VA OUTREACH CLINIC Proactive Now, Vets Are Screened For Problems

AVON PARK - Sharon Buckler was waiting for her husband Wednesday morning at the Sebring VA Outreach Clinic.

"The doctors here are fantastic," said Buckler, whose husband, Vietnam veteran James Buckler, was in with Dr. Andres Cordoba. "The service is great. The nurses are friendly."

A year ago, a Washington Post investigation of Walter Reed Army Hospital showed peeling paint, holes in the bathrooms, mouse droppings, dead cockroaches, stained carpets and cheap mattresses. Decades ago, deservedly or not, some Veteran's Administration hospitals had terrible reputations.

A quick tour of the Sebring VA Outreach Clinic showed no such problems.

Cordoba, Sharon Buckler said, found a blockage in James's carotid artery that no other physician discovered. On Wednesday, Cordoba was examining Buckler for a fatty liver.

"It does one hell of a great job," said Joseph Dionne, director of Veterans Services in Sebring. "It's a good clinic. And you can quote me on that."

New Management

The Sebring Community Based Outreach Clinic started three years ago under a contract with private providers. Late last year, the Veteran's Administration severed the contract and took it over.

"We felt more outreach could be done," said Dr. Ajay Dhawan, assistant chief of staff for the Bay Pines VA System. "The Sebring Clinic was in need of more support. We were able to improve quality and expand services."

He believes the VA system has become a model and a national leader in the past few years.

"The VA has been getting good press, in general," Dhawan said.

The outreach clinic is like a doctor's office, said Diane Hilliard, a registered nurse who is also the office manager. For that reason, appointments are needed.

"In case of an emergency," she added, "you need to go to the hospital, not here. If you're having a cardiac arrest, we'll take you back to one of the rooms and call an ambulance, but..."

Clinic patients get the sort of services a general practitioner can provide. Blood and other lab tests are sent every day by courier to Bay Pines, and the results are posted on the computer the next day.

If a patient needs a specialist, he (96 percent of patients are male) is sent to another clinic or a VA hospital. The VA system even provides heart and lung transplants, said Stephen Massey, the chief RN for Bay Pines' southern clinics, but patients may need to go to other cities, like Portland or Salt Lake City.

Big Turnaround

Dhawan asserts that VA hospitals and clinics are markedly better in the past decade. Why?

Three reasons, Dhawan suggested. One is that Dr. Ken Kizer, a top VA official, designed performance measures. The second was that the VA converted from a hospital-only system to a hospital and clinic system.

But there's a third reason, and that's a change in thinking.

"We own veterans completely," Dhawan said.

"We're going to care for them for the next 50, 60 years," said Faith Belcher, a Bay Pines spokeswoman. It makes perfect sense, she said, to offer veterans the best care available as young men and women, so that they won't need so much care when they're older.

But Dhawan's point, of course, is that the VA has appointed itself the primary caregiver, the way a spouse or a trusted doctor decides they must do what's in the patient's best interest.

That ownership concept is the reason behind a proactive approach to mental health.

When soldiers and sailors were in Vietnam, some found so much violence, cruelty and inhumanity, coupled with drugs and the lack of understanding when they returned home, that they descended into madness.

Gulf War veterans are facing different problems, but some are just as in need of psychological help.

That's why, said Belcher, that returning Gulf War veterans are screened by the Department of Defense before they're separated from active duty, and again three months later when problems reintegrating with society may occur.

"It's a lesson we learned from the Vietnam War," Dhawan said.

"Not everyone, up front, is asking for health care," Belcher said.

A psychiatrist and a mental health specialist have been added to the clinic space next door, Belcher said. A suicide hotline has been set up.

Iraq and Afghanistan vets are also screened for brain injuries, a result of encountering so many roadside explosive devices. So far, 1,800 Gulf War vets have returned and registered for VA services.

"There are many more than that," Belcher said. "That's just all that have registered."

Only 39 percent of Highlands County's 13,600 veterans have ever used the VA's health services.

"If you haven't seen us in some time, give us a chance," Dhawan said.

What's your experience at Sebring's VA Community Based Outreach Clinic? Post your remarks at Highlandstoday.com

Bay Pines VAHealthcare System

Services Available

Preventive health

Disease prevention

Diagnosis and treatment of chronic and acute illnesses

EKG

Laboratory Tests

Holter monitor and spirometry tests

Referrals to Specialists at Fort Myers clinic or Bay Pines hospital

Psychiatry

Are You EligibleFor VA Health Services?

If you're a single veteran with no dependents and make more than $27,000 annually, you're not eligible. But there are lots of exceptions:

• POWs
  
• Purple Heart recipients
  
• Operation Enduring Freedom veterans
  
• Operation Iraqi Freedom veterans
  
• Service connected disabilities
  
• Veterans separated after Nov. 11, 1998