver for care but in 2004 (or possibly 2003), I requested fee basis visits to a Rheumatologist here in Grand Junction.  I was denied though Dr. Clark requested it from the Chief of Staff.  I appealed this decision through the patient advocate and was denied again.  I was told they denied the request because there were no long-term Rheumatologists in Grand Junction and they did not want my care to suffer. 

Scleroderma is a serious illness that should be tracked by a Rheumatologist.  However, as a full-time employee, it is very difficult for me to travel to Denver.  In Tampa, I was told I should be seen quarterly to track my illness, but I have seen a Rheumatologist one to two times since I moved to Grand Junction solely due to the hardship of traveling to Denver.  I do not feel it is appropriate to take a full day off from work quarterly for 10 hours worth of travel and the time it takes to wait and see the doctor in Denver. 

In addition to Scleroderma, I have had three serious cancers that required treatment including two moles with Melanoma and one with Basil Cell Carcinoma.  I was lucky that these were caught early after seeing a Dermatologist in Tampa as part of the VA hospital fee-basis program.  This Dermatologist noted the moles and suggested they were removed. 

Unfortunately, the VA hospital in Grand Junction does not have a Dermatologist on staff.  I am sure the doctors at the Grand Junction VA hospital are very competent at their specialty and I appreciate all the care I get from Dr Clark, who I respect and appreciate very much.  However, the Dermatologist in Tampa practicing in his specialty noted the changes in my moles and likely has saved my life by removing them.   I am not positive a General Practitioner/Internist is as adept at noting these kinds of skin changes as a board certified Dermatologist would be as this is not the specialty of a General Practitioner/Internist. 

Note:  In preparation for my testimony on August 12, 2005, I called the Patient Advocate on at the Grand Junction VA hospital to ensure my testimony would be correct.  He brought this to the attention of the Chief of Staff and informed me in a call later that my appeal has now been approved and I would be granted the ability to see a Rheumatologist as part of the fee basis program.  After this call, I requested a referral from Dr. Clark to see a fee-basis Dermatologist and this request is pending currently. 

Summary

I feel my care at the VA hospital in Grand Junction is very good in certain areas and seriously lacking in others.  I have wonderful access to my Primary Care Physician, Dr. Clark.  Her nurse has always called me back within twenty-four hours for non-emergencies (usually much faster) and when I have had appointments, the care I have received is very thorough.  Dr. Clark is and will continue to be my primary care physician even though I will have access to a Rheumatologist on a fee-basis case in the future.  I would not want it any other way as I have all the respect in the world for the care I receive from Dr Clark. 

However, the lack of an onsite Rheumatologist and Dermatologist is a serious weakness in my health care.  This weakness could be mitigated by using a fee-basis program to ensure all veterans get the care they need or by hiring these specialists for monthly clinics.  I was paid approximately $50 for travel to and from Denver the last time I drove there, and this is just slightly less than what these specialists get paid for ongoing care consultations, if my memory from Tampa is correct. 

If you have any questions or need any further information, please contact me at 970-250-2306. 

 Sincerely,

  Paula Rothman