STATEMENT OF
TOM COOK, ASSISTANT COMMISSIONER
FIELD OPERATIONS AND CLAIMS
GEORGIA DEPARTMENT OF VETERANS SERVICE

BEFORE THE
U.S. SENATE COMMITTEE ON VETERANS’ AFFAIRS
FIELD HEARING
ON
VETERANS’ PERCEPTIONS OF COMMUNITY BASED OUTPATIENT CLINICS

C. PAUL SCOTT POLYTECHNICAL CENTER
OF ALTAMAHA TECHNICAL COLLEGE
JESUP, GEORGIA

AUGUST 26, 2009

Mr. Chairman and Members of the Committee:

Thank you for the opportunity to present the views of Commissioner Wheeler and Georgia Department of Veterans Service regarding veterans’ perceptions of Community Based Outpatient Clinics in Georgia.  Commissioner Wheeler sends his personal regrets in not being able to testify due to circumstances surrounding his wife’s health.  He wants you to know that he values the friendship and support of Senator Isakson; and he appreciates the interest and concern of the Senate Committee on Veterans’ Affairs regarding veterans having top notch and accessible health care available in the rural areas of Georgia, as well as in the more densely populated metropolitan areas of the state. 

Quality of Care

 Once we were notified of this hearing, we solicited comments from veterans and our department’s field office representatives throughout Georgia to prepare for the hearing.  Although time did not allow for investigation of complaints or confirmation of compliments, we believe that our testimony reflects the feelings of the majority of veterans who are being treated at our Community Based Outpatient Clinics (CBOC’s).

The overwhelming response has been that veterans are extremely pleased with the outstanding quality of care they receive in the CBOC’s.  The reputation of the CBOC’s among our veterans is exceptionally good.  Veterans generally report being treated with 
courtesy and respect by a great staff.  They speak highly of the screening done by the nurses.  They state that the physicians are very dedicated to their jobs, that they are very thorough in their examinations, and that they listen carefully to what they say.

 Veterans report that they believe the quality of care has improved at the Albany CBOC since the change from a private contract with Phoebe to a VA run clinic.  We believe this is a significant lesson learned in providing top notch VA health care for CBOC’s throughout the United States.

In some instances, veterans believe that personnel behind the sign in window are overly strict in the enforcement of “the line” to stand behind when another veteran is already at the window.  This is particularly true when veterans come to the clinic for the first time.  They may not know about “the line” and inadvertently cross over it.  In some cases, veterans describe being made to feel like a “criminal” and being somewhat rudely “ordered” to get behind the line.  Similarly, they state that in some cases the security guards are called out to ensure that they get behind “the line.”  Certainly, if a veteran is unruly, then calling security is appropriate.  However, calling security seems premature for innocent violations of policy regarding “the line” when no disruptive behavior is involved.

We know that the Privacy Act and HIPPA requirements impose a high level of sensitivity regarding access to veterans’ personal information.  We fully support protecting the privacy and identity of our veterans.  Perhaps some personnel are just being overly zealous in the enforcement of those requirements.

This is really the only area where we have received specific complaints regarding discourteous treatment.  We do not intend to chastise the VA by raising this issue because we really believe that the overall courtesy and treatment of our veterans at the CBOC’s is exceptionally good.  We raise the issue simply because we suspect it is one that merits being given some attention across the VA health care system in clinics and in medical centers.

We think this could be addressed by having more prominent signs posted at the clinics regarding the policy and by including written notice of the policy in correspondence that goes to the veterans.  We also think that training could be given to ensure that veterans who “cross the line” are treated in a courteous manner.

An additional observation along the same line of thought is that some veterans are frustrated by the protective glass window at some of the clinics.  They report feeling like they are “in prison talking through a bullet proof glass.”  So, perhaps the tension between the need for adequate security and the need for a “warm” reception needs to be evaluated.

Availability of Services

The feedback we have received from veterans indicates that they are very impressed with the steadily increasing availability and accessibility of outpatient treatment that is being offered through the CBOC’s in Georgia.  Many veterans are delighted that they no longer have to make the long drive to Atlanta, Dublin, Augusta, or Northern Florida for routine appointments in a VA Medical Center.

In most cases, veterans seem pleased that their appointments are scheduled in a timely manner.  Once they arrive for their appointments, they report being seen promptly.  In fact, some veterans report that they believe the CBOC’s are much better organized and run than the VA Medical Centers.

However, due to the steadily increasing number of veterans in need of treatment throughout Georgia, some of the CBOC’s (for example, Oakwood) have already reached capacity and are no longer accepting new patients.  Other clinics (for example, Columbus) are reported to be too small for the number of veterans served.  Some clinics (for example, Valdosta) are reported to be in need of another Medical Team because of the size of the provider’s panels.

These concerns highlight the need for VA to expand the size and staffing of existing clinics while opening additional clinics throughout Georgia.  We are pleased with the progress that has been made thus far, but we are very cognizant of the fact that we cannot remain stagnant.  We must continue to expand in order to provide the level of service to our veterans that they deserve.

We have received some complaints regarding the availability of specific treatment for women veterans.  Some in Smyrna state that they are being referred to non-VA providers.  Some women veterans have complained that pap smears and mammograms are not routinely provided in clinics. 

We have received many favorable comments regarding mental health treatment.  PTSD therapy has been overwhelming popular and has received many accolades.  The only drawback is the length of time for the appointments due to the popularity.

We received a number of complaints regarding being able to “get through” or “leave messages” on the telephone systems.  Similarly, some say that their messages are not answered and that their calls are not returned.  Also, we have been informed that the number for the Perry Clinic is not listed anywhere.  Consequently, our local office receives about 10 calls per day from veterans wanting the number for the clinic. 

We are told that the Athens Clinic does not show up on GPS or MapQuest.  Consequently, some veterans drive “all over creation” trying to find the clinic.  Perhaps sending veterans a strip map would be helpful. 

Co-location of State Veterans Service Offices within the CBOC’s enhances the level of services available for the veterans and facilitates one stop shopping for their health care and benefit concerns and entitlements.  We are presently co-located in the Athens, Savannah, St. Marys and Valdosta clinics.  We would like for future plans to include space for our department’s representatives as well.  We believe this is particularly important for Brunswick, Statesboro, Blairsville, Carrollton and Waycross.  We also would like for consideration of co-location to be given during planning for expansion of any of the other clinics, especially Newnan and Stockbridge. 

Placement of Clinics

We currently have 13 CBOC’s and two additional Outpatient Clinics open in Georgia.  We are aware of plans to open eight additional CBOC’s within the next couple of years.  Within the past year, new CBOC’s have opened in St. Mary’s, Perry and Stockbridge.  VA will open the Newnan CBOC in September of this year.

 We eagerly await the opening of CBOC’s in Brunswick, Hinesville and Statesboro.  VA has assured us that these clinics will open within the next year.  The addition of these clinics will greatly increase accessibility for veterans in Southeast Georgia.  Similarly, VA has assured us that CBOC’s will open in Blairsville, Carrollton and Milledgeville, which will greatly improve accessibility in other areas of Georgia.  We also understand that the CBOC in Carrollton will be a Mega, or Super, Clinic with up to 45K square feet of space and a number of specialty clinics, and that it will open within the next year.

 Additionally, we understand that VA is planning to open a CBOC in Waycross.  This location fills a great gap in distance for the veterans of Southeast Georgia.  It is vital that a clinic open in Waycross as soon as possible.

 These clinics are centrally and strategically located throughout Georgia.  It is critical that all of them open as planned for our veterans to have the accessible outpatient health care they deserve. 

 We also emphasize that Georgia is the largest state east of the Mississippi River in land area.  That fact, coupled with the steadily increasing veteran population in Georgia, highlights the need for additional clinics to be planned in the near future for other areas of the state.  We suggest Canton, Dalton, Tifton, LaGrange, Griffin, and Hazlehurst for consideration. 

Rebidding of Brunswick Contract

 We are interested in getting a CBOC in Brunswick as soon as possible.  In that regard, we are disappointed that the contract had to be rebid due to complaints from contractors.  Our understanding is that the latest estimates project that the clinic will be open by late September or early October 2009.  We have been told that the nursing staff has already been hired and that they are going through orientation training.  We have been informed that the physicians are currently going through the credentialing process, and that the remainder of the administrative staff position will be posted soon. 

Although the delay is inconvenient for the veterans in the area, it does not seem to us to be excessive.  We believe that VA is doing everything they can to open the clinic as soon as possible.

VA Hospital on West Side of Atlanta

Although the focus of this hearing is on CBOC’s, we believe that it is imperative that we emphasize the need for another VA Medical Center on the West or Southwest side of Atlanta.  The Atlanta VA Medical Center located in Decatur is faced with a continually growing number of patients and with a steadily increasing parking problem. 

On a daily basis, veterans contend with long lines of vehicles extending to the highway waiting for their turn to park at the Atlanta VA Medical Center.  Many veterans have to wait long periods of time before they are able to go to their appointment.  Once they get inside the hospital, they are faced with additional delays due to the ever increasing number of patients being treated at the hospital.

Even if we could solve the parking problem today, the patient care problem would still exist.  In fact, the number of patients will continue to increase due to the referrals that are made from the increasing number of CBOC’s in the Atlanta area, as well as due to the treatment of increasing numbers of OIF/OEF veterans.  The parking problem outside the hospital and the patient care problem inside the hospital combined are like trying to put a size twelve foot inside a size six shoe.

We need another VA hospital in Atlanta in order to provide timely and quality health care for the steadily increasing number of patients.  We believe the answer to this problem is the Southwest Atlanta Medical Center, which is available on the southwest side of Atlanta right now.  We are attaching information and photographs of this hospital for your perusal.  This facility has more than adequate parking and is ready made for patient care.  Once approved, VA will just need to negotiate the lease agreement and staff the hospital.

We understand that a request for another hospital is at the VA Central Office for a decision by Secretary Shenseki.  We request the active support of the Senate Committee on Veterans’ Affairs in getting this important request for an additional hospital in Atlanta approved by the VA as soon as possible.