Veteran Healthcare Policies & Politics Two Years After Investigations At The Manchester VA

Sep 10, 2019

Manchester VA

On September 11th, we look at health care for veterans. It's been two years since whistleblowers at the Manchester VA alleged poor care and oversight, part of a string of similar cases nationally.  We ask where the veterans health care system is at today, what changes have occurred, and the role of politics in veteran healthcare. 

If you or someone you know is a veteran in need of immediate help, you can reach the Veteran Crisis Line 24/7 at 800-273-8255. 

Veterans who have questions about their healthcare can contact the patient advocate at the Manchester VA Medical Center at 603-624-4366 Ext. 6491.

GUESTS:

  • Peter Biello - Reporter and host of All Things Considered on NHPR. Listen and read his recent episode on veteran healthcare since the whistleblower scandal at the Manchester VA for Word of Mouth
  • David Kenney - (CRD, USN-Ret.)  Chairman of the N.H. State Veterans Advisory Committee.
  • Leo Shane III - Deputy Editor of the Military Times, where he covers Congress, Veterans Affairs, and the White House. 

Transcript:

This is a computer-generated transcript, and may contain errors.

Laura Knoy:
From New Hampshire Public Radio, I'm Laura Knoy and this is The Exchange.

Laura Knoy:
There are more than 20 million veterans in the United States, many of whom signed up after the September 11th attacks. Eighteen years ago this day today, on The Exchange we look at the health care system that our veterans rely on and the challenges it continues to face. Five years ago, a VA doctor in Phoenix went public with his concerns over appointment wait times so long. Some veterans died while waiting. This sparked a national investigation into the VA system. Then two years ago in New Hampshire, whistleblowers at the Manchester VA alleged poor care had created extreme, unnecessary suffering for patients. Meanwhile, federal attempts to allow veterans to see doctors in the private system have been controversial as well as political. As the Veterans Health Administration is the largest federally like federally run health care system in the country. Veterans health care where it stands, where it may be going.

Laura Knoy:
With me in studio, Commander David Kenney, retired U.S. Navy commander. Chairman of the New Hampshire State Veterans Advisory Commission. Commander Kenney, nice to see you. Welcome back.

Commander David Kenney:
Thank you,. Good to be here.

Also with us, Peter Biello, reporter and host of All Things Considered on NH PR. He follows veterans issues for us, including a recent in-depth episode on how health care has changed since the whistleblower scandal in Manchester. There's a link to that story on our Web site. By the way, Peter, you've done a lot of work on this. I really appreciate your time.

Peter Biello:
Happy to be here. Thank you.

Laura Knoy:
Also joining us by phone, Leo Shane, deputy editor of the Military Times, where he covers Congress, Veterans Affairs and the White House. Leo has done extensive reporting on veterans health and we've got links to Leo's reporting as well. Leo Shane. A big welcome. We really appreciate you being here.

Leo Shane III:
Oh, no. Thanks for the invite.

Laura Knoy:
So, Leo, this is a very large, publicly funded, publicly operated health care system for people who aren't familiar with the system. How big is it and how does it work, Leo?

Leo Shane III:
Yeah, I feel like a run of the country doesn't understand just how how vast this system is. They think that this is something for veterans and doesn't really affect affect their lives. But, you know, this is a system that treats more than 9 million veterans a year. We're talking throughout VA over 400000 employees. And frankly, a lot of a lot of doctors from other hospitals have done residencies, internships at VA hospitals. So it's a system that it's that's really linked to the larger American health care system. So every every change, every problem that shows up there does have a ripple effect as we go along.

Laura Knoy:
What kind of ripple effects you're talking about, Leo?

Leo Shane III:
Well, for example, there's a there's a major effort right now to look at electronic medical records within V.A., try and sync them up with Department of Defense. You know, this seems like a wonky internal thing. This has been trying to figure out how how these records are going to follow service members their whole life. But what is happening on a larger scale is that there's going to be two two major federal health systems that are using a single electronic medical record. It's not inconceivable, for that's become the standard for medical care across the country. Just because there's so many so many patients involved there, you know, things like we'll get into the VA choice and the VA Admission Act and some of these broader questions about private care. But trends within that, you know, as we see problems with hiring in mental health care, as we see problems getting mail, these are problems in the larger health care system as well. So these these problems aren't simply, well: veterans are having problems getting getting medical care or getting good access. These are problems that are kind of canary in the coal mine for a lot of other issues.

Laura Knoy:
Wow. So a big system, lots of ties with the the other health care system, if I could call it that. Lots of overlap. Peter Biello, how does the system look a little bit different here in New Hampshire?

Peter Biello:
It looks a little different in that the Manchester VA is not really considered a hospital. It's a medical center in the sense that it's a relatively small VA. The White River Junction VA is as a lot bigger. So the Manchester VA doesn't have overnight surgeries or anything or anything like that. So it relies more than other VA hospitals on private sector partnerships.

Laura Knoy:
That's really interesting. And why is that the case? Peter, I know there's no easy answer that you're right.

Peter Biello:
There is no easy answer to that. Dave might have some insight on that as well. But it was billed at a certain size. And as the task force that Dave chaired sort of figured out that it would cost almost. I think, Dave. Half a billion dollars to bring it up to speed with other with other VA hospitals of that size. So that and the task force, I believe, determined that by the time that kind of construction project was completed, the need for such a large hospital here in New Hampshire would not be there. So they made the decision that it would be best to just continue to partner with the private sector.

Laura Knoy:
Well, and communicating this has been a longstanding issue, the fact that. Is either the only state or one of the only states without a full fledged veterans hospital. But the larger question for you is how adequate do you see the veterans health care system here in New Hampshire?

Commander David Kenney:
I think, you know, to your point, you know, at the initial point of the task force, we did hear a lot of that with regards to, gee, New Hampshire is the only place it doesn't have a full service hospital, but that does kind of give us an advantage in these current times, because.

Laura Knoy:
An advantage?

Commander David Kenney:
An advantage in the sense that while the rest of the country is now talking about partnerships with community based health care, we've already been at it for several years. And so just a case in point, with the Mission Act recently enacted, while other VA are trying to tackle that, that complexity of the Mission Act and how to bring it to bear within their local hospital, VA Manchester's already been doing that with a lot of partnerships out in the community. So we've already got an advantage in in initiating the mission at, you know, types of care in the community.

Commander David Kenney:
We have a very large geographical area here in the state of New Hampshire. And covering north country, for example, is a big challenge for us. And so part of what we focused on the task force was how do we get health care to the veterans instead of bringing them all the way down, for example, from North Country to Manchester. Can we bring healthcare closer to them? And so the VA Manchester does that using C box and using now 80 bucks a community based center, if you will, that provides basic services, fundamental services. And in some cases, you know, x rays or C.T. scans or things that nature also conducted in these locations. And now where we're actually at the process of getting ready to open up a huge C block that's a combination of two up in Somersworth that'll be opening very soon. And that's going to double the space of the original one to about 8000 square feet.

Laura Knoy:
So it's really interesting to hear you say what you just said, Commander Kenney, because again, the sort of general headline that you see, the complaint that you sometimes hear from our political leaders, is New Hampshire's getting short changed. We don't have a full scale veterans hospital.

Laura Knoy:
Why not? This is unfair. You seem to be saying, no, this is maybe an advantage.

Commander David Kenney:
It is indeed. Because. And I think you'll find even with the hospital system on the civilian side, they are looking at innovations. They're looking at ways in which they also can bring medical care closer to their patients. So, you know, our thought was, well, why not the VA if CMC and Elliott Hospital, a lot of these other great systems are doing things like telehealth and a lot of those, why not the V.A.? Let's tap into those innovations. Absolutely. And so what our thought on the task force was, we have a lot of resources right here in New Hampshire that can help us do that. And and so that was kind of our guiding principle in going forward with the types of healthcare that we're helping to promote in the future.

Laura Knoy:
So, Leo, Commander Kenney mentioned the Mission Act. That's one of several attempts to bring in more private healthcare to the system to expand access, especially in rural areas like the North Country, as the commander mentioned. What's the inherent tension, Leo, in these efforts? Sometimes they've worked out, sometimes they haven't. But what's the tension between bringing more private providers in to veterans health care?

Leo Shane III:
Yeah, it's really been a pretty tumultuous five years for VA health care because after a year we would reference the Phoenix scandal that was the VA nationwide. Look at wait lists and secret waitlists and at the Arizona VA And it really forced some some assessments of what can VA provide and what can't VA provide. What's what's realistic. So Mission Act, which was signed into law earlier this year, is designed to make it easier for a number of veterans to seek private care, at least go to private providers for a host of different host of different ailments and and treatments. Fundamentally, it sounds it sounds good to most folks. A lot of veterans are in favor of at least the concept, because if you if you sprained ankle or a few if you have pneumonia, there's not a VA specific really need in that in that treatment.

Leo Shane III:
You know, if your VA hospitals far away or if in your case, the VA hospital doesn't have maybe the same resources of the private medical facilities, why should I have to wait in line to go to V.A.?

Leo Shane III:
You know, it's not as much, but there are a lot of military specific injury service specific injuries where VA has become a specialist over the years. Some of them things like prosthetics, PTSD, TBI. It doesn't mean that the private sector doesn't have the same resources, but they might not have the same expertise. And there's also a concern among veterans groups that things like burn pit exposure, Agent Orange exposure we saw in the Vietnam era. Though the larger symptoms with that were were detected because veterans were going to VA and VA doctors were seeing similarities in these injuries and illnesses. So they started to develop a pattern. There starts to be more research and they start to uncover larger issues. So if veterans are spread out there, if they're going to civilian doctors that have never seen PTSD and don't usually diagnose that, if they go in for a sprained ankle, they might not hear. When a veteran says, by the way, I'm having trouble sleeping two and having trouble focusing at work. They may just write that off. So the concern is, you know, are you taking away from the VA system where you're taking away resources and attention from the VA system in favor of just giving veterans general care.

Laura Knoy:
And veterans say, Peter, that they do appreciate that special understanding that Leo is describing.

Peter Biello:
Yes, exactly. Two points on Leo's comments. First is that the research that the VA is able to do because of its size is is really impressive and underreported, in my view. But but it's worth looking into because they have such, I guess, a breadth of resources that they can draw on and up and frankly, a pool of patients that they can they can study if they want to. And so that's worth mentioning. But also, yes, the culture that the that veterans really do appreciate about the V.A., not just their specialized knowledge of how to treat wounds of war, but being able to walk into a V.A., for example, and and see some trappings of military culture, which, whether you've served for just a couple of years or decades, can be a source of great comfort for veterans.

Laura Knoy:
That's really interesting. And when we talk about emergency care and, you know, access to care in the community. Peter, some examples have come up like why does a veteran need to go to the VA Medical Center in Manchester if, you know, he just has pinkeye? But it sounds like from what you and Leo are saying or, you know, an infected finger or something, but it sounds like from what you and Lee are saying, yeah, you can get your pinkeye treated anywhere. But maybe there's other stuff going on that, you know, the urgent care.

Laura Knoy:
With all due respect, isn't going to catch. So what do you think about that, Peter?

Peter Biello:
Sure.

Peter Biello:
Well, I think the the word choice, right, V.A., the Veterans Choice Act, the word choice was really appealing to a lot of people because it would give veterans the choice, like if they had pinkeye, as as you recommended or as you as you mentioned, they could choose to wait and go to the VA if it's a little farther away or if they just couldn't wait. And maybe experiencing that bit of military culture and camaraderie wasn't that important to them. They could go to a clinic nearby that was really appealing to a lot of veterans.

Laura Knoy:
And, you know, I'd love to hear your thoughts to Commander Kenney. Sometimes there's pinkeye and maybe there's other stuff going on that a regular doc just might not catch.

Commander David Kenney:
Very true. You know, to to the prior point, though, I will say that the one advantage of having the VA treatment facilities is, in fact, the culture. It's that it's that camaraderie. And I've heard many anecdotes about veterans visiting the VA for morning appointments. And they're there all day because they're talking to their friends. They see people commonly almost every time they go. And it's just it's an experience for them. It's not just going for a doctor's appointment. And so there's a lot to be said for vets talking to vets. But to to go back to the point about, you know, the pink guy or the more rudimentary care, if you will. That's one of the advantages of the Mission Act, which really brought in our access to these new urgent care centers that are now springing up virtually at every corner that you see.

Commander David Kenney:
And even here in New Hampshire, there's quite a few of them that have sprung up.

Laura Knoy:
And veterans can access those with their VA medical benefits.

Commander David Kenney:
Exactly. And that's one of the beauties of the Mission Care Act, is that because they are generally so ubiquitous now, veterans can actually access those clinics when they have, you know, a particular need, like a cut finger or they have a headache or something along those lines. They can walk right into those clinics and they can get the same care that everybody else gets.

Laura Knoy:
Well, so you all are talking about the upside of the culture at the VA medical centers, hospitals, veterans, health care in general. Leo, to you first: Often when these whistleblower cases come up, doctors and nurses at VA hospitals nationwide say there's a problem with the culture at the V.A.. So what are they talking about there? What's the downside of the Veterans Administration culture, Leo?

Leo Shane III:
Well, sure. And I certainly don't want to make it sound like the VA has has everything figured out here. You know, the commander said he hears anecdotes, people spending all day VA because they're in there talking to other other patients and other folks.

Leo Shane III:
We hear anecdotes, people spending all their VA to because of wait times and because of because of a lack of doctors and a lack of appointment. So, you know, the knock the knock on VA has been. It is a giant federal bureaucracy, and when you're trying to manage that. The phrase that goes around a lot is if you've been to one V.A., you've only been to one VA So, you know, some hospitals are really good. Some hospitals need more work on customer care. Some hospitals are understaffed. Hiring has been a major issue throughout the medical community, in the country. But with VA in particular, they need more mental health specialists. If you're trying to get a mental health appointment, VA wants to get veterans in as quickly as possible. But if they don't have enough enough employees who can handle that, it's gonna be it's going to be a wait. And sometimes those waits can be can be weeks or even months.

Laura Knoy:
How has this culture dealt with dissent? Leo, this is getting to some of the fundamental issues that have come up in Phoenix, in Manchester, New Hampshire and elsewhere around the country.

Leo Shane III:
Yeah. So the leaders at VA have said they are trying to do everything they can to make sure that whistleblowers are protected, that when when employees see problems with with equipment or with poor care or with, you know, any sort of other problems, they can come forward and they can they can report this.

Leo Shane III:
It's been a mixed bag of results. We've heard from plenty of whistleblowers that say despite five years of of efforts and push, this is still the the kind of dreaded federal bureaucracy you worry about, where there are plenty of middle managers who are just there to protect their jobs and and to clock in. And when you speak out, you're the one who's retaliated against.

Leo Shane III:
We just had a hearing a couple of months ago up here on Capitol Hill hearing from whistleblowers, again, saying despite all these lofty promises, as soon as they pointed out problems with patient care, they were the ones who were written up for insubordination. They were transferred to another another agency. So there is a new office of whistleblower protection that has been set up under the Trump administration within within VA and that has gotten mixed reviews as well.

Leo Shane III:
There's, you know, folks within the administration say they are there better tracking these whistleblower complaints and making sure that these folks are protected. But we've heard from quite a few whistleblowers, again, saying, "no, this is just another layer of bureaucracy to sort of obscure what I put out there and not really offer any protection."

Laura Knoy:
Well, coming up after a short break, we will talk a little bit more about whistleblower protection, the role that whistleblowers played in the Phoenix scandal that kind of blew the lid off of this. And also, Peter, I'll get your thoughts on the whistleblowers that we saw in Manchester. We also have some audio from that committee hearing that you mentioned, Leo. Again, whistleblowers saying it really hasn't improved that much. We'll talk about the role that they have played and we'll look at how things have changed here in New Hampshire. We'll start taking your calls, too.

Laura Knoy:
This is The Exchange. I'm Laura Knoy. Today on September 11th, we're looking at how our veterans are doing, especially with the health system, to take care of them after their service. Two years ago, a scandal at the Manchester VA Medical Center caused national headlines. We're checking up on what's changed since then and what hasn't. And let's hear from you..

Laura Knoy:
We have three guests. Peter Biello, reporter, host of All Things Considered here on NH PR. He follows veterans issues for us, including Peter's recent in-depth episode on Word of Mouth on how health care has changed since that scandal. In Manchester, there's a link to that story on our Web site. And each pork slash exchange. Also with us in studio, Commander David Kenney, retired U.S. Navy commander. Chairman of the New Hampshire State Veteran's Advisory Committee. And with us by phone, Leo Shane, deputy editor of the Military Times, where he covers Congress, Veterans Affairs and the White House. And Leo, just before the break, you were talking about Phoenix, and a lot of listeners will probably think, oh, right. There was something big that happened in Phoenix five years ago. That's when this really large, in-depth look at the veterans health system began. Just briefly remind us, Leo, what happened in Phoenix. And then we've got some audio that I'd like to play of some of the whistleblowers involved in that scandal. Go ahead, Leo.

Leo Shane III:
Sure. Yeah.

Leo Shane III:
I mean, this this was a Phoenix VA was ground zero for this nationwide reckoning of wait times and Veterans Affairs, medical centers and hospitals. It turned out that there were some thanks to some whistleblowers going forward. It was a real there were these these wait lists, these secret list that were sort of obscuring how long veterans had to wait for appointments.

Leo Shane III:
Administrators there had been cooking the books to try and make sure that it looked like veterans weren't waiting so they could reach certain performance bonuses when in fact, some veterans were waiting months or even more to get in for basic health appointments. So in the wake of those revelations, then similar lists start to pop up at other VA hospitals that forced the resignation of several top VA officials, including then Secretary Eric Shinseki. And it really forced Congress to to start to re-evaluate what can what can VAB, what you're what is VA responsibility? That's when we really started to look at this idea of of choice within the VA system can be a being a everything medical provider for veterans, or should there be more reliance on the private care system for basic medical needs? And should VA be focused on veterans specific health?

Laura Knoy:
Yeah. That's the tension that we talked about.

Leo Shane III:
Exactly. And it's been fits and starts since then. You know, some some good moves forward and a lot of people's opinions, some concerns that this is outsourcing.

Leo Shane III:
A lot of the basic responsibilities of VA to the private sector review doesn't hold on to some of those responsibilities.

Laura Knoy:
I want to talk a little bit more about Phoenix, because it is connected to Manchester and play a little bit of audio for listeners from the recent hearing that you mentioned, Leo, at the Subcommittee on Oversight and Investigations Committee on Veterans Affairs, chaired, by the way, by New Hampshire First District Congressman Chris Pappas. Here's Dr. Catherine Mitchell. She's a physician who blew the whistle on poor treatment of veterans in Phoenix, reporting, as you said, Leo, the secret wait lists with named as many as 40 patients who died while waiting for care. Let's hear a little bit from her testimony in June.

News Sound:
I was ethically compelled to become a public whistleblower only because there are there were no other avenues to keep veterans from dying. My disclosures on access and poor quality care had national VA implications and encouraged a wave of VA employees to speak up about serious VA problems as a result. I received the 2014 Federal Employee of the Year award. The VA entered into a settlement agreement with me and gave me a patient care oversight position. I've been described by the VA as a whistleblower success story and as definitive proof that the VA braces whistleblowers. However, nothing could be further from the truth. And I'm here to set the record straight today.

Laura Knoy:
And then Dr. Mitchell goes on to say that she faced all kinds of retaliation, even though the VA said, look how well we treated this important whistleblower. Let's just hear her describe a little bit what happened to her after she started to come forward with her concerns.

News Sound:
In 2014, I testified at this committee's groundbreaking whistleblower hearing that finally brought VA retaliation into the spotlight. I'd hoped my 2014 testimony would help jumpstart positive change so that all employees could report problems without fear of retaliation. Unfortunately, the administrators today still continue to retaliate. The only change I've seen is that since 2014 is that administrators are now much more skilled at weapon sizing, investigation boards and manufacturing charges. In my case, over. Experienced ongoing retaliation that started shortly after signing a 2014 retaliation settlement agreement, for example, for nearly five years I've been prohibited from performing every major duty listed in the written job description that was given to me as part of the legally binding settlement agreement for about two years. I was banned from initiating contact with all VA Center Medical, all VA Medical Center staff at my region from 2014 until 2018. I had no regular assignments, although I am highly trained as a VA quality scholar. I am excluded from almost every oversight activity and I'm not officially allowed to intervene in patient care problems. I have not been silent about this retaliation, but I cannot seem to make it stop.

Laura Knoy:
She goes on to say, I cannot seem to make it stop. Peter Biello this is disheartening, to say the least. When I heard this audio this morning, I'm shocked that whistleblowers are still making these kinds of reports. In June of this year, after all we've seen.

Peter Biello:
I'm not.

Laura Knoy:
You're not?

Peter Biello:
No. I mean, there are laws like the Whistleblower VA Accountability Whistleblower Protection Act set up a new, I guess, paradigm, you could call it, where on the one hand it might be. Yeah, there's a mechanism to protect whistleblowers, but those who are determined to sort of make sure that the hierarchy of decision making stays in place will find new ways to to make sure that they can do what they need to do. As the whistleblower we just heard from just just mentioned, there may be, for example, preemptive measures on the part of administrators to make sure there's a letter in every VA employees file or many possibly potentially troublemaking VA employees please file so that if they need to take a disciplinary action, they already have that letter there. So and that is a strategy. I'm not saying anybody right now is is taking, but it is something that they could take. And it's a way to sort of make sure that they are in line with the laws that are that are in place.

Laura Knoy:
Commander Kenney, how does that testimony from Dr. Mitchell hit your ears, given again that, you know, you're chairman of this New Hampshire State Veteran's Advisory Committee and you've been very involved in improving care after whistleblowers came forward in Manchester?

Commander David Kenney:
Well, certainly I find it very distressing. It's and but it's not an unusual story in that when the whistleblowers came forward here in Manchester, we heard a lot of the similar stories where there was retribution and a lot of those things that were going on here locally. So the fact that it's still going on just demonstrates that how large the system is and the fact that some of the changes that we've implemented here in Manchester have not quite rippled out to the larger system yet.

Commander David Kenney:
But we're hopeful that it will, because one of the things I think we were very specific in doing is once the whistleblowers came forward, that was really a springboard for us to really take on some very large change at VA Manchester. And so when the task force was actually created. We were sure to incorporate one of the whistleblowers as part of our committee that was talked to Eric Funk. And Eric was was absolutely instrumental in making sure that the task force was kept that kept our eye on the ball, if you will, to make sure that we were addressing all of the whistleblowers concerns during our deliberations over the course of the eight months that the task force had met.

Laura Knoy:
Oh, that's interesting. OK. So and by the way, the director of the Manchester V.A., Dr. Al Montoya, could not join us today. It's 9/11. He is at a ribbon cutting for Hives for Heroes program, by the way, which addresses financial and personal wellness for veterans through professional training in beekeeping. So it is 9/11. It's a hard day for the director, the Manchester V.A., to be with us. But let's hear a little bit from Director Montoya talking this spring about how he feels about the whistleblowers and their role.

News Sound:
I actually am appreciative that they came forward and they brought up their concerns because it gave an opportunity for us to make these improvements, for us to really go out there and invest in the organization, invest in the services. And so I think, you know, if that had to come from them coming forward, then then so be it.

Laura Knoy:
Again, that's Al Montoya, director of the Manchester V.A.. So, Leo, to you and then I do want to move to our listeners. Where does this stand now with whistleblower protections, with people listening to these doctors and nurses who are saying, look, this isn't good enough for our veterans?

Leo Shane III:
Yeah, I mean, that's a good question. It depends on who you ask. As I've said, VA is insisting that they have have made changes, that whistleblowers can come forward and they will be protected. But what we've heard from from whistleblowers and from members of Congress, that they're still hearing plenty of reports about not just retaliation, but, you know, it's difficult to make someone whole after this.

Leo Shane III:
If someone comes forward and says, I see these problems with management, I see them failing in this way, even if it's corrected a lot of times that management isn't replaced.

Leo Shane III:
So now when that person comes up for a promotion or looks for something else or those same folks are going to view them the same way, or are they just going to view them as a problem forever? So so it's a difficult, difficult situation to balance. But on the whole, right now, what we're hearing from whistleblowers is, look, there's still not enough protections. And if I come forward, it may cost me my job.

Laura Knoy:
So what's the follow up from that hearing before the, again, the Subcommittee on Oversight Investigations on Veterans Affairs, chaired by, again, New Hampshire's Chris Pappas.

Laura Knoy:
What's the follow up to some of the pretty powerful testimony that came before that subcommittee? There are others who said what Dr. Mitchell said.

Leo Shane III:
Right, and they've promised that they're going to have more hearings. Keep following on this issue. There are a couple of pieces of legislation that are that are floating around here. But again, that's you know, that's contingent on on on VA officials following any any any law changes and any things. And, you know, as as Peter said, if you can if you can find some some creative ways around it, you can still find ways to punish these folks or at least leave that that option in there. So I don't know that anybody really has the silver bullet on how to handle this. Obviously, you can't just take every everyone who calls himself a whistleblower. You can just take all of their allegations and say they must be right. We have to react. But but the current system, you know, many still feel like it discourages them from coming forward.

Laura Knoy:
let's go to Rich in Farmington. Hi, Rich. You're on the air. Welcome. Thanks for calling in.

Caller:
Good morning. Good morning.

Caller:
I have recently had a fantastic experience with the VA I needed some surgery and was able to do it locally instead of having to go down to Boston or up to White River Junction and the people that set this all up to the community care program and that was fantastic. I got it this point. I would say nothing but positive things to say about the community care program. Been fantastic.

Laura Knoy:
Now it's you had your surgery done in Manchester, then at the medical center there.

Caller:
No, no. I had surgery done in Dover.

Laura Knoy:
I see.

Caller:
Which was like 15 minutes from where I live.

Laura Knoy:
OK.

Caller:
So it was really nice to be able to have family close by and all that.

Laura Knoy:
Absolutely.

Caller:
To know that the surgeons were actually from mass general.

Laura Knoy:
Wow. OK, so Peter, this sounds like another part of the VA system here in New Hampshire that we should describe for folks.

Peter Biello:
Sure it is. I mean, it depends on which had the surgery. I don't know if it was during the Veterans Choice Act area. The Mission Act has sort of replaced the Veterans Choice program. But he he mentioned generally care in the community, which is often kind of a broad umbrella term for any any program that sends veterans to the private sector that the VA pays for. I don't know which is still on the line, but I'd be curious to know. Like if if he knew if he was using Mission Act or community care. In any event, some of those programs worked better than others. The Veterans Choice program was really problematic because of their third party contractor Health Net, which was really kind of inept at scheduling consults in a timely manner.

Peter Biello:
The Mission Act is supposed to improve that, but alongside the Veterans Choice Act was something more broadly known as the Community Care Act. Community care or fee basis, which veterans really liked, which had a little less red tape. The Manchester V.A., for example, could more directly schedule care at private hospitals like the one in Dover, which may have gone to and it may have been really smooth process.

Peter Biello:
So a lot of veterans are hoping, a lot of legislators are hoping that the Mission Act will consolidate all those programs and make it really easy for veterans to just, hey, I want to stay in Dover. I'm a stay in Dover for this one.

Laura Knoy:
Rich, I'm glad you had a good experience. Good to hear from you. And Debbie in Alexandria writes. She is a visiting nurse and she asks if veterans only have primary doctors in the system. Where do they seek help after hours? As a hospice nurse, Debbie says she frequently has acute issues after hours. This is a big issue. Everybody knows health care problems seem to crop up after eight o'clock.

Laura Knoy:
So what about that? . Commander Kenney, what about after hours?

Laura Knoy:
Does the VA basically shut down at 5:00?.

Commander David Kenney:
Whell the VA has actually expanded their hours in the change of the Mission Act. And so now they actually provide services during the day all seven days of the week now. But certainly after roughly I think it's four o'clock, four thirty in the afternoon, the clinic shuts down. But they do have fundamental services that are still there available to veterans. But veterans still have the ability, though, to go to outside services after hours. So if they have an episode, for example, they need to go to an emergency room or they need to go to a primary care wherever the case might be. That is still covered and they can still do that. So they can present themselves to an emergency room or toward a, you know, a doctor if there's if there's an urgent need, if you will, to go or in the case of this individual, if they have an episode where they really need to talk to one at somebody and see somebody, they can certainly do that. I would also recommend that they they contact their primary care facilitator at the VA and say, look, I have these issues after hours. Do you recommend somebody that I can contact? And they can certainly probably provide them with some referrals.

Laura Knoy:
Will that VA provider be available, though, at 8 o'clock at night when you start getting strange headaches that may or may not be related to your combat service?

Commander David Kenney:
This is where this is where contracting sources outside the VA helps and the VA goes through the process of vetting a lot of these outside community based sources to make sure that they're partnered with the VA in a way in which they understand the care that the VA is expecting from them. So there's a quality, if you will, component to this.

Commander David Kenney:
And it's also exponentiated through the urgent care system and all these things. So when these folks are actually contracted and brought on board, it's a clearer understanding at that point that there's a certain level of care that they must provide and that care is managed and monitored by the V.A.. So and by the way, the one change that we've had here with the V.A., the new VA system, is that much of the care is actually case managed now.

Laura Knoy:
As our caller mentions.

Commander David Kenney:
That's correct. And that essentially centralizes the care to an individual that that that patient would actually communicate with. So if they need a particular service or if they need a specialty, for example, they're talking to one person. So they have that relationship with that one person who's familiar with their case and says, OK, I know what you need. Let me call this particular doctor. I'll set you up with an appointment.

Laura Knoy:
So the providers may not be specifically VA providers, but they've kind of got the ethos and and so on. And so forth.

Commander David Kenney:
That's correct.

Laura Knoy:
Peter, I can see you want to jump in go ahead.

Oh, I was just ... Commander Kenney may have something to say about this, too. But just broadly speaking, for veterans listening and who have questions about veterans health care, there is a patient advocate at the VA who answers questions and advocates for veterans if they if they need that kind of service. And as far as I'm I'm aware, Commander Kenney, that's that's a service that the VA offers and they can call them anytime.

Commander David Kenney:
Yes, that's exactly correct. And by the way, we have the one unique aspect in our VA and I will be very proud of this. Director Montoya is not shy about giving on his personal cell phone numbers should any veteran run into an issue at the V.A.? Because the one thing about Director Montoya is he is a walkabout type of manager. So he wants to make sure that every veteran gets the appropriate care.

Laura Knoy:
Well, coming up, Leo, I want to ask you how this all fits in with mental health care for veterans. I know you've covered that. Veterans suicides is a big concern. So we'll talk about that after a short break. This is The Exchange on NH PR.

Laura Knoy:
This is The Exchange. I'm Laura Knoy. This hour, we're looking at veterans health care. Five years after a scandal at the Phoenix VA made national headlines and two years after whistleblowers came forward at the Manchester, New Hampshire V.A.. Join our conversation with your comments. Let's talk about this whole system that we've been describing this hour and how it has worked or not worked for veterans with mental health issues. You've written, for example, Leo, that suicide rates are quite high for veterans. So go ahead, please.

Leo Shane III:
Yeah, I mean, unfortunately, the suicide rate has has remained steady for a number of years now.

Leo Shane III:
It's been an issue that VA has tried to tried to throw a lot of different tools at and thus far hasn't seen a lot of change. You know, mental health care is a difficult prospect throughout the medical community in the country because of the demand and the lack of providers. And VA over the last few years has really tried to to work on its recruiting and retention of those specialties to make sure they're available. They've also made an extra push to try and cut down on wait times, knowing that when someone's, you know, in an emotional distress or having mental health issues, that time is of the essence in some places. We've seen dramatic drops in that time and in other places it's it's still difficult to get in.

Leo Shane III:
And this was part of the impetus for these changes in the push for outside care is if if a veteran is facing a month long wait to get a a appointment for for PTSD, for post-traumatic stress disorder, for some for major depression, why make them wait for a month if there is an available doctor within a week of who's who is close by? So that's that's the balance. You know, we're only a few months in. It will be interesting to see over the next few years, you know, what effect that change has on the suicide rate. But sadly, you know, we can't really wait five years to see if it worked or not and then re-evaluate. This is something VA has to be constantly adapting to on the fly.

Laura Knoy:
So, Leo, the hope with this mission act that we've all mentioned that again, adds access to private providers for veterans care. The hope is that, you know, if you have to wait a month to see a mental health professional, the V.A., but maybe you can get an appointment within a couple of days in the private system. The hope is that that will help with this.

Laura Knoy:
On the other hand, and we keep going back and forth with this, veterans say again, with their physical and mental health, maybe even more so with their mental health. Leo, I wonder what you know, they really appreciate that veteran understanding.

Leo Shane III:
But one of the one of the most popular, you know, available treatments for for PTSD and some of these mental health issues is is peer counseling, group counseling with other veterans who have shared some of the same experiences, who can who can talk through and really bond with with folks as they're trying to deal with this. If you go to the private sector, the chances are that won't be available because you don't have that great concentration of veterans there. That's the kind of thing that that really only VA can provide and mask to groups.

Leo Shane III:
But is it worth waiting again a month for that when you could get an appointment with a perfectly qualified doctor who might not special for specializing in military issues, but knows the basics of post-traumatic stress disorder and can can get you some prescriptions or can get you into some other alternative treatments in a much quicker, quicker timeframe. So so it is it's tricky. You know, the answer when I talk to veterans groups most the time is we want everything. You know, we want to make sure the VA is still getting all of its funding. It has this robust resource system.

Leo Shane III:
We want to make sure that VA is the premier medical treatment option for veterans across the country. But we also want to be able to go to the private sector when there are when gaps develop.

Laura Knoy:
And Leo, just remind us quickly about the suicide rates among veterans. You reported on this and it's pretty striking.

Leo Shane III:
Yeah, it's 20 a day of that. You know, it's it's easy to just lapse into the statistic there, but we're talking about a lot of folks who who have no contact with V.A..

Leo Shane III:
Whatsoever, as I said, there's about nine million folks who receive regular treatment from regular health care or treatment from VA each year. But that leaves another 11 million veterans in the country who don't have regular contact with VA services or VA assistance programs.

Leo Shane III:
And what we've seen is about 14 of that 20 a day are folks who were outside the VA system. So outreach, bringing more folks into the VA system to be seen to know what these resources are is a major a major focus for V.A.. But you're running into the problem of as more folks are adding or the resources there. Can we increase the number of mental health appointments or doctors available?

Laura Knoy:
So it's a circular problem 20 a day. I'm so struck by that. And I want to let everyone know. The veterans crisis line is 1 800 273 8 2 5 5. 1 800 273 8255. We'll also put that number on our website. Karen wrote us about this. She says, Where are the mental health inpatient beds for veterans? I work in a local emergency room. And when veterans come in, we have to search in other states, Massachusetts, Vermont, because New Hampshire does not have any inpatient services. When will there be psychiatric, mental health, inpatient and crisis service services available for New Hampshire veterans? Karen, thank you for writing. Commander Kenney, what can you tell us about that?

Commander David Kenney:
I think what we're currently is going on with mental health, particularly at the V.A., is they've just hired a director of mental health services. I had a brief introduction with her a few weeks ago. And we've also had a recent summit with Congressman Pappas and Kuster, of which in a lot of these issues were actually brought forward in direct relation to suicide and and the mental health challenge. The fact is, is one of the things that we learned in the task force was that there's actually a codified limit here in the state of New Hampshire with the amount of beds that are available in the community. And so we've had contracts, for example, with Concord Hospital in the past.

Commander David Kenney:
And I think that's something that that the VA is is working on, largely because they they do understand that there is a there is a definite need for that kind of service here. And so in addition to what the VA can provide in Manchester, I think what they're looking at is other resources in the community where they can provide beds. So in addition to having, you know, urgent care and all those other medical needs closer to the veteran, we're also trying to do that with a with the mental health aspect of things, too. And we'll see box are also being are being staffed with mental health professionals as well.

Laura Knoy:
So just as sorry to interrupt, but just to clarify, because a lot of listeners may not be as familiar with the system as you commanders. So right now at that Manchester VA Medical Center, there are no mental health beds for people to stay when they're in crisis.

Commander David Kenney:
That's correct. That's my understanding.

Laura Knoy:
And would that be helpful?

Commander David Kenney:
I don't know if the. I'm not really sure what the the forward plans are. I think Director Montoya could probably answer that better than I could. I do know that there's some there's some construction going on over there right now for clinic space.

Commander David Kenney:
And so one of the advantage of doing that is that as clinic space is created and some of the services that are in the core medical center there are brought down into the clinic space that will free up space in the core hospital to allow for other services to to either expand or to be broadened. So in those circumstances, perhaps that might be a plan in the future is to offer some service like that when when the space is available.

Laura Knoy:
Well, talking about what veterans want, Peter, and you know, everybody wants access in the community, especially in a rural state. But you also want that specialized care at the Manchester VA There are funding issues. Congress has gotten involved. We heard whistleblower testimony earlier. It's about health care, but it's also about politics. Peter, and I wonder, you know, in not a 30 second elevator pitch, but maybe a three minute elevator pitch. How would you describe the politics of this issue that we've been talking about this hour?

Peter Biello:
Well, we're talking essentially about government health care. And there are few things that are as politically polarizing as government health care. We often don't think about the VA as that, but that's what it is. And there are active advocacy groups who will leap on any story, positive or negative, about the VA to push their overall agenda.

Peter Biello:
So, for example, if you see a story about some kind of malfeasance on the part, like there's one in Arkansas right now, a doctor really did some some horrible things there at the VA And this is fodder for those groups that say, see, government health care is awful. We need to dissolve. V.A., it's doing no good, it's harming veterans. And and so the VA is incredibly sensitive to that. And in part of the reason for that is that while the VA does offer some very helpful things for veterans and they're terrified that stories like that will send a message to veterans, that is kind of inaccurate.

Laura Knoy:
Don't go, "It's a problem".

Peter Biello:
Yeah. You see a story about a bad doctor at a VA It's easy to sort of make the mistake to extrapolate and say, well, all views are like that and therefore, I should stay away. Stay in the private sector no matter what. So the VA is very, very sensitive to that. It changes the way they interact with the media. Like I'll just share a personal reporting story. I have encountered a veteran really who recently who had a less than stellar experience to less than stellar experiences with the Manchester VA So I am working with her to figure out the best way to tell her story.

Peter Biello:
And in part of that, I've asked the VA to talk to them about this veteran. And there's a procedure to go through for that because of Hepburn and privacy and all that. So I've I've completed those privacy requirements and they still decided, no, we're not gonna talk to you about this. They're very sensitive to this.

Peter Biello:
Now, I'm doing my due diligence as a journalist, but at the same time, they are in defense mode because they do not want a negative story and they wouldn't want to take a risk with that. I understand that. But it's still my job as a journalist to go out and report these things. So that's where the political thing comes in.

Peter Biello:
It's also these negative news stories, for example, can cause people to lose their jobs. In the past few years, for example, you've seen a lot of that. Well, yes, there were problems with whistleblowers. The whistleblowers turn their attention on a few select administrators, both at the Manchester VA and at the regional level. Those regional leaders were told not to talk to the press. So what did we have? We had one sided stories where the whistleblowers said everything they wanted. These people who were the targets could say nothing because they were ordered to say nothing. And so the political pressure increased. Congresswoman Annie Kuster, for example, responded to that public pressure and called for some of these people to be removed. And that's the kind of susceptibility that the VA has to public pressure that perhaps private sector hospitals do not.

Laura Knoy:
Very interesting. Leo, I'd love your thoughts on this, too.

Leo Shane III:
This is what you feel many, many, many of your news stories with the politics that go ahead. Ours. Yeah, I know. But go ahead.

Leo Shane III:
Look, I mean VA in the last five years has had two secretaries forced forced out of office. And, you know, be it is a it is a political, you know, bear trap for her. A lot of folks that step into just to to Peter's point there. And so the point I raised earlier about the number of veterans who were outside the system who who take their lives every day. You know, I hope that our coverage does not give people the impression that they should avoid the Department of Veterans Affairs. There are many great programs. There are many great services there. There are many things need to be improved to. So that's the that's the constant battle for us as we cover this.

Leo Shane III:
And that's the battle for VA on the political side. They don't want to be seen as a broken, failed system. We've seen politicians on both sides from both parties call them that. And then as the White House has changed hands, we've seen their their views change hands as well. But suddenly things that were fixed before are broken. Certainly things that were broken before are completely fixed. So. So there's a lot of back and forth here. The bottom line is that with so much money going in, we're seeing record high budget levels for VA Over 200 billion dollars is their request for next fiscal year. There's a lot at stake here and there's a lot to be said for. Are they are you know, is this money just being thrown away to fix problems that could be better used in the private sector? How do you how do you reach those balances?

Laura Knoy:
So that sounds like the debate that you're going to be covering in Washington. Leo, when it comes to veterans health care, sort of how much private, how much public, how much to bolster the VA system, how much to open up access to the private system, where the dollars fall down and and so forth. And what about the whistleblowers and the whistleblowers?

Leo Shane III:
Like there's never, never a shortage of stories. Unfortunately, there's there's plenty of stuff to cover here. And rightfully so. I think that, again, a lot of the public just doesn't think about how big this system is and how much it affects with 21 million veterans out there. You know, we hear so much about the civilian military divide and how few Americans actually served in the military. But that does not mean that you probably don't know a veteran and that this does not affect you at all. This is probably if it's not affecting a family member of yours, it's probably affecting someone on your street.

Laura Knoy:
Well, and there are a lot of veterans here in New Hampshire. In fact, I think New Hampshire has a higher rate, a higher percentage of veterans in the general population, higher than most states. Not the highest number. Highest. Yeah, higher.

Commander David Kenney:
That's about number five, I think, in this state. In the country.

Laura Knoy:
Ok. That's pretty high as well. I want to close out with one of New Hampshire's whistle blowers, Ed Kois, who sadly died in a car accident just recently. But, Peter, you. We're lucky enough actually to talk to Dr. Kois in July, and he responded to your question, are things better now? And let's hear what Ed Kois had to say.

News Sound:
There is a fundamental amount of it in a different bureaucracy that is detrimental. We are not clearly where we want to be. But we're so much better than we used to be. And we at least seem to be all pulling oars in the same direction.

Laura Knoy:
Do you agree with that, Commander?

Commander David Kenney:
Absolutely. You know, I've had the pleasure of not only being a patient of Dr. Kois', but also Dr. Kois was an integral part of the task force as well and would visit us frequently to make sure that we were we were on target in a lot of the things that we were talking about. And I would like to say that we were very encouraged by listening to that comment. And some of the others that I had I had here heard from him personally about the fact that we were finally pulling the oars in the right direction and that it took a lot in terms of changing the leadership at the top, which was fundamental to making a lot of the changes that were made at the VA in Manchester.

Commander David Kenney:
So a lot can be attributed to the team down there in terms of their success. And by the way, contrary to what the national might be seeing, the wait time right now for New Hampshire is nine days for a mental health appointment and it's about 13 days for another appointment. So we're we're bucking the system, if you will, in bucking the national average. And a large part of that is due to the the extra effort that's been put at Manchester in terms of making the improvements, making sure employees are engaged, that patient safety is number one, and that that that momentum, if you will, continues to that 2025 goal that the task force has has had as as its underpinning. So we're very encouraged by all of the good things that are going on up there and we hope it continues.

Laura Knoy:
Well, and Peter, I want to direct listeners to the excellent, really in-depth piece that you did for word of mouth on how health care has changed since that whistleblower scandal two years ago. There's a link on our Web site and HP York Slash Exchange. But real quickly, Peter, what else are you going to be watching as all these new systems roll out?

Peter Biello:
Well, I'm always curious about how the VA uses metrics to figure out how well they are doing. That was one of the big complaints. Whistleblowers had an over reliance on metrics that kind of didn't help them say exactly how things were messed around. So another apparently not using just those metrics. There's a little more of a hands on feel. I'm curious about what kind of results that will yield.

Laura Knoy:
All right. Leo Shane, Commander David Kenney, Peter Biello, thank you all very much for being with us today. We will definitely follow up with you again. Thanks a lot.