VA backs directive against recruiting
        Activists question policy on hospitals
 

By Laura Ungar
        lungar@courier-journal.com<mailto:lungar@courier-journal.com
        The Courier-Journal, Louisville, Kentucky


        The U.S. Department of Veterans Affairs is standing behind a regional directive that says veterans hospitals "may not aggressively take steps to recruit new enrollees or new workload."

        "We have not abandoned the policy," said Sandra Glover, spokeswoman for VA MidSouth Healthcare Network, which includes hospitals in Louisville and Lexington.  Both local and regional officials argue the policy doesn't preclude all outreach to veterans -- the Louisville Veterans Affairs Medical Center, for example, has participated in numerous such activities, including health checks at an AMVETS convention, a safety fair and smoking cessation activities.

        But Amanda Hedlund, acting public affairs officer for the Louisville medical center, reiterated that the hospital is not allowed to "go after" new enrollees. The policy question arose after former Miss America Heather French Henry moved a veterans wellness event from the Louisville Veterans Affairs Medical Center after officials there told her the language on her event posters was a problem.

        The posters included the phrases: "New Resolution? Try the VA Solution," "Enroll for VA Healthcare" and "Learn about other Veterans Benefits."  Citing growing enrollment and limited resources, a 2002 federal memo directed regional VA health officials to "ensure that no marketing activities to enroll new veterans occur within your networks."

        Second memo issued


        A 2004 federal memo sought to offer further guidance, reiterating points made in the 2002 memo but also saying network directors need to maintain or improve outreach to veterans and distribute information about benefits and services to eligible veterans.

        The MidSouth directive, issued last July, outlined which activities are allowed. "For me, the situation is absolutely shocking. I cannot believe our legislators -- the people in Washington, D.C. -- would allow such a directive. . How can this be when our soldiers are giving their lives?" said Sandra Myers, a retired Army sergeant from Cadiz who is the host of a radio program called Veterans' Voice. "At the bottom line, it's the dollar. Somebody needs to step in and do something."

        Mike Penney, state commander of the Veterans of Foreign Wars, said he plans to raise the issue when his group meets with members of Kentucky's congressional delegation in March.

        U.S. Rep. Anne Northup, R-3rd District, and a member of a House subcommittee dealing with the VA, said through a spokesman that she plans to discuss outreach policies with the new VA secretary.

        "I support outreach efforts to veterans in our community. At the same time, we must ensure that current enrollees receive quality care," she said, adding that VA health-care dollars have risen significantly in recent years.

        In response to the controversy surrounding Henry's wellness event, VA officials released a statement this week that said the Louisville hospital has participated in 11 major veteran outreach events, that it will continue to participate in such events and that it will not turn away veterans eligible for care.

        Officials pointed out that the Louisville medical center's returning combat veterans coordinator attended Henry's event and distributed brochures -- even though Henry said at the time that she knew of no one from the medical center at the event.
        They also said the hospital has increased the veterans it serves by more than 10 percent in the past three years. But the statement also said:

        "We are concerned, however, about the possibility that the large increase in demand Louisville and other VA facilities now face may create increasingly long waits to see VA health-care professionals in the future, and so we try to balance our ability to solicit veterans to enroll for our care with our available capacity and resources."

        Demand exceeds resources


        The 2002 federal memo from Laura Miller, deputy undersecretary for health for operations and management, tied the marketing restrictions to "the continued demand for healthcare services that exceeds our resources."

        VA officials said Miller's 2004 memo said the Veterans Health Administration has continued to reach out while eliminating the backlog of patients waiting for VA health-care providers and reducing the number of new enrollees waiting for appointments. It asked regional health network directors to continue outreach "while recognizing the need to balance commitments to new populations with available capacity and resources," and said specific outreach to veterans who fought in Afghanistan and Iraq is especially important.

        Five months later, the MidSouth network's "outreach activities policy" said facilities within the network may continue to participate in health fairs, open houses, veterans' service organization conventions and conferences. But they can't, it said, distribute enrollment applications en masse, issue public-service announcements on enrollment, send mailings to veterans about enrollment or collect names of veterans who want to enroll. The directive says it expires "when the moratorium on enrollment marketing, imposed by VA Central Office, is lifted."

        Enrollments based on need


        All veterans are potentially eligible for VA care, but they must enroll in the program, and the VA enrolls based on priority groups, which include those with disabilities connected to their military service, former prisoners of war and certain low-income vets.

        In the Kentucky and Indiana counties served by the Louisville VA Medical Center, there are 166,609 veterans, and 48,892 were enrolled at the end of the 2004 fiscal year. Nationally, federal officials estimate there are more than 25 million veterans, and 7.4 million were enrolled in VA health care facilities at the end of fiscal 2004.

        Some veterans and advocates said Congress needs to provide more VA funding.
        The Louisville medical center's budget rose 22 percent from fiscal 2001 to fiscal 2004, slightly less than the regional and national budgets. The Louisville medical center's budget is $132.6 million this fiscal year, officials said.

        Charles Walter of La Grange, a former VA psychologist who worked in various medical centers, also said the VA needs more money for its medical centers, and agreed that some veterans are unaware that they may be eligible for care.