The Roseburg Veterans Affairs Medical Center emergency room may soon be downgraded to an urgent care.

Director Keith Allen said in an interview this week he’s requested approval for the change because he believes it’s safer for veterans to obtain emergency care at other hospitals that provide full services. If approved, the switch could be made as early as December.

Allen is the permanent replacement for Doug Paxton, who left the VA in February 2018 and was replaced by two interim directors, first Dave Whitmer and then Kevin Forrest. Allen has been at the Roseburg VA since March 17 of this year, but this was his first interview with The News-Review.

While he spoke about his love for the mild, four-season climate of the Pacific Northwest and his desire to make this his final job before retirement, he also didn’t shy away from the much more challenging topic of the ER’s future.

The ER has been a flashpoint for tension between veterans and the VA senior leadership for many years, starting with the move to close the VA’s intensive care unit in 2009. The VA said the ICU was closed because it did not receive enough use. Veterans disputed that and fought for years to have it reopened. Some asserted that it was the VA’s first move in a longer-term plan to close the ER.

Allen wasn’t in Roseburg during those years but said he doesn’t think the VA was planning all along to close the ER.

“I think they tried the best they could to keep the emergency department,” he said.

But they weren’t able to retain providers or specialty services or even the support services necessary to maintain a quality emergency department, he said.

“We’re not providing the service. We’re an emergency department on the name of the building only and there’s very little we can do inside other than safeguard them and then send them off to Sacred Heart or Mercy or another facility that then does have the proper care for them,” he said.

Allen said he’d rather have the veteran needing emergency care go straight to a full-service ER. When veterans stop first at the VA, there’s a delay before they receive the emergency care they need. That increases the veteran’s risk and the VA’s liability, he said.

Allen also said 89% of the veteran visits to the VA’s Emergency Department are actually for problems that aren’t really emergencies, but rather urgent care. He said while emergency care is available for veterans in the community at Mercy, there currently is no private urgent care signed up to the VA’s network.

Urgent care, he said, is what the veterans need, and he wants to focus on improving that care.

“I mean when you look at it, we’re really providing urgent care right now. We call it an emergency department, but it’s urgent care,” he said.

During his time here in 2018, Whitmer had also considered downgrading the ER to an urgent care, but rejected the plan. In part that was due to plans to make the VA campus the site of a 150-bed Oregon State Veterans’ home, which would increase the demand for emergency services.

That’s also a concern for veteran Dan Loomis, who said he’s hoping that gets factored into the current decision on whether the VA downgrades its emergency department. Loomis also said such a downgrade would leave Roseburg with a single emergency room — the one at Mercy — and he worries it could become overwhelmed.

“As long as the VA shows that the emergency room at Mercy is sufficient to handle all the county’s emergencies and not have the three and four hour wait time for emergency care for the veterans, as long as there’s some form of agreement and understanding between the VA and Mercy that Mercy is going to increase their capacity to handle emergencies, then I think that would be a good solution,” he said.

However, he said the better solution would be to restore the VA’s emergency department to one that is fully capable of handling veterans’ emergencies.

Douglas County Veterans Forum President Larry Hill said he thinks the decision makes sense, given the current status of the emergency department.

“To me, it’ll be OK. In the long run, this too shall pass and it’ll work out well,” Hill said.

Hill said his main concern is that billing for trips to Mercy will continue to be an issue, with veterans sometimes receiving large bills in the mail because the VA hasn’t paid them in a timely fashion or has rejected the claim.

Hill said he thinks most veterans will accept the downgrade at this point, but he predicted 10% to 20% would not — at least not without a lot of explanation and hand-holding. And those who hate it will soon come out of the woodwork, he said.

“He just has to be prepared for it. It’s going to be a rough ride, but it’ll get done,” Hill said of the director’s task ahead.

Allen said he knows the decision will be controversial.

“I’ll be open and honest with ‘em and I’ll take my shots. That comes with the territory. That’s what comes from sitting in this seat. I knew that when I took this. But I want to do the right thing,” he said.

An Army infantry veteran who served in the early 1980s, Allen joined the VA in 2006, but has had a long career working for the federal government. He was a truck driver for the U.S. Postal Service but said that job was taking a physical toll on him and he knew he couldn’t continue it until he was 65. So at 40, he decided to attend college.

After earning his bachelor’s degree in electrical engineering, Allen took a job as a mechanic and then obtained a position as a project engineer at the Tampa, Florida VA. He moved his way up the ladder after that, becoming project section chief, chief of maintenance and operations, acting assistant chief and then acting chief of facilities. In 2013 he moved to Seattle where he joined the Puget Sound VA as chief engineer.

Allen obtained a master’s in national strategic resources at the National Defense University in Washington, D.C., a degree that put him on the executive track. After that, he worked his way up to deputy director at Puget Sound. While serving there, he did a brief interim stint at the Roseburg VA in 2017, lasting about six weeks.

He then became the interim director for the Walla Walla, Washington VA for 10 months before being appointed director in Roseburg. He said he likes the area for its four seasons with mild winters and non-humid summers. He loves mountains, lakes, parks and camping.

He also said he met many staff members during his short stint here in 2017 who really want to provide great service to veterans and felt he could work well with them. His primary goal is to provide what he calls “a center of excellence in healthcare for the veterans.”

He also said he wants to ensure that whistleblowers aren’t retaliated against, and that staff members feel psychologically safe and are willing to point out issues that impact the VA’s performance and patient care.

Allen said since he first entered VA leadership, he has striven to become a facility director and now he’s achieved that goal. So he doesn’t intend to use the Roseburg VA as a stepping stone to further advancement in another city.

“I’m where I want to be, so unless someone says, ‘Look Mr. Allen, we really need you to go here because that’s what the veterans need,’ I have no plans on leaving. This should be my last duty station,” he said.

Reporter Carisa Cegavske can be reached at ccegavske@nrtoday.com or 541-957-4213.

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Senior Reporter

Carisa Cegavske is the senior reporter for The News-Review. She can be reached at ccegavske@nrtoday.com or 541-957-4213. Follow her on Twitter @carisa_cegavske

(12) comments

CitizenJoe

This is the right decision. I get my care at the VA, and I'm a retired physician; no thinking person wants to go to a low-load ER, or have a CABG by a surgeon and team that only do a few. The patient load is insufficient to maintain skill sets. I do have reservations about shunting patients to a hospital system that routinely ignores patients' advanced directives, medical powers of attorney, and women's autonomy.

chicagomike

At the Roseburg town hall last night some of the veterans that attended voiced their concerns about eliminating the emergency room services. I shared one of my experiences with being in the ER when it was standing room only and asked If the VA had discussed with Mercy, their ability to accept the Veterans in the event the ER was shut down. The director responded that he would be having that discussion with Mercy this week. I asked if he had already made the request to shut down the ER and Mr. Allen replied he had not and he was still researching this idea. I pointed out that Director Whitmer before him had initially proposed shutting down the ER at night but backed off the proposal citing the building of a 130 bed Veterans home at Roseburg as one of the reasons for backing off his proposal at that time. I asked the director if he had factored this into his decision to request to shut down the ER. The Director responded he was unsure if the state, (ODVA) had any requirements for ER services in connection with the building of this home and that the Roseburg VA was committed to deeding the land and support the building of this veterans home but that ODVA had to come up with the money. With regards to the Roseburg VA's problem of not being able to hire enough providers to keep the ER open, I pointed out that Mercy doesn't seem to have a problem providing enough staff to keep their ER open. The director responded that Mercy can afford to pay their staff more money than what the VA can pay their staff. It seems that this idea of shutting down the ER has not been well researched before being proposed and efforts to shut the ER down have been underway since 2009. I would encourage the Director when he discusses with Mercy their ER patient load, and whether or not they can guarantee ER services to Veterans, to also find out what Mercy is doing right with being able to attract and retain Medical personnel. Their are many more questions that need to be asked and answered before even making the request to shut down the Roseburg VA ER. The Director did state the Douglas County Veterans Forum (DCVF) was involved in the discussion. Thats another problem. The DCVF is not the voice of all Roseburg VA Veterans. The DCVF isn't what it used to be. I did not see Larry Hill at last nights town hall meeting.

dlindsey

They can't keep an ER open because they don't staff it and provide the services of a real ER. I once asked about bringing suicidal vet's in for POH (Peace Officer Holds), and got the good ol' "Oh no, we don't do that here." All of the local vets know that there's only one doc on call and a couple nurses in there, so they don't even bother! All of these services would be used if they were actually being PROVIDED. You can't just buy all the equipment, not hire people to man it, not provide treatment arguably the most deadly problem plaguing your SOLE source of clientele. At this point it seems that the ER was only around for the convenience of everyone filing the same paperwork.

Rise722

Why doesn't the Armed Services start stationing doctors/nurses at the VA facilities? That way, there would be the necessary staff to keep ER's open. I always thought that a soldier went where their orders stated.....it's way past time to tell the ones in the medical field that they will be going to places like Roseburg.

chicagomike

Here we go again! Director Allen is in lockstep with previous directors to further reduce critical medical services to Veterans to what he claims is the solution to the problems caused by the VA previously reducing critical medical services to Veterans. The October 2011 ODVA article titled "Veterans Forum Saves Roseburg VA Hospital" has been copied and pasted in part below. Senators Merkley and Wyden and Congressman DeFazio joined the fight at that time to keep the ER open. "VA: Roseburg Will Remain a Full Capacity Level II Hospital By Nicole Hoeft RosebuRg — Whoever said the little guy never comes out on top obviously never met Jim Little and the 11 other members of the Douglas County Veteran Forum (DCVF). Their group has made it their mission to “save our Roseburg VA Hospital” and to draw attention to the recommendations made by the Maryland- based consulting firm ‘Booz/Allen/Hamilton’ to downgrade the Roseburg hospital’s services. About a year ago, veterans learned that the Roseburg VA Health Care system (VA RHCs) planned to eliminate its emergency Room and downsize the Intensive Care Unit (ICU) to a Telemetry unit. The plan was to send veterans needing these services to local hospitals, such as Mercy Medical in Roseburg and sacred Heart in eugene. After learning of the plans, the Douglas County group quickly jumped into action. Joining the veterans in their opposition were u.s. senators Ron Wyden and Jeff Merkley, and u.s. Rep. Peter DeFazio. Their efforts worked. on July 26, after careful consideration and input from veterans, lawmakers and the community, the u.s. Department of Veterans Affairs announced that VA RHCs will remain open and operational, retaining the current level of medical and surgical services. This includes a 24/7 Emergency Department," . . . This is coming from VISN20 not Mr. Allen or Whitmer who claimed responsibility for this bad idea previous to him. What will our Senators and Congressman do this time? Larry Hill, you do not speak for all Roseburg VA Veterans.

Marinewife1

After the rude treatment at the Mercy ER, my veteran husband was released to go home with a diagnosis of ‘stable angina’ - even though he was popping nitro like candy. A couple days later, I skipped calling an ambulance and rushed him to River Bend. My apologies to anyone else on the highway that morning but I knew he had to get to a good hospital fast. They quickly assessed him and he underwent open heart surgery. That so-called stable angina was anything but stable. One of the bypasses was on the main descending artery nicknamed ‘The Widow Maker’. Thankfully we have our own health insurance and can go where we want when we think it’s in our best interest. Without the VA ER to triage and assess cases ambulances will take all veterans directly to Mercy ER for rude and questionable care.

Marinewife1

I need to follow through with the outcome of that ER visit to Mercy. Mercy ER released my husband and sent him home with a diagnosis of ‘stable angina’ even though he was popping nitro like candy. A couple days later I skipped the ambulance and rushed him to River Bend where he underwent open heart surgery. My apologies to anyone on I-5 that morning but I knew I had to get him to a good hospital fast. If I had called an ambulance, they would have taken him back to Mercy ER for more rude treatment because he’s a veteran and another bad diagnosis. Even a layperson like me KNEW his angina was anything but stable and that his condition was serious. Thankfully we have our own health insurance and can make our own choices. I pity any vet who has no other choice but to get taken to Mercy ER. If we’d done that, my husband would possibly be dead now because one of his bypasses was on the main descending artery nicknamed ‘The Widow Maker’.

mynamehere

No surprise about the down-grade. This is probably why the VA has a "suicide problem." From what I've heard, it's the VA itself which is responsible for the high number of Veteran suicides.

Marinewife1

Last Fall my husband was having chest pains and the VA had the ambulance take him directly to Mercy ER. On top of being in a life-threatening health situation, my husband got to experience being a VA patient at Mercy by their ER staff. When the nurse was told by the EMT’s who brought him in that he was a veteran, she rolled her eyes and began complaining loudly to anyone who would listen that they ‘shouldn’t have to deal with veterans’. Won’t that kind of hatred and disrespect give veterans who are forced to go there confidence that their safety and health issues will receive the care they deserve? My husband is a decorated Marine who gave up his health because he chose to SERVE HIS COUNTRY. Too bad Mercy staff has zero respect for him and other veterans.

gary may

i had a one on one with Dave whitmer in which he stated because of the whistle blowing and negative media of corruption, retaliation etc... " WE SHOT OURSELVES IN THE FOOT " he stated because of it he was going to shut down ER to a UC and shut down the medical floor ( in which they had already set it up for failure by reducing the beds on the medical floor from 24 beds to 11) tho it didn't happen while Whitmer was director the wheels were turning. like wise our ICU was kept down to 4 patients out of 6 for " remodeling" therefore making it not cost effective to keep open yet maintaining surgeons that were top of the line on payroll that had all the privileges and wanting to perform surgeries they were more then qualified to perform but all of the sudden couldn't because we had no ICU. millions of dollars are ear marked to use or lose and is, just drive thru there ANYTIME and there is construction, why to better Veterans care by closing programs and shutting down credential care services. or why? Mr. Hill we get acut throat director and you think it's so great, shutting down ER is a good decision? really??? your not speaking for the majority of Veterans, so that is only your thoughts and I wonder why? when we did the no confidence vote on the COS and they didn't fire him but let him work from home, you were happy with that?? weak... after 23 years there i know what would work, open our ICU back up, increase medical beds and a full ER. In 23 years ive seen acorrupt management get rid of top of the line surgeons and specialists, why? the only thing I saw was to open up more earmarked money for a chief of surgery that maintained aposition even after barred from performing, and his wife that was chief of staff, nepotism?? i would think so. then the firing of a 29 year Veteran that did 5 tours as head of the combat surgical unit, who within a month saw the Veterans lifes being put at risk, went to this chief of surgery with these life threatening issues and was fired to hush him from whistle blowing on them. Veterans need to wake up and unite as a whole to build a torn VA back up for our care that we were promised when active. this is only another decision to close OUR VA without us knowing till it's done. i wonder why they need a chief of surgery when they are setting up some of the best surgeons there is to run them off or take away what they love to do, help Veterans, save Veterans. yet let's continue to sink millions in a sabotaged VA from within...

gary may

Also Mr Allen I worked ER for several years, you stated 89% of Veterans really didn't need ER, hummmm I worked the front line and i don't know what hat that number was pulled from but i can tell you ER was being set up for failure to shut down like ICU and the medical floor, towards the end of my retirement, ambulances being deverted were like at 90%, even if the fictitious number of 89% were so, isn't the VA, ICARE and other mottos that don't line up were true, If one of the 11% was my dad's life it warrants serving Veteran's with afull functioning ER, by the way he was one if the 11% you claim, as was I and many many others I checked in and whose lifes were saved. I don't know maybe you took the % off a seasonal month, yeah we had older Veterans come in for colds ect... but im not one who can look in the immediate future to see if it would turn into pneumonia or something else, i wouldn't assume you don't either. Our VA team was one of the best and I was proud to be a part of it, much like when I Worked ICU or when I worked a 24 bed medical floor.

gary may

i pray mr. Allen your focus is not just the season's and retirement. #1 should be positive care for Veterans... welcome aboard

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