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February 28, 2014
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Guest column: Why not contract for highly skilled ICU nurses and doctors at the VA?

In 2009, the Roseburg Veterans Affairs Medical Center’s intensive care unit was closed due to underutilization, not enough doctors, etc.

Before that, this facility began reducing the level of medical services, sending patients to the Portland VA hospital for more complex procedures, bringing the status of this facility from a Level II full-service hospital to a Level III giant clinic.

The VA commissioned a report from the firm of Booz, Allen and Hamilton. That report came out in 2010, recommending the continued closure of our ICU, citing the reasons listed above primarily.

Veterans’ meetings and public forums were packed with angry veterans wondering why. They were not buying the reasons behind the ICU closure. We began picketing the facility’s entrances. We received endorsements from all levels of political leadership. Roseburg’s City Council made a resolution demanding the ICU be reopened. We were also supported by the Douglas County commissioners, the state Legislature, Congressman Peter DeFazio and Senators Ron Wyden and Jeff Merkley.

Recently, the VA’s chief of staff and the director reiterated their position about keeping the ICU closed. It must be noted that these decisions were not made by them, but at the Veterans Integrated Service Networks (VISNs).

VISNs are regional VA areas across the country that make decisions on what to do with the federal VA funds. The VISNs are often at odds with one another, meaning that veterans get better care in some VISNs than in other VISNs. Ours is VISN 20, covering the states of Washington, Oregon, Idaho and Northern California. The previous head of VISN 20 made the decision to close the ICU. There used to be veterans’ councils working with VISN 20 to advise them on what was needed, but the previous VISN director disbanded them.

Let’s look at some of the reasons given for closing the ICU:

1. Usage of area medical facilities that are non-VA. I asked our chief of staff what I should do in a life-threatening situation (heart attack, car accident, etc.). He told me that our VA is NOT able to provide for such emergency treatment. Got that?

2. Another factor overlooked in all of this is the expenses incurred by the veterans who have to use non-VA hospitals for emergency treatment. Many veterans believe that the VA will reimburse them for such expenses, but the VA must be told about such non-VA treatment within 72 hours if payment is to be made. Even then, I hear of veterans being stuck with medical bills in the thousands of dollars. Also, if in such an emergency you tell the emergency medical technicians/paramedics giving you that ambulance ride that you do not want the VA treating you — even knowing they can’t — you are completely on your own. The VA will not reimburse you (I hope you have other insurance, as well). We had a guest speaker at our last Vietnam Veterans of America meeting who laid this all out to us. If by chance they do pay, it may take many months, maybe longer. So I think that VA reimbursement is at best uncertain.

3. Their next big reason for closing the ICU was that it wasn’t being used enough. The Roseburg VA’s chief of staff used this to raise safety concerns: ICUs with fewer patients are less safe than ICUs with more patients (?). Fewer services means fewer patients using the ICU, thus its closure. Another consideration might be this: The new dental facility on the VA campus is almost finished. It looks really neat on the outside, but I and others will never see the inside of it. A veteran must have a 100 percent service-connected disability rating to be eligible for dental care, thus fewer patients will be there on any given day. How is this for “underutilization?” The cost: millions, and again, allocated by VISN 20. The Roseburg facility couldn’t use these funds for anything else. Don’t get me wrong, veterans with full service-connected disabilities are fully entitled and deserving of all benefits, but shouldn’t all veterans be provided dental care as well?

4. Having surrounding medical facilities is a good thing. Why should a veteran with cancer have to go all the way to Portland, when one of the country’s finest nonprofit cancer centers is right here in Roseburg? The VA picks and chooses what treatments provided by non-VA care providers will be paid for by the VA or by the veteran.

5. The VA regards the ICU issue as “beating a dead horse” and the subject is closed. Shouldn’t the ICU be reopened? Not just for us, but for the thousands of future veterans.

Here are some examples of how this could work. They have for other hospitals and clinics.

1. Contract for ICU personnel. The contracting firm can ensure the doctors and nurses keep their skill levels up.

2. Have an agreement to exchange VA ICU personnel with Mercy Medical Center, on a rotation bases.

Robert O’Brien of Sutherlin is chairman of the board of Vietnam Veterans of America, Umpqua chapter 805. He also belongs to the Douglas County Veterans Forum and the Sutherlin Veterans of Foreign Wars post. He served in the Navy aboard the USS Enterprise in Vietnam’s Tonkin Gulf during 1972 and 1973. He can be reached at

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The News-Review Updated Feb 28, 2014 06:58PM Published Feb 28, 2014 01:00PM Copyright 2014 The News-Review. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.