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Shawn Vestal: Spokane veterans’ hospital struggles with specialty care
Wed., July 16, 2014
Doctor shortages in the optometry services have been the primary reason for longer-than-usual wait lists at Spokane’s Mann-Grandstaff VA Medical Center this summer, and none of the waits has involved urgent care, a top hospital official said Tuesday.
The hospital is acting quickly to move veterans off that list, aided in part by the hiring of an optometrist and in part by a new initiative that allows more patients to be seen by community providers if they can’t be scheduled quickly at the VA, said Nancy Benton, associate director of patient care.
Benton said that the departure of two optometrists earlier this year immediately created a backlog of waits for mostly routine eye exams.
“Our waiting list immediately inflated, despite the fact that we were immediately recruiting for a replacement,” she said. “We now have one (new) optometrist on, and one coming on.”
Benton said that in a large system like the Spokane hospital, which schedules more than 22,000 appointments at any given time, the wait times “wax and wane,” and can be affected by staff shortages in a particular department. That coincides with one of the difficulties officials here face in hiring specialists.
“We struggle all the time with some of the specialty care,” she said. “Quite frankly in our community here, some specialists are very difficult to find. We’ve been recruiting for a gastroenterologist for more than a year.”
Generally, though, Benton emphasized that the wait times for Spokane appearing in the new audits are a reflection of temporary problems already being addressed. She said there are no problems with access to urgent or emergency care in the hospital – there may be waits or backups, but those in crisis are seen to quickly.
The nationwide VA system has begun carefully tracking many wait-time measures, in the wake of the controversies that arose following allegations at the Phoenix VA that wait lists were being manipulated. Audits at the Spokane hospital on June 1 and June 15 showed that it had among the longest Electronic Waiting Lists – patients unable to be scheduled within 90 days – in the country, and particularly long lists of patients waiting more than 120 days.
On Tuesday, Benton provided some of the explanation for those figures, as well as some updated ones. The interview followed a column last week in which I criticized the VA administration of Linda Reynolds for not doing a better job of explaining the audit figures in recent weeks. To the administration’s credit, hospital officials responded this week with concrete details about the waits. Reynolds is currently out of town, and Benton is the acting director in her absence.
Between June 15 and today, the hospital has slashed its waiting lists, she said. The EWL was above 1,500 on June 1; it was 1,210 on June 15. As of Monday, according to hospital figures that have not yet been released in a national audit, the EWL was down to 303. That figure can change daily.
About 200 of those visits are for routine eye exams, she said, and another 50 are for vasectomies. Others involve waits for admission to specific programs within the hospital.
Furthermore, she said, the longest-of-the-longest waiting list – the EWL for those waiting for more than 120 days – has been cut from 441 on June 1, to 373 June 15, to 142 on July 1, she said. All of those are eye appointments, she said, emphasizing that the numbers change frequently based on patient needs and staffing levels.
Benton said that hospital officials are meeting daily and strategizing about ways to overcome any access problems. One national initiative that has followed the uproar over the Phoenix hospital – which led to criticisms and federal audits of systemwide problems involving wait times and the way they are recorded – is called the accelerated care initiative. In essence, it provides more money to outsource care to community providers when the VA can’t cover it.
A lot of veterans have contacted the newspaper in recent weeks to talk about their experiences. Some complain about delays or problems in their own care; some are harshly critical of administrators and the system of bonuses they see as corrupting.
Many, though, praise doctors and staffers and are happy with the quality of care, but see the system as fundamentally short of the resources it needs to provide veterans with the care they need. They criticize grandstanding politicians who vote against funding the VA, and then pound their fists about agency failures when the passing spotlight lands on the subject momentarily.
Here’s what one wrote to me this week: “I went to the Spokane VA Friday and again received excellent care. The short time I was there, their computers went down twice. Very frustrating for their staff doing their best to serve us. Since I’ve been traveling the past few years I have been to VA clinics in Tucson, Destin Fl. and Memphis, again with the same results, competent, friendly and professional care. And all of them were backed up for new enrollees. And of course short staffed.”
Benton said that some good has arisen from the recent focus on wait times and the way they are – or aren’t – tracked. She also said that it has been a difficult period for the people who work for the VA, due to news coverage – including this column – that has focused solely on the problems.
“It feels like in the media we’re painted as stupid, lazy, deceitful, gaming the system and just interested in our bonuses – and that is just so not the true story,” she said. “We consider ourselves public servants, and we take that very seriously.”