Martha's Vineyard veterans angered by lack of local healthcare
Photo by Janet Hefler
A group of Island veterans and Dukes County officials told National American Legion representatives they are fed up with a lack of locally provided Veterans Administration (VA) healthcare.
Due to a lapsed contract between the VA and Martha's Vineyard Hospital (MVH), Island veterans with a VA health plan must now receive pre-approval through a clinic manager in Hyannis in order to obtain medical treatment and prescriptions on Martha's Vineyard. Depending on their service-connected disability rating, many veterans must travel to the Providence VA Medical Center (VAMC) or to the Hyannis Community-Based Outpatient Clinic (CBOC) for healthcare services.
"They're going to have to give us our medical clinic back, the way it was," Marine veteran Woodrow "Woody" Williams of Vineyard Haven said of the VA. "It's plain and simple. They've got to pay. These are earned benefits."
Although Providence VAMC public affairs officer Tom Antonaccio and MVH chief executive officer Tim Walsh were unable to attend the meeting, in follow-up phone conversations with The Times this week, both said they empathize with the Island veterans' plight and are working towards a new contract.
"We're still optimistic about early 2012," Mr. Antonaccio said on Monday this week. "Barring any unforeseen challenges, I think that in the early part of the new year we can have something in place. I can't commit to an exact month or an exact date."
Mr. Walsh affirmed his support for the veterans in a phone call Tuesday from Dallas, where he is attending a conference.
"I wish I could make it happen faster," he said. "I can tell you, if they [the VA] could present me a contract tomorrow, by tomorrow afternoon we could have a contract signed and ready. I really want to do this, because I admire the vets and everything they've done for us, and we'd like to at least make it so they can stay on-Island and get the basic service, at least."
National Legion reps visit
The team from American Legion headquarters in Washington, D.C., made a trip to American Legion Post #257 on November 3 to host a roundtable discussion about VA healthcare.
The three members of a task force in the Legion's Systems Worth Saving program visited the Providence VA Medical Center (VAMC) earlier in the day as part of an annual tour to assess the quality and timeliness of healthcare at VA medical centers nationwide.
National Field service representative Steven Henry said the national American Legion office became aware of the healthcare issues Island veterans face a few months ago. As a result, he and Todd White, past national vice-commander, and Jacob Gadd, deputy director for healthcare for the legion's National Veterans Affairs and Rehabilitation Commission, included a trip to Martha's Vineyard with their visit to Providence.
About 30 Island veterans attended the meeting, along with Dukes County Veterans agent Jo Ann Murphy, Dukes County manager Russell Smith, and commissioners Carlene Gatting, Thomas Hallahan, Tristan Israel, and Melinda Loberg.
"Our goals with this focus group are to understand your concerns and recommendations on how the VA can improve its delivery of care to veterans living in rural areas, as well as specific concerns veterans face with accessing VA healthcare on the Island," Mr. Henry said. "Your input and feedback will be included in our Systems Worth Saving report and shared with local and national VA leadership, as well as Congress."
Contract before and after
The Providence VAMC signed a contract effective December 18, 2000, that allowed MVH to provide a CBOC under the auspices of the VA. At that time, approximately 1,400 veterans lived on the Island. Now, there are about 350, according to Ms. Murphy. Not all of them are on a VA health plan; some are enrolled in private health insurance plans and some in MediCare.
The contract lapsed sometime around 2004, which went unrecognized by the VA until 2008, Mr. Henry said. Since then the Providence VAMC and MVH have been negotiating a new contract for veterans eligible for VA care.
"Three years ago, we started getting hellacious, thousands and thousands of dollars' worth of bills, from collection agencies on behalf of Martha's Vineyard Hospital," said Mr. Williams, who has a 100 percent service-connected permanent disability rating. After a lot of phone calls and letters, he found out the VA had closed the Vineyard clinic.
Mr. Williams kept up his letter-writing campaign to elected officials over the past year, and was instrumental in bringing the issue to the national American Legion's attention.
Under the current process, although Island veterans may continue to see their Island primary care physicians, they must contact the Hyannis CBOC for pre-approval. Consultations and diagnostic tests require a veteran's Island medical provider to submit a fee-basis request for approval through the chief of staff's office at the Providence VAMC.
Some veterans are eligible for a fee medical card, which can be used towards primary care at any Martha's Vineyard clinical treatment facility/clinician.
On the positive side, Ms. Murphy pointed out, "When the contract lapsed and they told everybody there would be no VA services here on Martha's Vineyard anymore, the VA is still honoring prescriptions from all these doctors that were contracted doctors."
Complaints heard round the table
The current cumbersome pre-approval and referral system that requires travel to Hyannis and Providence, plus the expense, time and difficulty involved, were the veterans' key complaints.
On their way to the meeting, the national Legion team experienced the Island veterans' travel challenges first-hand. They missed the 4 pm ferry and made it to the scheduled 5 pm meeting an hour late. And as they learned from several veterans' comments, they were lucky bad weather was not a factor.
"When it blows, you can't go, and if it looks like it's going to blow, you're not going to get back," VFW commander Ron Klein said. "Then you're going to have to spend the night over on the other side in a hotel room some place, and hotels aren't cheap over there.
"And then you talk about the price of gas, the ferry price, and everything else," he added. "It's quite the expense."
Veteran Nelson Smith of Edgartown also attested to time spent and difficulties he has in traveling to Hyannis for routine care. He said he questioned VA clinic officials about why he should make two separate trips to Hyannis for a blood test and physical. Although he was told he could get the blood test done on Martha's Vineyard, he subsequently received a bill for $600.
Ms. Murphy said it took more than a month for one elderly veteran to receive pre-approval to get a hearing test and was told to get it done in Hyannis or Providence.
"I've got guys that are 80 or 90 years old, and for them to get off the Island is really a hardship," she said. "They don't drive, so they have to have someone take them. There are places here where they could have a hearing test."
Veteran Stan Mercer of Chilmark asked the Legion team if there are other communities that have the same problems with VA healthcare as Martha's Vineyard.
"I went to Anchorage in April, and there were some veterans in Alaska that told me they had to fly to Washington State to get care," Mr. Gadd said.
The VA's policy is to provide care at a system facility or within the network first before considering other options such as fee-based or purchased care, he said.
"It's a national policy, but it doesn't look at local or specific concerns like those on Martha's Vineyard," he pointed out. "There have to be some exceptions, and I think we're finding that out."
Over the past year, the Dukes County commissioners and Mr. Smith lent their support to Ms. Murphy and took up the veterans' cause.
"What the Island is looking for, and I think I speak for everybody here, is not special services," Mr. Russell said. "What we really want is for the hospital that's here and the services they provide to be available to the veterans through the VA, not an expansion of services, and that question often comes up."
New contract challenges
As Mr. Antonaccio explained, many factors have changed since the first contract, including that MVH became an affiliate of the Massachusetts General Hospital and a member of Partners HealthCare in 2007.
"Our goal is to provide as many eligible vets on that Island with the primary care, the primary lab, the primary x-ray, to get the largest population we can support as possible, and to make sure that some of the weaknesses that were built into the old contract, now that we've gotten 10 years smarter, are addressed and identified and the right controls are in place up front, to make sure we don't have a relapse of this," he said.
Mr. Antonaccio said he could understand the Island veterans' frustration over it taking more than a year for the VA and MVH to iron out the contract. However, the VA's contract process has many steps and takes a lot of time, he said.
"We also want to make sure what we provide to the Vineyard veterans is the maximum of what we can provide up there, so this is not just giving them the bare minimum," Mr. Antonaccio said. "That's another reason it took a little bit longer, to make sure we fleshed everything out and figured exactly what it is we can provide and that we do in fact provide it."
In the meantime, Mr. Walsh said, "We're willing to do anything to get this settled; it's not a money issue to us at all. And I've said before, until we get a contract, if a vet needs to see a doctor on the Island, he or she should just come in and we'll work with the VA about whether or not we get paid, rather than put them through what they have to go through to try to get off-Island and all."