The end came with more of a whimper than a bang.
The Roseburg Veterans Affairs Medical Center’s emergency department had been on a slow, downward spiral for a decade, but the ending was swift. Emergency doctors backed out of their contract with the VA in August. Support staff quit. A new sign went up out front. And the emergency department became a 12-hour, five-day-a-week urgent care.
In the three weeks since the downgrade, though, the VA said things have been going very well.
“The conversion has had no impact on our ability to provide care,” VA spokesman Tim Parish said in an email.
In fact, he said the urgent care had more patients coming in on its first day than had been in the emergency department on its last day the Friday before. But then, he said, the emergency room was not very busy to begin with.
Larry Hill, the head of the Douglas County Veterans Forum, said he’s been surprised how quiet veterans have been about the transition.
“That’s strange. We’ve got to have some people bitching and moaning out there, we really do. It just hasn’t happened yet,” Hill said.
Veterans suffering from medical emergencies are being encouraged to go to the nearest full-service hospital — Mercy Medical Center for Roseburg residents. Parish said staff members are available to redirect veterans to obtain care in the community after hours and on weekends.
Director Keith Allen has said the change was motivated by the loss of staff, which he said made it unsafe for veterans to seek emergency care at the VA.
Fred Tempest, a former member of the VA’s Patient Centered Care Committee, offered a different interpretation. He believes the shift to urgent care was long-planned and directed by the VA’s regional network VISN-20. Each of the recent directors has been no more than a puppet for the regional office, in Tempest’s view.
“They sure haven’t increased any services. They just keep decreasing them,” he said.
Karl Tanner, who was until July the president of the American Federation of Public Employees Local 1042 that represents Roseburg VA employees, believes the Roseburg VA has been on a path toward privatization since it closed its intensive care unit in 2009.
He said the problem goes higher than VISN-20, straight to the VA Central Office in Washington, D.C.
But Parish said fears the VA is headed toward privatization are unrealistic.
“VA privatization is a myth that has been thoroughly debunked,” Parish said. “VA is seeing more patients than ever before, has more employees than ever before and its budget is bigger than ever before,” he said.
He cited Secretary of the VA Robert Wilkie’s June statement, which appeared in national news outlets like The Washington Post and National Public Radio, that if the VA’s privatizing, it’s going about it in a strange way. Nationwide, the VA has a $220 billion budget and 390,000 employees. Ten years ago, Wilkie said, the budget was $98 billion and the VA had 280,000 employees.
But at the local level, Tanner asserted that Allen, likely following orders from above, created the staffing shortage he’s now using as a reason for the downgrade.
“Right when he came in, he stopped the hiring of 200 jobs. He stopped. He said we are not going to hire, stop hiring, stop hiring. He’s the one that did it. So let’s see, you create a problem and then you resolve it,” Tanner said.
While the short-term issue is in fact safety, Tanner said, the big picture is more about money.
The rules are more strict for paying outside providers than for providing care within the VA’s walls, he said. Veterans could visit the VA’s emergency department and receive treatment for any problem, but Tanner predicts veterans visiting Mercy for emergencies not connected to service-related injuries will find the VA refuses to pay those bills.
“Will this save the VA money? It’ll save them tons of money. But it’s really going to create a bad problem for the veteran,” he said.
Payments for outside care are a worry for Hill, too.
“The problems are going to come when it comes time to get things paid from the ER. That’s when the problems are going to happen, I just know it, and I don’t care what they tell me,” Hill said. “I am very pessimistic about that, I really am.”
A little over a decade ago, the Roseburg VA was a full-service hospital. Then, in 2009, its emergency department faced its first downgrade as its intensive care unit was closed and the hospital was dropped from a Level II hospital to Level III.
State and federal legislators fought the change, as did local veterans, to no effect. The ICU remained closed, but the emergency department continued on for another decade. It remained a source of friction with veterans through successive VA administrations.
In 2017, the hospital faced another crisis when its emergency room physicians complained that VA leaders were overriding their judgment about what was best for patients. The doctors said the hospital was turning away patients with complex medical problems in order to improve statistics used to determine the leaders’ bonuses.
The VA’s emergency doctors were contracted through Emerald Valley Emergency Physicians. Some had worked at the VA for as many as seven years.
Most of the senior leadership from that time, including then-director Doug Paxton, have since left the VA. They were pushed out of their jobs in early 2018, following an investigation by the federal Office of the Medical Inspector that found, among other things, the management created a toxic environment for employees.
Dave Whitmer stepped in as interim director. During his tenure, he proposed the emergency department’s hours be reduced to 12 per day. That plan was scrapped when the hospital couldn’t receive a waiver.
During his final town hall meeting with veterans in December 2018, Whitmer announced the Emerald Valley doctors wanted to exit their five-year contract with the VA. He warned veterans that could lead to the emergency department being downgraded to an urgent care.
Keith Allen took over as director in March 2019. He didn’t give his first interview with The News-Review until June, the same month he held his first town hall. But right away he made clear he was moving toward a downgrade to urgent care.
Allen cited a shortage of support staff in laboratory, radiology and respiratory services, and said patients with emergencies would be safer going straight to Mercy. Already, he said, 89% of the cases brought to the VA’s emergency department were urgent care problems rather than true emergencies anyway.
In June, Allen said he was aiming for December as the month for the downgrade. So many veterans were surprised when the VA suddenly announced at the beginning of August that the downgrade would take place Aug. 16.
The sudden timeline shift was blamed on the loss of additional laboratory staff.
For the past three weeks, the urgent care has been open Mondays through Fridays from 8 a.m. to 8 p.m. That’s left a gap on weekends for Roseburg area veterans.
A new urgent care benefit under the Mission Act allows veterans to seek urgent care at private organizations within a VA network put together by private contractor TriWest.
The trouble is, that only one of these in-network urgent cares is in Douglas County, and it too is closed on the weekend. Roseburg veterans with urgent weekend problems must choose between paying out of pocket to visit a local urgent care, driving an hour or more to an in-network urgent care, or waiting until Monday.
The VA said it will consider reimbursements for travel — two-way for emergencies and one-way for urgent care — on a case-by-case basis.
U.S. Sens. Ron Wyden and Jeff Merkley wrote Tuesday to TriWest CEO David McIntyre expressing concern about the shortage of urgent care facilities available to rural veterans in Roseburg and other areas.
Eventually, the VA plans to take charge of its own network. It’s working with TriWest to expand the network. Parish also said if the vacant lab positions can be filled, the VA will expand to seven days a week, 8 a.m. to 8 p.m.
“Recruiting qualified emergency health care providers can be challenging — especially in rural areas like Roseburg,” Parish said. “Roseburg VA Health Care system cannot provide emergency department services without the staff to deliver them.”