Veterans concerned over VA clinic changes
Thom Shagla is a veteran.
A United States Marine, he served in the Vietnam War for 13 months and took part in the duration of the Tet Offensive.
A half-century later, he lives with the medical repercussions of his service.
“I’ve got neuropathy in both legs caused by Agent Orange, I’ve had quadruple heart surgery and bypass,” Shagla says gathered with and socially distanced from his fellow veterans in the parking lot of Rolland Kidder’s office on Fluvanna Avenue. He then holds up two bags filled with prescription medicine bottles.
“These are my daily pills — all from the (Department of Veteran Affairs),” he says. “Every freaking day, I take this many pills.”
Shagla — like so many other local heroes who defended their country in combat and war — are nervous about a recent announcement that the Jamestown VA Outpatient Clinic on Third Street will be moved to a new facility on Hazeltine Avenue.
Despite the new facility being 3,000 square feet larger than the current one, the move will include a cut from two full-time equivalent health care providers — a full-time physician and a full-time nurse practitioner to 1.6 — a full-time physician and a part-time nurse practitioner.
Kidder, who represented Chautauqua County in the New York State Assembly from 1975 to 1982, organized and gathered the group of concerned veterans together, who are not sure why the cut in care is being made — especially in the middle of a pandemic.
“Why cut primary care especially at a time like this?” Kidder said. “The office has been growing, there have been some problems of turnover there if you read the background and stuff, but it’s been a lot more solid recently. If somebody gets sick as a veteran, it’s going to cost the federal government a lot more than if we keep primary care where it should be.”
Michael Swartz, executive director of the VA Western New York Healthcare System, explained in an email to The Post-Journal the full-time equivalency was determined based on how many veterans the clinic serves.
“Currently, the Jamestown VA clinic serves 1,500 veterans annually with the capacity to serve more veterans,” Swartz said, noting that VA panel guidelines mandate a full-time physician for 1,200 patients and a full-time nurse practitioner for 900 patients.
“Staffing is adjusted based on enrollment whether it increases or decreases,” he added, further explaining that this decision is “not a downsizing initiative.”
Because the clinic has served within a medical services contract model since its inception in 1995, Federal Acquisition Regulations govern the maximum length of medical services contracts and requests for new proposals are “competitively solicited” nationwide, Swartz noted. The previous contractor, Sterling Medical Associates, had operated the clinic for the last five years.
But, Greg Carlson, the county’s veterans services director since 2016, found several problems with this approach.
“Numbers are simply a snapshot in time,” he said. “So there is a possibility that when they started the contract process and they looked at the numbers, those numbers are two or three hundred patients different now than they were.”
Additionally, Carlson said he was frustrated that the clinic’s medical director, Dr. Rudy Mueller, who left his private practice to serve local veterans at the clinic, was not consulted in the decision.
“The number one problem with this entire thing is that the guy who has the title, the doctor, the medical doctor, Rudy Mueller, who is the clinic director, had zero input,” Carlson said. “None. They didn’t ask his opinion. He’s not the VA, he’s not the contractor, but he’s on the ground.”
Carlson said that since Mueller — who declined to comment for this story — arrived at the VA in 2018, enrollment numbers have gone up significantly.
“Not only did I have veterans wanting to enroll in VA healthcare for the first time so that they could keep Dr. Mueller, but I also had spouses of veterans asking if they could use the VA since their spouse was a veteran,” he said.
“The current doctor here is very well respected and has been in the community,” added Mike Lyons, who also was in attendance at Kidder’s office. “It’s amazing to me that he left private practice to go to the VA. He would tell you that he came because he wanted to help veterans. He’s terrific and every doctor around here will tell you that. Then all of a sudden to shake it up from the outside without having him participate is absolutely wrong and for the whole community, it is wrong.”
Swartz, however, claims that decision was made by the contractor.
“An award is made to the responsible offeror whose proposal, conforming to the solicitation, is fair and reasonable and has been determined to be the most advantageous to the government,” he said. “Sterling Medical Associates would be responsible for discussing contract specifics with their employees.”
Still, local veterans fear that cuts could continue to the Jamestown facility, forcing numbers to continue to diminish and forcing others to travel farther to receive care.
“That’s the only insurance I’ve got is through the VA,” Shagla said. “No one wants to go up to Buffalo. I can’t go up to Buffalo because I’m more susceptible than anybody of catching anything and it’s 150 miles round trip from Bemus Point. So what do they do? They go to the clinic in Warren, Pennsylvania, and once they go to the clinic in Warren, Pennsylvania, they get assigned to the VA in Erie, which is 40 miles away from our house. They’ve lost people here for several reasons: but one of them being that fact there.”
Bob Dickey is one of those veterans who has “bounced around,” due to several conditions that couldn’t be met here in Jamestown. When he finally found a VA physician in Dunkirk who could care for one condition in particular, the VA threatened to prevent him from using the Jamestown facility.
“Here I was left waiting to receive some reasonable care from the doctor out in Dunkirk, but was receiving nothing here in Jamestown,” he said. “Here they have this fantastic edifice with extra square footage. That’s politics for you, right? It looks good, but that’s about it. Just to show you the things that I’ve been through as far as bouncing around, the only thing that’s happening to me is deteriorating.”
Though the current decision cannot be reversed, Swartz noted, he did note that the contractor could allow staffing to be adjusted if enrollment grows. Carlson, then, believes he has a solution, issuing a call to action for local veterans in Chautauqua County.
“We have 11,000 veterans in Chautauqua County,” he said. “If you are a veteran, go do your patriotic duty and enroll in VA health care, even if you are just getting your physical once a year. That’s gonna increase number and if you increase the number you have no choice but to have two providers.”
He added, “There’s a misconception that if I’m a veteran and I’m relatively healthy and I go in (to the VA), that I am taking care away from someone else. Enrollment is based upon the eligible veteran pool who is enrolled, so you are actually taking it away from your fellow veterans by not enrolling in a benefit that you earned through your service because now we have 1.5 providers instead of two.”
Local veterans, meanwhile, who has appealed to state and federal representatives, is hopeful that this change can simply be held off for the time being.
“With 11,000 here and coronavirus affecting people who don’t have jobs, there may be greater demand just with coronavirus at a point in time,” said Dave Shepherd. “We have plenty of people who need the service who is eligible for it and this is just foolishness.”
Added Kidder, “One of the words that have come out of this current lexicon with this pandemic is the word ‘Pause.’ Maybe we need to pause what the VA is doing there and the staff over there to bring up the numbers.”