By Helen Klein
The Brooklyn Veterans Administration Hospital may be a great place to visit, but, as to what the future may hold for the institution, there are no guarantees. That was the upshot of a visit by Department of Veterans Affairs (VA) Secretary James Nicholson to the Brooklyn VA Hospital, at Poly Place and Seventh Avenue. The visit, which was hosted by Representative Vito Fossella, was intended to highlight the important role that the facility plays in providing medical care to the tens of thousands of veterans from the New York City area who rely upon it. The visit was strategically timed. Currently, a feasibility study is being conducted by PricewaterhouseCoopers at the recommendation of the CARES (Capital Asset Realignment for Enhanced Services) Commission, with the goal of providing an appropriate level of medical services to area veterans over the next two decades. One possible outcome of the study – which has veterans and advocates concerned — is that the VA would close down or consolidate medical services in the New York City area. Process “Midstream” That the Brooklyn VA Hospital would be shut was a possibility that Nicholson declined to rule out. While noting, “This is truly another star in the constellation of VA medical facilities,” the secretary said, when asked about the institution’s future, that the CARES process was, “Midstream. “It’s not completed,” he emphasized, “and it would be ill-advised and premature to in any way preempt that system. But, as I said earlier to a group of staff here, the prime determinant will be what is best for the veterans. We are trying to make sure that veterans’ health care is excellent, accessible, convenient, safe, modern and cost-effective.” Fossella, for his part, noted that the hospital, “Services thousands of veterans annually. It does a great job and it would be a shame if it were to close. I intend to do everything possible to keep the Brooklyn VA open.” One argument, that he recalled he had made at a public hearing a few months back, was that, “Given the quality of care here, it would be in the nation’s best interests to keep the facility open. “We are trying to pull out every stop,” Fossella added. “We have a responsibility to all the men and women who defended and protected America to ensure they have access to the highest quality health care. As the old saying goes, ‘If it ain’t broke, don’t fix it.’ I will continue to oppose any changes that could lead to a reduction of health care services at the Brooklyn VA or the hospital itself being closed.” Three Possibilities There are three options that Fossella said would be acceptable as a result of the CARES study – keeping the status quo, adjusted to provide appropriate amounts of various services; realigning services along clinical lines, keeping oncology in Brooklyn and siting cardiology, orthopedics, surgery and women’s health in Manhattan, with acute care services at both locations; and the incremental consolidation of specialty services at both sites, with existing Community Based Outpatient Clinics expanded and new ones developed. Currently, according to Nicholson, there are 157 VA medical centers across the United States. Of the 24.8 million veterans, he said, 7.5 million are “enrolled in the health care system.” Questioned as to the effect that being at war has had on the call for VA medical services, Nicholson said that, of the million military personnel who have been “deployed to the combat zone,” approximately 135,000 have been enrolled in the VA medical system. “Interestingly,” he noted, “many of those have come to us for dental care,” because of the lack of such treatment during their deployment. Gap in Care Nonetheless, while, according to Fossella, “The VA budget has grown by 50 percent in the last five years,” there may be a gap in services provided, particularly to veterans returning now from war. According to the Republican Policy Committee, over 15,000 military personnel have been wounded in Iraq and Afghanistan. “The majority of the wounds sustained resulted from explosive devices, which produce blast and fragmentation injuries,” the committee wrote in Homeward Bound, a paper dedicated to analyzing the “long-term health care needs of our returning veterans.” A reality, said the committee is that, despite body armor and helmets, “Arms and legs are often unprotected, resulting in extremity wounds. Severely injured limbs require amputation. Likewise, large explosions produce concussive injuries to the brain and spinal cord. A far greater proportion of the injured veterans returning from Afghanistan and Iraq have sustained head and spinal cord injuries and extremity wounds requiring amputation than in previous wars.” Because of this, the committee wrote, medical care for many of the new veterans will be “life long” and “greater than in previous wars.” Yet, according to From Vietnam to Iraq: Ignoring the Veteran Health Care Crisis, a paper produced by Vietnam Veterans Against the War and co-sponsored by Iraq Veterans Against the War, veterans’ health services are, “Underfunded and overwhelmed by a growing number of veterans seeking quality medical care. This crisis will continue to grow as the system is flooded by new veterans who have been injured during their tours of duty in Afghanistan and Iraq. “Without massive changes,” the veterans groups wrote, “millions of veterans who have been promised access to health care will slip through the cracks of the VA system.” While the VA is undergoing an assessment to decide upon possible consolidation of services, From Vietnam to Iraq contends that precisely the opposite is required. “The VA,” the paper reads, “must expand current services and improve access to quality medical care in order to meet the actual needs of the millions of veterans across the country in a timely manner.” Some Stats Approximately 60,000 veterans are enrolled for care at VA New York Harbor, according to statistics provided by the Brooklyn VA Hospital. Approximately 16,500 Brooklyn veterans use the Brooklyn VA, as do 3,825 Staten Island veterans, for a total of over 222,000 visits per year for veterans from the two boroughs. VA New York Harbor includes the facilities in Brooklyn, Manhattan and Queens. In total, according to a hospital spokesperson, there are about 720,000 ambulatory care visits per year in the region’s facilities, with about 305,200 to the Brooklyn VA hospital. About 1,500 returning Iraq and Afghanistan veterans are enrolled for care at VA New York Harbor. The Brooklyn VA hospital has 147 beds, and served approximately 3,000 in-patients in 2004.
