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.