Tester holds hearing on veterans' health care needs

U.S. Sen. Jon Tester heard a firsthand account on Saturday of why health care for veterans needs to change.

In tearful testimony, 27-year-old Casey Elder of Billings, a veteran of the war in Iraq and Purple Heart recipient, told of her frustration in getting the care she needs.

"Today I want to speak on behalf of the veterans that are disillusioned and frustrated and feel brushed off by the VA," she said during a 2½-hour field hearing of the Senate Committee on Veterans Affairs.

Elder was one of 10 speakers on two panels who addressed Tester during the hearing held at the Hilton Garden Inn in Billings. The focus was on improving access to quality health care for rural veterans.

A room full of veterans and others listened to the speakers and to Tester's comments and questions, and several shared their thoughts at the end of the meeting.

Tester welcomed the crowd at the start of the gathering, saying similar meetings in the past have proved beneficial.

"Today's hearing is the latest in a long series of meetings I've held in Montana to hear from veterans about what is working and what isn't," he told his audience.

Already that input has helped to boost mileage reimbursement rates for disabled veterans, opened new clinics and vet centers around the Montana and helped pass the rural Veterans Health Care Improvement Act, Tester said. But more can be done, he said.

Members of the panel included officials within the Veterans Administration, medical representatives who work with vets and retired members of the military. Several of the speakers agreed that there have been improvements over the past several years.

But many of them also pointed out the struggles veterans in a rural state face trying to get the health care they need. Issues range from a lack of coordinated  electronic medical records to the difficulty of getting timely appointments, from the long drives required for medical attention to the shortage of specialty physicians.

Elder, now a full-time student at Montana State University Billings, served in Iraq from 2003 to 2004. She sustained injuries in an IED attack during the last month of her deployment.

When Elder arrived home, she enrolled in the VA health care system to get continued care for her wounds. For the past eight years, she received most of her medical care in the system.

Elder commended the VA for using technology, such as Telehealth, which has allowed her to meet with her Helena-based physician online, saving her many hours of travel.

But she has experienced frustration as well. Last fall, as she battled a persistent case of bronchitis, her Billings provider referred her to an ear, nose and throat specialist.

That meant two four-hour round-trips to Fort Harrison in Helena. She went once, and saw a physician for less than 15 minutes.

When she was asked to return for a second visit, she couldn't bring herself to do it.

"Due to the nature of having a traumatic brain injury, driving for more than an hour or two at a time can be incredibly taxing and exhausting for me," she said.

In another case two years ago, Elder needed to undergo an in-office cervical biopsy to check for abnormal cell growth, for signs of cancer. She had undergone the procedure before and knew about the pain it involved.

Elder asked to have the procedure in Billings, which required a referral to a non-VA physician, and she asked to see a female physician. Instead, after phone calls to five different people, she was told she would have to travel to Helena to see a male physician for the procedure, and she'd have to wait three months.

"None of this was sufficient, given the threat of cancer," Elder said. "I was seen by a local female doctor less than 10 days later and paid for the procedure with $300 out of my own pocket, funds that are scarcely available to full-time students.

Since then, Elder said she has received all of her obstetrical care in Billings and paid out of her own pocket.

James Ahrens, of Cascade, chairman of the VA's Veterans Rural Health Advisory Committee, told Tester that once members of the military come out of the service, they don't always enroll in the system.

"So people are lost," he said. "I have a friend who lives next door to me who has never been in the system. He was in the Korean War."

More care needs to be offered in the towns where vets live, Ahrens said. Since the majority of vets in Montana live in rural areas, "why don't we take services out to them?" he asked.

Jeffrey Neuberger, associate chief of Patient Care Services for the VA Montana Health Care System, gave an overview of care available to vets in the state. Neuberger said the VA has tried to meet the challenges posed by the state's geography.

That has included participation in the Access Received Close to Home (ARCH) program, a three-year pilot program to provide health care closer to home. Under ARCH, eligible veterans can seek care from Humana network providers that have contracts to provide inpatient care and consultations.

The program began in Billings in late August 2011.

Billings will see an expansion of its community-based clinic, he said. And a Telehealth program is in place to connect vets and providers with no need for travel, he said.

"There are over 25 active Telehealth programs in place, making it one of the top performers in the VA," Neuberger said.

Dr. Mark Rumans, physician in chief at the Billings Clinic, said his organization is glad to be part of the ARCH program.

"Overwhelmingly we have seen vets who are grateful to get their needs met in the community," he said.

Rumans related cases of vets who had waited a long time for surgeries that they got quickly through ARCH. But Rumans also told about 22 patients enrolled in the clinic's oncology program, also through ARCH.

All of a sudden, the VA pulled the patients back into the veterans system in January, with no explanation, he said. Even with intervention from Tester's office, Rumans said, only three were returned to Billings Clinic for follow-up.

"It was difficult to facilitate an orderly transition of care," he said.

Norm Paulson, of Billings, junior state vice commander for the Disabled American Veterans, spoke about the challenge vets face traveling long distances for medical care. Paulson told the story of an 84-year-old Plentywood man who had undergone a wrist operation and had to go to Fort Harrison in Helena for a follow-up visit.

The five-day trip, done in segments, took him from Plentywood to Miles City, Miles City to Billings and Billings to Helena, and then back home, all for an X-ray to see if the wrist had healed.

"I know for a fact they have X-ray machines in Plentywood," Paulson said, drawing some laughs from the audience.

After the hearing ended, Tester said he was leaving with one major overall thought: communication.

"I think we need to do a better job of communicating between the VA and private providers," he said. "I think we need to do a better job having the VA communicate to veterans the services that are out there."

Tester said some components of the health system are working very well, and some need improvement. He added that with more women joining the military there also needs to be more attention paid to their health care needs.