Spokane7
40°
August 13, 2009 in City
VA doctors protest ‘crisis’
Hospital adds to staff as psychiatrists complain patient caseloads threaten care
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.
They made their stand amid growing 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 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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George_Sands on August 13 at 6:01 a.m.
The real crisis is that most the people employed by VAMC are incompetent in the first place. Scarey to even set foot in the Death Hotel.
8258 on August 13 at 10:44 p.m.
The VA is doing the best they can with what they have. George, I have to deduce that because you are still alive you have not set foot in the VA hospital, ergo, your assessment of the personnel working there is as flawed as your view of the VA in general.
Of course, if you have hard evidence of the rampant incompetencies there, you should be able to share them. If not, I suggest you think twice, type once. It may keep you from looking like a bigoted fool.
Pat_Smith on August 14 at 5:06 a.m.
For decades our government has done a very good job of saving taxpayers’ money with inadequate Veterans Affairs funding.
President Obama recently made excellent leadership appointments to Veterans Affairs. Even with their proven leadership abilities, and impeccable credentials, both Secretary Eric Shinseki and Deputy Secretary W. Scott Gould are facing the cumulative inadequacies of decades past. The tiny fuse of overmedication that has kept this whole VA system operational for 30-some years now desperately needs to be replaced with major re-wiring.
This young generation of veterans should not have to experience the palliative treatment of health care most veterans using the VA have experienced for decades. It would be great to see the VA step into the 21st century as the leader in world-class health care.
But after decades of under-funding, this proposed new VA budget is not enough. For our new leadership to achieve its full potential along with world-class VA health care, a one-time, additional funding of $20 billion for a ‘21st century investment in VA healthcare’ is desperately needed.
The VA has many good doctors working there who will feel much relief to actually have the opportunity to treat their patients instead of just medicating their symptoms.
RPershing on November 28 at 9:02 a.m.
The individuals who signed this letter should all be fired. Our veterans deserve more than being told “we just aren’t going to treat you”.
3 months have passed since this article and yet even though several new psychiatrists have come onboard the incompentency of the ones who signed the letter is still rampant.
Our veterans are committing suicide in light of the inadequate and ineffective care in the behavioral health dept. Not hospitalizing them when in suicidal crisis, mismedication management.
The latest which was said to me at my last appt for complex PTSD and depression was that I simply needed to have positive thoughts,offered no medication for depression when requested since I was informed medication and placebo’s have the same effect on people.
Lastly in an attempt to discuss antidepressants one last time was told by one of the afformention psychiatrists if I needed information about antidepressants to just go “google it”.
George’s assessment of personal is actually right on the money.