Nation

Mental health care found wanting at North Carolina VA hospital

NationHospitals and ClinicsU.S. Department of Veterans Affairs
For new mental health patients, the average wait time is 104 days at the Durham VA Medical Center
North Carolina's VA hospitals struggle amid one of nation's largest veteran communities

 Andrew Danecki, a Marine Corps veteran who served two tours in Afghanistan, suffers from sleep apnea that left him nodding off on the sofa and behind the wheel of his car. He said he waited eight months to get a sleep study performed at the Durham VA Medical Center.

Dennis Hunter, a Vietnam-era Army veteran, waited several months for an orthopedic appointment for knee and back injuries that require him to use a wheelchair.

The Durham VA Medical Center had the longest average wait time for new patient mental health appointments — 104 days — in a nationwide auditof veterans' healthcare facilities released this month. The hospital also had the nation's seventh worst average wait times for new patient specialist care appointments: 69 days.

"I feel like they just don't know what they're doing, and don't really care," said Danecki, 27. "It's like vets get healthcare for free, so why should they do their best work?"

North Carolina's four main VA hospitals struggle under demands from one of the largest veteran communities in the nation — about 770,000, many living near large military bases such as Ft. Bragg, Camp Lejeune and Seymour Johnson Air Force Base. The Durham VA served 64,000 patients last year, and to many veterans, the facility seems impenetrable when it comes to getting specialty care.

"They have so many problems here, I don't know where to start," said Hunter, 68, perched on his wheelchair in a crowded waiting room inside the red-brick hospital in downtown Durham.

Officials at Durham have challenged the national audit's methodology, saying that more than half of new mental health patients were actually seen within 14 days this fiscal year, with new patients waiting an average of 25 days for their first appointment.

"We are heading in the right direction and have already made significant improvements," said DeAnne Seekins, the Durham VA director.

The hospital said it has added dozens of mental health staffers in the last two years, and is recruiting 18 additional mental health providers. The hospital opened a Mental Health Access Center last year, which provides emergency psychiatrist services, in an effort to reduce wait times.

"We have made great progress in wait times, but are not where we want to be yet," said Dr. Richard Weiner, chief of mental health services at the Durham VA.

Pete Tillman, a spokesman at the facility, said growing patient demand and a lack of hospital space had contributed to problems. He said the hospital had expanded its hours, opened weekend clinics and planned to open a third mental health access clinic.

Two employees, a doctor and an administrative staffer were placed on administrative leave last month after an internal review found irregularities in appointment scheduling.

The VA audit found that none of the 141 medical facilities examined across the country met the agency's goal of seeing all new mental health patients within 14 days. At 30 facilities, the average mental health wait was more than 40 days.

The Durham VA, affiliated with top-ranked health systems at Duke University and the University of North Carolina, has enjoyed a reputation for quality care — once it's delivered. And even veterans who complain of long waits and poor follow-up care say specialty treatment there has been good once they finally receive it.

But experts in mental health say follow-up care is often inadequate at VA hospitals, in part because the agency is unable to attract enough psychiatrists and other specialists to meet new demands.

The VA's lengthy hiring procedures — up to six months — discourage promising young interns from working there, said Lizbet Boroughs of the American Psychiatric Assn. Unlike private hospitals and many other government hospitals, she said, the VA doesn't offer medical loan forgiveness to job applicants, who are often up to $100,000 in debt.

"The VA needs a more level playing field" to compete for mental health providers, Boroughs said.

The problem with mental health care goes beyond wait times for appointments and stretches far more widely than the hospitals in North Carolina, say many who have worked with VA facilities.

Internal VA reports and federal investigations dating back nearly 14 years have documented long wait times, inadequate care and mental health shortcomings.

In 2011, a federal appeals court in San Francisco declared the VA's mental health treatment so inadequate that it was unconstitutional. "The VA's unchecked incompetence has gone on long enough," the court majority wrote in a 2 to 1 ruling that was later overturned. "No more veterans should be compelled to agonize or perish."

Ralph Ibson, who studies mental health issues for the Wounded Warrior Project, said VA hospitals often cut costs by pushing veterans with mental health problems into group therapy when they need individual therapy. The VA has limited programs for follow-up mental health treatment, he said, often delaying such care "until the veteran's condition deteriorates to the point of crisis."

He said the agency tended to use a "dart throw" process that allocated precious mental health staff erratically, with the facilities that need the most help often not getting it.

Danecki, the Afghanistan veteran, said he was able to see a VA psychiatrist without an extended wait. But when the doctor prescribed a sleep study for his apnea and exhaustion, it took eight months to schedule it.

He ultimately received a machine to regulate his breathing, and now his apnea is under control. He also has been diagnosed with PTSD, he said, but will not be visiting the Durham VA for treatment. "After what I went through there, it wouldn't be worth my time."

david.zucchino@latimes.com

Copyright © 2014, Los Angeles Times
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