Spokane7
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August 12, 2009 in News, City
Spokane VA will boost psychiatric staffing
Amid a revolt by its staff psychiatrists, the Spokane Veterans Affairs Medical Center has begun expanding a behavioral health department strained by an increasing number of veterans seeking help.
In a July 24 e-mail, all four of the department’s psychiatrists and one psychiatric nurse practitioner said they would refuse to accept new patients. They said they could not add to their caseloads, which they said in some cases were more than 70 percent above the VA standard.
“We have an ethical obligation to be available to our patients for timely appointments and communications,” the e-mail said. “We are no longer able to fulfill these obligations to our huge caseloads, let alone offer this to the dozen new patients coming into the clinic each week.”
The e-mail was electronically signed by Dr. William Brown, Dr. Minerva Arrienda, Dr. Adalina Carter and Dr. Jeffrey Schack and psychiatric nurse practitioner Patrice Griffin-Codd.
Their stand came amid increasing concern across the nation about the mental health of service members returning from Iraq and Afghanistan and after a spike in suicides last year among veterans in the Spokane area.
An investigation by the VA’s office of Medical Inspector found that from July 2007 through July 7, 2008, at least 22 Spokane-area veterans killed themselves, including 15 who had had contact with the Spokane VA Medical Center.
Dr. Gregory Winter, chief of behavioral health, said that he understood his colleagues’ position but that they were duty-bound to treat veterans.
“It was communicated to them that we don’t have the option of not seeing new patients,” Winter said Wednesday. No one has been permitted to refuse new patients.
However, he said, adjustments were made in psychiatrists’ schedules and time carved out time to see patients, some of whom have complained of waiting three months or more to spend a half-hour with a VA psychiatrist.
Medical center Director Sharon Helman said she has approved increasing the behavioral health staff to eight psychiatrists and a total of 80 employees, up from 50. Two new psychiatrists will arrive next month. In the meantime, the medical center has hired two psychiatrists on a temporary basis.
Helman said a miscommunication with the psychiatric staff led them to mistakenly believe there was a hiring freeze, a belief the doctors noted in their e-mail to Winter. But she said it is difficult to find psychiatric professionals when VA and nongovernment hospitals across the nation are recruiting them.
“We encourage staff to bring up concerns,” she said. “We have addressed those concerns.”
The psychiatrists wrote that the new job openings in behavioral health came at the insistence of Winter and the medical center’s former chief of staff, Dr. Nirmala Rozario.
“Due to the Herculean efforts of Drs. Winter and Rozario, we were able to again get approval for hiring,” the e-mail said. “But clearly there is a lack of appreciation for how the care of our veterans is suffering from the current state of affairs,” the e-mail said. “And this has led to a crisis.”
The psychiatrists said they are obligated “to practice within community standards and to refuse to enable any system that endeavors to circumvent this.”
The medical center also is seeking a new chief of staff to replace Rozario and a new chief of behavioral health to replace Winter, who said he will take a yearlong sabbatical.
One year ago, the medical center’s behavioral health staff included eight staff psychiatrists and a nurse practitioner as well as Winter, the e-mail said. One psychiatrist has been on medical leave.
Spokane VA behavioral health service provides inpatient care in an eight-bed unit at the medical center as well as outpatient services. The center and its clinics in Wenatchee and Coeur d’Alene serve 215,000 veterans in Eastern Washington, North Idaho and Western Montana.
Helman also said she is negotiating with private health care providers in places such as Republic, Wash., and Libby, Mont., to provide health services “where the veterans live.”
Winter said Spokane VA is anticipating another wave of patients with the return from Iraq this month of the Washington National Guard’s 81st Heavy Brigade Combat Team.
The psychiatrists’ e-mail said their caseloads in some cases exceed 850 patients. The VA standard, they said, is fewer than 500 patients per provider.
Winter said a review of his colleagues’ caseloads showed they were smaller than they stated but higher than the current VA average of about 650 patients.
VA records obtained by Veterans for Common Sense, a Washington, D.C.-based, veterans advocacy group, show that U.S. military operations in Iraq and Afghanistan have created nearly 1 million veterans.
More than 425,000 are being cared for at VA hospitals. Of these, nearly 194,000 are being treated for mental health conditions, including 115,000 diagnosed with post-traumatic stress disorder.
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jrsygrl on August 13 at 7:08 a.m.
Dear Kevin,
Given the fact that 15 Veterans committed suicide in a 12 month period (in Spokane alone), I though you might be interested in the fact that the VA has options. There are trained professionals who would love the opportunity to work with soldiers and their families. They only need to be given a chance. Here is legislation that has been in the works for over 3 years now and stalled somehwere in the bowels of the political process. What a shame that this delay is costing the lives of those who keep us safe and tearing families apart.
1) Alexandria, Va., December 11, 2006 - The American Mental Health Counselors Association (AMHCA) today applauded the passage of S. 3421, the Veterans Benefits, Healthcare, and Information Act,” legislation that, among other things, will allow the Department of Veterans’ Affairs to hire mental health counselors. S. 3421 now goes to President Bush to be signed into law.
The bill, which passed the House by voice vote and the Senate under unanimous consent, includes the AMHCA and American Counseling Association (ACA) supported provision to add mental health counselors to the list of appointed positions within the Veterans Healthcare Administration (VHA). .
Currently, the VA cannot hire mental health counselors at the same pay grade as clinical social workers, nor can mental health counselors apply for supervisory positions open to clinical social workers and others.
The provision will allow mental health counselors to be eligible for better paying jobs with a greater potential for promotion at the VA. Currently, licensed mental health counselors do not have a federal Office of Personnel Management (OPM) General Schedule (GS) occupational classification, which is necessary for a counselor to be employed by the U.S. Government.
The inclusion of licensed mental health counselors by the VA and the quality of services they provide will make it easier for those who served our nation and in need of mental health services to get the health care they need.”
2) Salazar Urges VA to Expedite Implementation of
Law Allowing Hiring of Counselors
Alexandria, Va., December 12, 2008 - U.S. Senator Ken Salazar (D-CO), on December 11, 2008, sent a letter to Department of Veterans Affairs (VA) Secretary James Peake, M.D., voicing his concerns about the delay in implementing provisions from the Veterans Benefits, Health Care, and Information Technology Act (P.L. 106-491), that allows the Department to hire licensed mental health counselors and licensed marriage and family therapists as authorized mental health providers.
The letter urged the VA to increase the number of qualified mental health specialists, specifically mental health counselors and marriage and family therapists, to improve access to quality care for veterans. Salazar, a strong supporter of the legislation when it passed in 2006, also pointed to the overall shortage of mental health providers in rural areas, which has also reduced access to mental health services for veterans.
This is one answer to the VA’s dilemna–-hire Mental Health Counselors/Marriage, Family Therapists who have a Master’s degree. Before attaining a license in most states, Mental Health Counselors and Marriage, Family Therapists, must intership for a total of 5 years under the supervison of a licensed professional and take a licensing exam. Like Social Workers, Mental Health Counselors can learn case management and can provide clients with community resources that will improve their quality of life not only for them but also for their families.
The need is great. There are many professional who are qualified and would love to help the men, and women who have served our country and their families. Why, I wonder is there such a delay in welcoming these professionals who care deeply into the VA ? Who pays the price?
website: http://www.amhca.org/news/releases/index.asp#121608
Jrsygrl