April 13, 2008 – Some locals say that care and customer service at veterans’ medical clinics in Galveston County has been so bad it’s made some sick and left others worrying they might get sick if they keep using them.
They question whether an arrangement under which the U.S. Department of Veterans Affairs pays a contractor a flat, per-patient rate to operate the clinics gives the contractor a financial motive to deny care.
Whatever the cause, patients have become so frustrated with the clinics that they’ve been quitting them and are driving back to the Michael E. DeBakey Medical Center in Houston.
The clinics were opened a little more than two years ago under a $19 million contract intended to give the county’s 25,000 veterans — many of whom lack transportation — a convenient alternative to driving to Houston. But enrollment numbers at the clinics have actually dropped in the past two years after a big initial signup.
The president of the company that runs the Galveston County clinics said he hadn’t been told of widespread complaints about the clinics and said the VA’s internal and outside reviews of service had been glowing.
But the VA on Thursday said it hasn’t been satisfied with the company’s performance in Galveston County.
It said it had taken action against the company and would do more if its performance didn’t improve. The VA, however, refused to say how it disciplined the company or what it might do in the future.
And despite its dissatisfaction with the company’s local performance, the VA has more than a dozen other contracts with it to operate outpatient clinics across the United States.
The VA and the contractor apparently even opened a new one on Friday.
In December 2004, the VA made an announcement that was a big deal to the county’s veterans: It would open outpatient clinics on 61st Street in Galveston and on the Emmett F. Lowry Expressway in Texas City.
“We were really happy to get them,” said Jim Rose, president of the county’s chapter of Vietnam Veterans of America. “We tried very hard for a very long time to get them here.”
The local clinics, part of an initiative to open 156 such facilities across the country, were to be run by American Medical Services of Fort Lauderdale, Fla.
Under its contract, it would be paid $400 annually for every vet who received primary care at the clinics.
The deal would be worth $19 million throughout five years, Larry Seward, outpatient clinic coordinator at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, said at the time. The VA last week wouldn’t say how much it had paid the company.
The contractor has since changed its name to Valor Healthcare and moved its headquarters to Miami.
That’s not the only thing about the clinics that has changed. Many veterans’ enthusiasm for them quickly evaporated.
Rose said veterans were treated disrespectfully at the clinics and had difficulty getting through on the phones — often to clear up minor problems with prescriptions and other small matters. But if they went to the clinics in person, they often would have to wait most of the day to be seen, Rose said.
Worse, personnel at the clinics seemed bent on limiting the care veterans received there, Rose said.
“It seemed like the more money they saved, the more money they made,” Rose said. “If you went in with something drastically wrong, you wouldn’t get the test because the test costs money.”
Gerald Bloom, a Vietnam veteran who now works as a dispatcher for the sheriff’s department, said his doctor ordered that tests be done every three months.
“More than 50 percent of the time, they called and postponed my three-month appointment by more than a month,” he said.
Rose said that in time, most of his group’s more than 60 members stopped going to the local clinics and started driving to the VA-run facility in Houston instead.
Staffing Adequate, Company Says
Dr. Ray Lanier is president of Valor. In a phone interview Wednesday, he vehemently denied the troubles local vets complained of at the clinics his company runs.
“We’ve been seeing in excess of 1,000 people a month. There’s a disconnect in some way,” Lanier said. “If I thought there was a problem, I would come down there and take care of it myself.”
In terms of not getting through on the phones, Lanier said he’d called the Texas City clinic three times that day without a hitch. And when The Daily News called, the phone was answered on the third ring.
In addition, Lanier said, his company’s clinics have enough resources to provide good care.
“There are more than enough staff and providers for our patients,” he said, explaining that his company intentionally left open three or four slots in each doctor’s schedule each day to accommodate patients without appointments.
More generally, Lanier said that the “cafeteria rate” the VA paid his company was enough for it to turn a profit and give good care.
But Lynn Richards isn’t buying it. Because her husband, Danny Richards, is a 100 percent disabled veteran, she qualifies for medical care from the VA as well.
Richards and her husband are well known among Galveston County veterans. For years they’ve donated their time and money in efforts such as driving veterans without transportation to medical appointments. Lynn Richards also is an officer in the Texas Chapter of the Veterans of Foreign Wars Ladies Auxiliary.
A diabetic, Richards, 55, said that her doctor at the VA hospital told her to get tests done once every three months to make sure her blood sugar was at acceptable levels.
But she said she was enrolled at the VA’s Texas City clinic for a year-and-a-half before it was checked even once. When her blood was finally checked by a professional, it was badly out of whack, Richards said. She transferred to the VA center in Houston and is only now getting back to normal, she said.
“We transferred up there because (the Texas City clinic) almost killed us,” Richards said of herself and her husband.
Richards said she’s heard similar complaints from many of the veterans she works with through her volunteer efforts.
And if county vets are voting with their feet, they’ve voted down the local clinics.
Between October 2005, the first year the clinics were open, and September 2006, they had a total of 8,132 patients, according to numbers furnished by the VA. Before the clinics opened, officials at the VA predicted they would draw about 8,000 patients the first year and grow from there.
But the following year that number dropped to 7,815: about one-third the number of county veterans.
Some of the loss could be due to the rapidly declining number of World War II veterans. But at the same time, new veterans are returning from the wars in Iraq and Afghanistan.
Lanier, the president Valor, insisted that his company’s performance has been consistently evaluated and has passed every test. He said the VA conducted internal checks, the agency’s inspector general looked at it and it was reviewed by the agency that accredits hospitals.
“They found great results,” he said of the Joint Commission, the accrediting agency. He said the VA’s inspector general also produced a glowing review.
But the VA did not respond to a request for copies of those findings.
In an e-mail response to written questions, the agency reported significant problems with the company.
The VA “is not satisfied with Valor Healthcare Inc.’s performance at our outpatient clinics in Galveston and Texas City,” the agency wrote. “We have concerns about their failure to meet established benchmarks and standards including wait times, access and patient satisfaction. We continue to work with the contractor to make improvements; however action has been taken against the contractor and if performance does not improve, further action will be taken.”
But the agency wouldn’t say what that action was or whether the company’s contract would be renewed when it expires.
Lanier didn’t return follow-up calls late last week to ask about the VA’s concerns.
Those concerns apparently don’t run very deep, though. Lanier on Wednesday said his company runs 16 outpatient clinics for the VA and was opening another on Friday.
A spokeswoman in the VA’s Washington, D.C., headquarters couldn’t say last week whether that was true and if so, where the clinic was.