Is the VA all about 'cost savings?'

Ken Fay makes the seven-hour round trip from his home in rural Tripp County to the Sioux Falls Veterans Affairs Medical Center about twice a month.

Fay, a 66-year-old veteran with chronic heart disease, lives in Witten, a small town less than 20 miles from a small clinic run by the VA in Winner. Fay would rather travel to the Sioux Falls VA because he believes that is where he gets the best medical care.

The trips leave Fay exhausted. When they are over, Fay says he spends the next few days in bed, in pain.

"It's debilitating," Fay told The Daily Republic in an interview earlier this month.

It is not just the physical effort, though, that takes a toll. The cost of the trips is also an issue for Fay, who lives on a fixed income from Social Security and disability from his three years in the Navy from 1966 to 1969.

In the past, Fay, was reimbursed by the VA for his mileage for the entire trip to and from the Sioux Falls VA, but that is no longer the case. Now, Fay is required to pay the cost of traveling beyond the nearest facility run by the VA that offers the needed medical care. That means Fay must pay to travel anywhere farther than the clinic in Winner for his primary care.

"They sell the idea of me going to a local clinic as being a convenience for me, but the medical care available at the local clinic is limited," he said.

Darwin Goodspeed, director of the Sioux Falls VA, told The Daily Republic in an interview this week that the policy for travel reimbursement has not changed, but has been more strictly enforced since a report critical of the financial controls and oversight of the program was released in February 2013.

"There haven't been any appreciable changes in the policy, but a more strict application of the rules as they've always been written," Goodspeed said.

Fay claims there is an effort by the VA to reduce costs by forcing veterans who live in rural areas to go to the nearest clinic and not one of the larger facilities.

"This is all about cost savings," he said.

The report, prepared by the VA Office of Inspector General, says VA medical facilities nationwide paid about $89 million more in travel reimbursements than was approved by those facilities between January 2010 and March 2011. The discrepancy was in part caused by $46.5 million of mislabeled expenses, but the remaining $42.5 million was totally unexplained.

"There were certain cases where we weren't following the policy as closely as we should have been," Goodspeed said.

The effort to more strictly enforce the travel pay policy has been publicized in newsletters and at town hall meetings held in recent months, Goodspeed said. As more veterans have come to understand how the policy will be applied, the number of complaints has dwindled, he said.

Goodspeed said he knows of Fay and, on at least one occasion, met with him personally to explain the travel pay policy.

It would be unfair, Goodspeed said, to pay Fay differently than other veterans when it comes to travel pay.

There are other veterans, like Fay, who may live closer to smaller clinics but still travel to the Sioux Falls VA, both for the quality of care they receive and the convenience of being able to get multiple types of services at the same place.

According to South Dakota Secretary of Veterans Affairs Larry Zimmerman, there are about 9,900 veterans in South Dakota who live more than 40 miles from the main VA medical facilities in Sioux Falls, Hot Springs and Fort Meade. That's about 13 percent of the roughly 75,000 veterans in the state.

There were, as of May 2014, about 5.3 million veterans living in rural areas nationwide, about 24 percent of the 22 million living veterans, according to the VA Office of Rural Health.

Fay harshly criticized Goodspeed when he spoke with The Daily Republic, saying the administration at the Sioux Falls VA operates "through a culture of fear and intimidation."

"Everybody is afraid," Fay said. "The patients are afraid that if they complain, they're going to lose their medical care."

Goodspeed, who has served in his position for just more than a year, characterized his work and the work of his administration in a much more positive light.

"It's been a very challenging year, but I'm very fortunate that I've got a very wonderful team that wants to do good things for veterans every day," he said.

The long wait times for appointments that have plagued VA medical centers and clinics across the country have been relatively rare in Sioux Falls. According to VA data, on Dec. 1 the Sioux Falls VA had 15,737 pending appointments, with 598 scheduled more than 30 days from the preferred date.

"We are consistently getting people in within 30 days of the day they want to be seen," Goodspeed said.

For comparison, on Dec. 1 the Minneapolis VA Medical Center had 52,204 pending appointments, with 1,391 scheduled more than 30 days from the preferred date.

Fay claims, though, it took him at least four weeks to simply schedule a follow-up appointment at the Sioux Falls VA after he suffered a heart attack -- not his first -- this past summer.

"I called the VA and nobody would call me back," he said. "Nobody would call me to get an appointment."

Fay says he called two to three times per week, but was only contacted after reaching out to a supervisor in the VA emergency room.

Fay was also told the emergency care he received for the heart attack at the Avera Heart Hospital in Sioux Falls would not be covered by the VA, because it was not connected to his military service.

That was a surprise to Fay, who worked with chemicals during his time in the Navy, and at least one of his doctors told him those chemicals contributed to his heart condition, Fay said. That doctor no longer works for the Sioux Falls VA, according to Fay.

In 2010, Fay underwent triple bypass surgery, which the VA deemed connected to his service, as was treatment for another heart attack that took place shortly after the surgery.

Fay says the recent heart attack left him with about $70,000 in medical bills, though much of the cost was covered by Medicare.

"They're pushing vets onto Medicare by denying them services," Fay said.

Steve McClure, a former veterans service officer for Davison County, said he rarely, if ever, had problems getting veterans appointments at the Sioux Falls VA.

"I had no problem getting them in there," McClure said. "Once you're in there, you're treated just like gold."

McClure resigned in October after 10 years in the position. At the time, McClure said he was "pushed out" by the Davison County Commission, whose members said they wanted someone better able to use technology.

McClure said most of the veterans he worked with traveled to the Sioux Falls VA for medical care, but there were others who elected to go to the VA clinic in Wagner. McClure said he never heard many complaints from veterans about the quality of care they received at the Wagner clinic.

When McClure resigned, he was being paid $17.47 per hour. His replacement, 37-year-old Jessica Davidson, was hired last month and will be paid $15 per hour. If she passes a six-month probationary period, she will receive a 50-cent per hour raise.

In August, a bill -- the Veterans' Access to Care through Choice, Accountability and Transparency Act -- was signed into law meant to reduce wait times at VA medical facilities. It came following the resignation of U.S. VA Secretary Eric Shinseki in May after an investigation found evidence of cover-ups of the long wait times at some VA medical centers and clinics.

The law gives veterans the chance to look for medical care from another provider if they have to wait more than 30 days for care from their preferred date or the date medically determined by a doctor, or if they live more than 40 miles from the nearest VA facility.

Goodspeed said veterans have rarely sought outside care as a result of the new law since it took effect.

"It's always their choice," he said.

Zimmerman, the state VA secretary, urged veterans to rely on the network of veterans service officers in the state when dealing with the new law.

"Each veteran and each health issue and each one of those appointments is a different situation and might have a different answer," Zimmerman said.

Goodspeed admitted the wait times at the smaller, rural clinics can sometimes be longer because of the smaller staffs at those facilities.

Fay claims the VA is limiting the number of hours doctors and nurses can work on purpose.

"They cut the doctors' hours, which creates this phony doctor shortage, and force the veterans to wait longer for their care," Fay said.

Goodspeed said the Sioux Falls VA does not have a problem recruiting and retaining doctors or nurses, but admitted it can sometimes be hard to find and recruit certain specialists. That is an issue faced by health care organizations across the state, he said.

Zimmerman also said a shortage of doctors and nurses in the state is not unique to the VA.

"The state is doing everything it can to make it a more friendly state to come to, but it is rural no matter how you throw the dice down," Zimmerman said. "We have to live with that."

It can often be difficult for veterans to complain about their experiences with the VA, Fay said.

"There are so many veterans that don't question what they get from the VA," Fay said. "They're so grateful they get anything."

Fay plans to continue traveling to the Sioux Falls VA because, despite his problems with the administration, he said it was his "best choice for medical care in South Dakota."

"The VA taking away my travel pay is a conscious effort to force me back into rural medicine in an effort to save money at my expense," he said. "Maybe other veterans have money to do this, but I am not one of them."