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The Spokesman-Review Newspaper
Spokane, Washington  Est. May 19, 1883

VA contract in Ferry County expires

Lack of high-level doctors, expired contract with the local health district, leave vets in Ferry County facing even more obstacles to reliable health care services

Will Rumburg, a Korean and Vietnam war veteran, learns about changes to his health care coverage on Thursday at Republic Elementary School in Republic, Wash. Veterans Affairs didn’t renew its contract with the Ferry County Public Hospital District. (Tyler Tjomsland)

The help wanted ad has gone unanswered for three years: Board-certified doctor to work and live in remote northeast Washington, only accessible by high mountain passes or ferry. Frontier hospital with high veteran and elderly population located in paradise of national forests and lakes. Good fishing.

This lack of a high-level physician left Ferry County veterans reeling this month when Veterans Affairs failed to renew a five-year contract with the county’s public hospital district. The contract allowed eligible veterans to get health care services in Republic or Curlew instead of traveling to Tonasket, Colville, Spokane or Wenatchee.

“I can’t afford to go anywhere else,” said Daniel Hay, a 58-year-old disabled U.S. Air Force veteran. “If I can’t do it here, I won’t be going anywhere.”

Veterans make up about 12 percent of Ferry County’s population, or 891 out of 7,667 residents in 2013, according to the U.S. Census. The county’s population also is older, with 21.4 percent older than 65.

The VA contract required Ferry County to staff a board-certified doctor, which is a problematic requirement not just in northeastern Washington but in rural areas across the country. The Mann-Grandstaff VA Medical Center, based in Spokane and serving 64,000 square miles including Republic, has similar struggles attracting and retaining certified doctors. That’s why the center stopped accepting ambulances in January and is now considered an urgent care center instead of a 24-hour emergency department.

The canceled contract that ends today doesn’t mean veterans can’t get care in Ferry County or at the county’s 25-bed hospital in Republic. In simple terms, it is just a shift of where the money comes from to pay for the services and how the veterans make appointments.

Now veterans will have to use the Veterans Choice Program to see local providers who don’t work for the VA. Veterans in Ferry County automatically are eligible for Choice because they live more than 40 miles from a VA medical center. Congress passed this requirement in August 2014 in response to a record-keeping scandal in which the VA falsified patient wait times. The idea was to get medical services for veterans more quickly and closer to home.

If veterans don’t want to use Choice, which is non-VA health care, they can go to VA clinics in Tonasket, Colville, Spokane or Wenatchee. Or veterans can use both. For example, they could get annual exams and prescriptions from the VA clinics and use Choice to see local doctors when necessary.

Hay and about 50 other Ferry County veterans and their families attended a forum Thursday at the Republic Elementary School with Ron Johnson, Mann-Grandstaff’s interim medical center director. The panel also included Brenda Parnell, the CEO of the Ferry County Public Hospital District, VA specialists and a representative from TriWest Health Care Alliance.

The questions reflected confusion, fear, distrust and frustration about frequent VA changes – changes that some veterans said put more burden and penalty on them. The medical staff of the county hospital district also asked lots of questions, trying to figure out how to serve their veteran patients in this new reality.

“This is really scary,” Parnell said, disappointed in the canceled contract but vowing that she and the staff will help veterans navigate the changes and get service as close to home as possible. “We don’t want to delay care.”

Parnell added local providers have been seeing veteran patients for years and have a strong connection, which means a better continuity of care and trust.

Johnson agreed.

“We encourage you to access care locally as much as you can,” he said. “It’s more convenient.”

Currently the county public health district only schedules veteran appointments on Wednesdays. Under Choice, veterans can get appointments any day the clinics are open. A downfall is that veterans have to call the Choice Program to get preauthorization before every appointment or schedule change. They can’t call the local provider directly.

Under the contract, when a Ferry County veteran received care from a local provider, the federal VA picked up the bill with the money coming from its general budget, which Johnson said has a $2.7 billion deficit. That’s why Congress wants veterans to use the Choice program, which is funded separately and has available money. When Choice was established last year, Congress set a $10 billion budget, which Johnson said has at least $8 billion left in it.

Some of the veterans complained about long waits through Choice, just like when trying to get an appointment at a VA clinic. Then there’s the time required to travel outside the county to see specialists. Johnson agreed there are still kinks in the new program.

One woman said her veteran husband recently had pneumonia and the local provider ordered an X-ray. It took five days to get pre-approval. Because the man couldn’t wait that long, he had to pay for it through Medicare.

“You sure make us jump through a lot of hoops,” the woman said.

Besides a need for physicians, Ferry County hospital district has also gone through several CEOs in less than a decade. Yet Parnell isn’t intimidated by the demands of a rural hospital. She has worked in Barrow, Alaska, the largest town on the North Slope located above the Arctic Circle. The only way in and out was by bush planes that used ice as a runway.

“I’m bringing a lot of what I’ve learned over the years about rural medicine,” she said, adding that Ferry County needs more telemedicine. In Alaska, she witnessed a telebirth.

Yet she acknowledges that is a steep learning curve, especially with an “old school” population where people aren’t too comfortable using cellphones much less talking to a television screen or robot.

The hospital district only has two doctors, neither board-certified, and five midlevel providers – physician assistants and nurse practitioners. Parnell said that’s about the same level of staffing as what comes to town on the VA Medical Mobile bus.

Attracting a high-level doctor to the woods along the Canadian border is difficult, yet not impossible.

“It takes a certain personality,” she said.

Erica Curless wrote this article with support from the Journalists in Aging Fellows Program of the Gerontological Society of America and New America Media, sponsored by AARP.