HIBBING, MINN. – The 6-inch scar running down the middle of Lonnie Lee's chest is one sign that all might not be well at the Veterans Affairs clinic here.
Lee, a 65-year-old Navy veteran of the Vietnam War, wears the scar as a badge of honor. He had to wait five months for open heart surgery and said he endured a circuitous ordeal of mixed signals, runarounds and missed cues to get it.
Veterans like Lee and their advocates contend that problems began at the clinic last year, when the VA hired a new company, Cincinnati-based Sterling Medical Associates, to run it. The complaints about the clinic, located in an old storefront on the outskirts of town, resemble problems evident at VA medical facilities across the country.
Internal e-mails about record keeping suggest that managers were concerned about failing to meet a 14-day appointment window and urged employees to go in and fix the desired date after the fact.
Vets in chronic pain say they have been stripped of medications after being branded drug abusers. Some say they are forced to buy drugs on the street to relieve their pain.
"They're just trying to make a profit as a corporation and that's understandable," said Lee. "But it's on the back of the veterans and it shouldn't be done that way."
Sterling strongly denies that it has instructed its employees to falsify records. It points out that the Hibbing clinic and its satellite in Ely recently were audited by the VA and no evidence of wrongdoing was found.
The Minneapolis VA, which operates the Hibbing clinic, said it has a strong partnership with Sterling and has no concerns about how it schedules patients. Under Sterling, the VA says, more veterans are being seen and wait times for appointments have decreased.
"There is no evidence of inappropriate scheduling practices at these clinics," the VA said in a statement.
Hugh Quinn, a veterans advocate for Itasca County with a 29-year career in the Army, said his office has accumulated more than two dozen written complaints about the clinic since Sterling took over.
"Until this new provider took over, there were very few complaints about the service there," Quinn wrote in a letter to U.S. Sen. Al Franken.
U.S. Rep. Rick Nolan, the congressman who represents the area, called the reports "very disturbing" and has scheduled a July forum in Hibbing to hear more.
System under fire
The VA medical system, which serves almost 9 million veterans annually, has come under fire amid claims of false record keeping and long waiting lists for care at facilities across the country. A May report from the VA's inspector general called inappropriate scheduling "systemic." In some places, veterans have died while waiting for care. The furor led to the resignation of VA Secretary Eric Shinseki.
The scandal so far has focused on improprieties at some of the 151 large VA hospitals like those in Phoenix and Albuquerque. But the VA also operates 820 clinics like the one in Hibbing, providing outpatient and primary care to vets. The numbers of outpatient visits are skyrocketing as an aging veteran population coincides with young combat veterans suffering from multiple medical and psychological issues.
Complaints begin
The Hibbing VA Clinic serves about 3,400 enrolled vets from four counties in northern Minnesota. California-based Health Net had operated the clinic under a contract with the VA since 2002, providing primary care, mental health care, women's health care and preventive health services to enrolled veterans.
Sterling was awarded the Hibbing contract in March 2013. It is reimbursed $62.02 per veteran per month by the VA, with additional reimbursements for such things as mental health services.
Shortly after taking over, Sterling announced plans to move a satellite clinic from Cook to Ely, about 45 miles to the east in St. Louis County.
Then the complaints began from vets like Lee. He went to St. Mary's Hospital in Duluth for heart scans in October. The doctor said they had detected blockage in his heart and recommended an angiogram and possible stents. Lee said he needed permission from the VA, and St. Mary's sent the results to the Hibbing clinic, which forwarded them to the Minneapolis VA. After two weeks the St. Mary's cardiologist called Lee.
"They said, 'You need to get in here right away. This is serious,' " Lee said. Lee said his doctor in Duluth called the Minneapolis VA, who told him they had looked at the results and didn't see anything wrong.
In March, Lee had another heart attack and was taken again from Grand Rapids to Duluth, where a pacemaker was put in. During a follow-up visit in Minneapolis for prostate cancer, Lee confided his concerns about his heart to a patient advocate. A few weeks later, Lee got a letter telling him to come down to Minneapolis. They wanted to do an angiogram.
After the angiogram, Lee said he was told he needed open heart surgery immediately. He was on the operating room table the next day. It had taken five months.
"Five months is a little bit too long to wait when you are having an emergency heart problem," Lee said.
Lee said there have been clear changes since Sterling took over the Hibbing clinic.
Kraig Olson, a 45-year-old veteran of the Minnesota National Guard, has been on VA-prescribed pain medications for years. He suffered a back injury when a large box fell on him during summer training exercises.
Olson is homeless, living in a lean-to outside of Grand Rapids with a Chihuahua mix named Poncho. He's been unable to wean himself off the prescribed painkillers at a time when the VA has tightened its rules for distributing its narcotics.
Seeking relief wherever he could find it, Olson tested positive for marijuana and was booted off VA medications. He admits to buying his pain meds on the streets. Olson said he once waited on hold for four hours to speak to someone at the clinic before the office closed for the day and his call went to voice mail.
Political pressure
"Before it was a bureaucratic mess and it was a nightmare, but if you stood there and walked it through you could make some things happen," Olson said. "Since the new people started, they're nonexistent. You can't get any response."
Eighth District congressman Nolan has received complaints from veterans about how the clinic is operating, ranging from high staff turnover, to a spike in the number of patients, to lack of access to medications such as insulin, to systemic problems within the VA bureaucracy that inhibit open communication.
"Make no mistake — we are going to get to the bottom of this situation and fix what needs to be fixed," Nolan said in a statement.
Fourteen-day window
An e-mail to Sterling employees last October suggests managers have concerns about appointments that extend past the 14-day goal established by the VA.
The e-mail, from a Sterling clinic coordinator in Minnesota, reminds employees to pay attention to "desired date vs. actual apt. date" and raises concerns about 63 errors on what are known as clinic access reports. The e-mail suggests correcting the error by "fixing the desired date (as was put for the date the apt was made and was not the actual desired date). This should be no more than 14 days apart."
The e-mail continues: "We cannot 'lie' with this as I am sure there are some acts that have to wait 14 days over the desired d/t availability, but hopefully we can start improving this as well."
Sterling, responding through a Dayton, Ohio, law firm, said the e-mail shows employees were only being asked to correct appointments scheduled incorrectly to begin with, not to falsify records, and said it conducted two days of training for schedulers when they transitioned from the old contractor.
"If there are truly scheduling errors, then they should be fixed," the statement said. "The (manager) specifically instructs staff not to lie and if some appointments need to stay as is, they should do so."
'Unfair favoritism'
Dr. Bruce Garbisch worked in the Hibbing and Cook VA clinics with Health Net for almost a decade, but quit during the transition to Sterling. He said he became concerned when Sterling began plans to move its satellite clinic in Cook to Ely, saying it could serve more vets. Garbisch said he protested to officials in Minneapolis, challenging Sterling's figures justifying the move, and said that veterans in the Cook area would be inconvenienced.
Sterling and the Minneapolis VA seemed set on the move, Garbisch said, to the point where he sensed "inside politics and some unfair favoritism."
Sterling offered Garbisch a position but he declined, and now works in private practice at the Scenic Rivers Health Services in Cook, where he said he sees a number of his patients from the VA clinics. He saw Sterling's approach as unprofessional and penny-pinching. "I said, 'I am not going to have any part of it,' " Garbisch said.
Asked about Garbisch's charges, the VA said data showed that at the time of the new contract 429 veterans lived in Ely and 222 vets lived in Cook.
"The former provider in question also works at the Cook Hospital [location of prior Cook VA Outreach clinic] and advised that he did not want to travel from Cook to the new outreach clinic [in] Ely," the VA said in a statement.
'Strong partnership'
In response to written questions from the Star Tribune, a Minneapolis VA spokesman said the VA does not have concerns about how appointments are scheduled at the Hibbing and Ely clinics. The clinics in Hibbing and Ely were not flagged for additional review of scheduling issues in a nationwide audit released last week, though a community clinic in Rochester was. The VA said it communicates at least weekly with Sterling about access for patients.
Same-day appointments with a desired provider have increased under Sterling from 36 percent to 56 percent, the VA said. Since Sterling took over, it has added more than 200 new patients.
"The Minneapolis VA has a strong partnership and close working relationship with Sterling," the VA said in a statement. "The Minneapolis VA and the community clinics, operated by the Minnesota VA and its contractors, follow national performance guidelines."
Mark Brunswick • 612-673-4434
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