What's going to happen at the Hot Springs VA?

As he stated in an interview in 2008, BHHC director Peter Henry says things are changing. He maintains that perspective in 2010.

“We are undergoing changes,” Henry said. “But the facility in Hot Springs is certainly not closing.”

Henry said that missions for all three major campuses in the Black Hills – Fort Meade (Sturgis), Rapid City as well as Hot Springs – are being reviewed. “Things have not evolved at quite the pace that I was hoping, when we talked in 2008,” Henry said.

After the review is completed, Henry says that recommendations will be made to VA Headquarters.

“They will say ‘drop dead,’ or ‘that’s cool, we support you,’ or whatever they say; then we proceed from there,” he said.

“But,” he added, “the Rapid City clinic is going to expand, both in square footage and services offered.” Henry said that there are no plans to remove any medical services offered in Hot Springs.

“Not at all,” he said.

But to others at the Hot Springs VA – including Patrick Russell – the message for Hot Springs is there to see, if you look at what is being said.

“When I read between the lines of things like ‘Concern of quality of care for inpatients’ and couple that with the VA leasing an apartment building in Rapid City to house the Domiciliary patients,” Russell says, “I get concerned.”

Russell is the president of the local American Federation of Governmental Employees, overseeing the staff at the VA. He is employed by the VA and is a veteran as well. His primary concern would be for the employees at the VA, right?

“No,” he said quickly. “My primary concern, as is all of the medical treatment staff here, is for the healthcare of the veterans.” Russell said that his secondary concern is for the employees of the VA.

“Will there be fewer employees here?” Henry asks. “Yes, I believe that in five years, there will be fewer employees here and at Fort Meade. Fort Meade’s workload will be going to Rapid City, while Hot Springs’ reduction will be because that it will be treating fewer patients.

Russell said that he’s heard the discussion of why inpatient care is being talked about in Hot Springs. “Yes, ‘patient numbers are down, fewer veterans being treated,’” he said. “That’s the argument. But here’s a different view; maybe fewer patients are being treated, because so many are being diverted.”

Russell said a staff member told him that, on one occasion, six patients who sought treatment in Hot Springs, were diverted to Rapid City. “That could account for few patients being treated,” Russell said. He said staff reductions have led to having too few people available to treat patients. “The staff wants more patients,” Russell said. But if there aren’t enough to handle the job, care suffers.” Russell said he has heard it from many staff members.

And cost of care comes into play as well.

“At least one refused (to be diverted) and went home,” Russell said. “What if something happens and that veteran dies?” Russell asks. “What if it is determined that he was at the VA, there was nobody to care for him and he went home rather than take a trip to Rapid City?”

He said that those are concerns he hears from the employees. Concerns for patient care and secondarily, what happens to the employee if low staffing levels force care to suffer?

Russell said that when a patient in the VA system is diverted to Rapid City, he or she is put into the private healthcare sector, where costs can often run twice as much, although the bill still comes to the VA.

Henry says that patient numbers have been in decline for the past four years. “But any changes that are made in Rapid City are going to affect Fort Meade much more than Hot Springs,” he said. “We have the services here now, why would we change?”

Henry points out that the VA in Hot Springs is continuing renovations to buildings on the campus. “That should certainly be seen as a sign that nothing is closing,” he said. Although the buildings in Hot Springs and Sturgis are very old and the overhead costs are sizeable, Henry said, “That’s what we have to use. The buildings are here and they’re paid for.”

Henry said that he doesn’t see where an increased workload in Rapid City affects Hot Springs at all. “At one time,” Henry said, “There was a model being discussed at one time that placed a Super CBOC (Community Based Outreach Clinic) in Rapid,” Henry said. “But that idea has been shelved. Nothing that happens there affects here.”

Henry said that quality of care, cost of that care and access to care go into the decision-making process. “Approximately 35 to 40 percent of those enrolled in the VA live in and around Rapid City. That’s where the largest part of our population is located.”

Hot Springs serves approximately nine percent of the enrolled veterans, according to Henry. Hot Springs does serve a very wide area, as it draws patients from northwestern Nebraska and eastern Wyoming.

“When it comes to access of care, it’s not always best for everyone to have a large, centrally located clinic,” Russell said.

For example, he said that a veteran who lives near Ellsworth AFB travels for 15-20 minutes to get to the Rapid City clinic. “If he goes to Fort Meade, for something they can’t handle in Rapid, that’s what; 35 or 40 minutes?”

Russell agrees that putting a large facility in Rapid City will help that local veteran. “He’ll see his trip cut by 15 or 20 minutes. But what about the veteran who lives in Chadron, or on the reservation? Now he is told that he has to drive an extra two hours (if the Hot Springs VA was closed) for the care he currently gets. How does that benefit him? This question should be about patient care first and not about dollars. That’s a disservice to our veterans.”

Henry maintains that nothing can be determined until the review is completed and recommendations are made. “I would hope the review would be finished within the next month.” He could give no timetable as to when recommendations would be sent in, or when they would be acted upon.

“The assumption,” Henry said, “is that if Rapid City goes up, Hot Springs goes down. Patients who are seen in Hot Springs, who are seen for things such as lab work or radiology will not, in my mind, be channeled to Rapid City.”

For Russell, he is wary of what remains to be determined.

“Maybe I read too much between the lines,” he sighed. “Staff has shrunk and not been replaced and I hear ‘quality of inpatient care is a concern.’ If the Dom goes, and inpatient care goes, suddenly there is no need for a fire department, a police department, food service and other things.”

Russell points out that a similar scenario played out in Iowa last year. Knoxville, Iowa, had been the home of a VA Medical Center – off and on – for 90 years before its patients were moved to a new extended care building in Des Moines, 40 miles away. Knoxville now houses a community-based outpatient clinic.

Next week: What is the Dom, how has its focus changed, and how does it figure into the VA?

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