Veteran’s Choice Program Failed To Target Wait Times Even In Southern California
Friday, January 27, 2017
Photo by Kris Arciaga
Steve Walsh, KPBS General Assignment Reporter
Congress passed the Veterans Choice law in 2014 to lower wait times for patients seeking care from the Veterans Health Administration. A year-long investigation by KPBS, NPR and other public media outlets revealed that the law often failed to work as intended.
Veterans Choice was designed for veterans like Charlie Grijalva, who was diagnosed with post-traumatic stress disorder (PTSD) when he was still in the army. His case illustrates the toll that VA staffing shortages and delays in treatment can have on vulnerable veterans.
Back in 2014, Grijalva lived with his wife, Gloria, in Imperial Valley, about two hours from the VA hospital in San Diego.
After spending 18 months deployed in Afghanistan and a year in Iraq, Charlie Grijalva started having suicidal thoughts.
The VA tried to reach out to him. Early in 2014, his wife said, Grijalva’s health-care providers at the VA had put him on prescription medication that seemed to alleviate his symptoms. By summer, though, his psychiatrist had left the VA and Grijalva was transferred to a nurse practitioner. He missed an appointment in September 2014, according to records provided by the VA, but the new provider agreed to refill his prescription over the phone.
Medication ran out
Because San Diego’s wait times were so long, under the new Veterans Choice program, Grijalva qualified to see a private doctor outside the VA system. Grijalva had an initial consultation with a private psychiatrist near his home. But then in December 2014, his medication ran out.
Grijalva had a young family and a new baby on the way. His wife said he insisted on giving his kids a magical Christmas.
“He said, you know, ‘I want to do what I did as a kid,’ ” she said. “Play some Christmas music, have the kids decorate the tree, drink hot chocolate. . . Even though he was feeling the way he was, he wanted to have that kind of Christmas for his kids.”
But it wasn’t to be. A few days before Christmas, his wife found his body. He had hanged himself a few hours after he had texted her “I love you.”
“He has told me when he was at his lowest that — ‘Didn’t want my kids to see me like this . . . I don’t want to put my kids through this,’ ” she said.
One last appointment
His VA records show Grijalva went to one last appointment at the VA in San Diego in December. A refill of his medication arrived just before his death. Around the time of his death, the VA was just beginning to implement the Veterans Choice and Accountability Act. Congress passed the law in August 2014 specifically to give the VA system the resources to cut down on the long wait times at VA hospitals around the country. The long waits which had made headlines that summer.
Part of the law was designed to allow veterans to go outside the VA system to see a private doctor, providing the veteran had to wait more than 30 days for care or lived more than 45 miles from a VA facility. Another part of the law included more than $2.5 billion to tackle wait times by allowing the VA to add staff at its hospitals.
“Our goal is to get them the health professionals that they need,” said David Shulkin, undersecretary of health at the Veterans Administration. “So that the choice money. We wanted everybody to go out and execute on it. And to use that money as quickly as possible because we have a sense of crisis."
Trump’s pick to become VA secretary
Shulkin joined the VA after Veterans Choice passed. He was there as the last of the money was being allocated to hospitals around the country. The White House recently announced that Shulkin is President Donald Trump’s pick to become the new VA secretary, making him one of the highest-profile holdovers from the Obama administration.
The KPBS and NPR investigation of VA facilities in Southern California found no discernible pattern in how the VA actually spent the money earmarked for hiring. The VA says 5 percent of $2.5 billion was held so they could give priority to 33 VA hospital systems around the country. In fact, every Southern California VA medical center was given priority except San Diego’s.
Review Of Implementation Of The Veterans Choice Program
Report shows that veterans faced barriers accessing medical care through Choice during its first 11 months of implementation.
To view PDF files, download Acrobat Reader.
Yet in 2014, if a veteran needed to see a mental health specialist, San Diego had one of the longest wait times in the country. San Diego originally asked for 40 mental health providers to tackle its wait times. It was allowed to hire 24 people the first year.
When San Diego made its funding request the second year, the money was all gone, said Dr. Niloofar Afari, the acting chief of staff for Mental Health.
“At that point, we heard that the funding that had been received by the facility was not enough to cover both years. It was really only for FY ’15,” she said.
Mental health professionals
So San Diego didn't get everything it asked for, at least when it came to mental health professionals. Overall, among the four VA hospitals in Southern California, San Diego received the second most staff positions under the Veterans Choice law — 144 people. On the other hand, Los Angeles received the fewest new positions — 108 — despite being one of the largest VA hospital systems in the country and having significant issues with wait times.
Loma Linda, the smallest of the four VA centers in Southern California, received the most staff positions — 215. But two years later, the number of veterans waiting more than 30 days for an appointment at Loma Linda has actually increased in all three major categories tracked by the VA.
This scenario is repeated around the country. KPBS and its partners at NPR found nearly every VA in the country received at least some money from the Veterans Choice program to hire staff, whether or not patients faced longer-than-average wait times in 2014.
Wait times started to come down
In the last several months, the wait times to see a mental health provider in San Diego have finally started to come down, although more veterans are waiting longer than 30 days to see a mental health provider in San Diego than when the law passed in 2014.
Overall, the time it takes a veteran to see a provider has not come down nationwide. Shulkin attributes some of the lack of progress to an overall spike in the number of veterans who have sought VA care over the past two years.
With Shulkin now scheduled to be elevated to VA Secretary, the experience with the Veterans Choice law illustrates just how difficult it can be to tackle a problem like wait times in a system as vast as the VA.
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