Loading...
HomeMy WebLinkAboutCOM 0339.001 2004-2006 O7/1i/20n5 14 ?8 FAX Bob 43? 0355 COS OFFICE !dj,OG2ln1o DEPARTMENT OF VETERANS AFFAIRS VA PACIFIC ISLANDS HEALTH CARE SYSTEM Spark M. Matsunaga Medical Center 459 Patterson Roatl Honolulu HI 96819-1522 In FOply Reigr To' 00 Constance R. Kiriu, County Clerk , _r Council of the County of Hawaii 25 Aupuni Street Hilo, Hawaii 96720 r;. Members of the Council Of the County of Hawaii r am in receipt of your resolution dated July 7, 2005 pertaining to VA's proposed relocation of the PTSD Residential Treatment Program from Hilo to Oahu in January 2006. I deeply appreciate the interest and concern expressed by the Council in your resolution. I fully recognize the importance of this program to the Hflo community and approclate the many years of community support. The proposal was made only after lengthy deliberation, and only after weighing the profound benefits to ttte entire Pacific Islands veteran population. In spite of the convictions expressed in the resolution, our staff is contained with three fundamental points: 1. The resolution fails to address the exorbitant lease rate that drains scarce resources from direct care givers and plows them into rent; 2. The resolution tells to address the recruitment issue that has resulted in under-staffing for several years; 3. And finally, the praposed solution fails to provide a means by which VA can expeditiously combine the resources of the chronic residential treatment program with those resources needed to enhance acute PTSD treatment for returning combat veterans in a location and in a manner that meets their needs. I am enclosing with this letter additional attachments that provide more detailed infannation on the rationale for the relocation of the program. I do want to take this opportunity to emphasize that the plan for the move Includes an enhancement of existing mental health services in Hilo that will provide scheduled appointments for treatment of PTSD and substance abuse, services which are not now provided. I realize how important VA services are to your community, not only at the PTSD Residential Treatment facility, but at the Vet Center and the Hilo CommunRy Based Outpatient Clinic. We are committed to working with you in the administration of these clinical programs. Both my staff and I ere happy to meet with you or community stakeholder groups to further respond to any contains. Thank you for your ongoing interest and support, and for providing me with an opportunity to respond to the County Resolution. If you would like to follow up on this, or other issues, please contact Fred Ballard from my Office of Public Aftalrs, at (80B)-4~3-0049. Comm. No.~_ Ref. To: 07/15/2005 14 28 FAX 608 433 0355 COS OFFICE ~1~'» Page Two Council of the County of Hawaii Sincerely, I ~ Brian J. O'N~, M~ D Ailing Director cc: Senator Daniel K. Inouye, Senator Daniel K. Akaka, Representative Ed Case, Representative Neil Abercrombie, Governor Linda Lingle, Senator Lorraine R. Inouye. Senator Russell S. Kokubun, Senator Paul Whalen, Reprexntetlve Dwight Y. Takamine, Representative Jerry L. Chang, Representative Glift Tsuji, Representative Helene H. Hale, Representative Robert N. Herkes, Representative Josh Gresn, M.D., Repnsentatrve Cindy Evans, Robert L. Wiebe, M.D. Enclosures (2) ` ~ COS OFFICE mi'041~~1 07/15/?005 14 8 FAX 608 433 '355 ~t,, '~w DEPAATME=NT OF VETERANS AFFAIRS SPARK M. MATSUNAGA MEDICAL CENTER 459 Patterson Road Honolulu HI 96819-1522 Questions and Answers June 2005 Plans to Relocate The Hilo Residential PTSD Program to Oahu 7, Why is Vp coneidering taking away another program veterans need? VA is NOT taking a program away. Plans to move the PTSD inpatient program from Hilo to Oahu will in no way diminish mental health Care programs for Hawaii veterans. In fac(, the main reason VA Is doing this is to provide better, more comprehensive health care to even more veterans. Under this proposal, Hilo veterans will have expanded outpatient mental health care, including new sulr~tance abuse and specialized PTSD counseling. The inpatient program will still be available to them in Oahu. Veterans gain from this proposal. 2. When will the change take place? The lease for the Hilo facility will expire Dac. 14, 2005. After the December graduation at Hilo, the VA Pacific Islands Health Cara System (VAPIHCS) would like to relocate the program to Oahu and reopen in early 2006. Currently the Hilo lease is $5135,000 per year. Despite efforts by VA's contracting staff, the department was unable to renegotiate s lease at a reasonable market rate. In tact, the vendor has indicated the lease would ba raised to more than $700,01]0 annually. This alone would not have made us evaluate moving the program, but combined with the ability to better attract medical staff ai Oehu antl provide optlm um health care to our veterans, M seams the best thing to do. 3. What will happen to veterans In Hilo? A transitional program will remain in Hllo to provide continuity and follow up to patients. New patients requiring residential care, or prior patients requiring follow•up residential care, will still be able to access the care at Oahu. Under this proposal, Hilo veterans will have expanded outpatient mental health care, including new substance abuse and specialized PTSD counseling- Thls is a gain for Hilo veterans. It is important to note that nearly 67 percent of all users of the Hllo PTSD inpatient program do not come from Hilo (sea question 010). These individuals will have to travel wherever the program Is located, and on Oahu. VA will be able to provide a more comprehensive medical care package and a strong outpatient program to augment the inpatient program. 4. How will ihls move impact our newest veterans from Iraq and Afghanistan? Moving the PTSD program to Oahu will allow VA to provide better mental health care to our youngest veterans returning from Iraq antl Afghanistan. Preliminary studies have shown that over 15% of these combat veterans will suffer from some form of combat stress. These men antl women typically suffer temporary, rather than Irfe-long PTSD. The best treatment for them is outpatient, which aims to integrate treatment with their families and communities. The vast majority of Iraq antl Afghanistan veterans live 1n Oahu. The retumaes are younger, have more recent trauma exposure, and have less long-term medical and psychological problems. They will have different combat and traumatic experiences than previous patient groups. There will be a larger number of females with combaVtrauma exposure, Including military sexual trauma (MST). Many of these patients will be fulty employed, returning to prior jobs. They are less inclined to, and have less medical need for, a cohort or residential treatment model. The restructured program in Oahu will meet their needs in a way that the current program at Hilo cannot. Page 1 at 5 Pages ~~,i ii5Jnln n7/15/2005 14 29 PAX 808 43? x355 CDS OFFICE In tact, as leaders in the world for PTSD treatment, the Army has asked VA on Oahu to provide PTSD services to active duty soldiers in Oahu. This move will allow us to more effectively partner with the active duty. - 5. Explain how the current program at Hilo Is atruoturetl? The HjIaPTSD Residential Rehabilitation Program (PRRP) provides treatment for chronic (long-term) Post Traumatic Shess Disorder (PTSD), predominantly Viefiam veterans. Currently located in a secluded building in Hilo, the program provides a residential Betting wHh hospital stays up to 10 weeks. Though it is a 16-bed program, It is difficult to recruit medical staff at Hilo. Consequently, the program only operates nine beds. The patient population is small, with only 830 users during the past 10 years. The PRRP has done an excellentjob over its t0 years of operation caring for veterans with chronic PTSD. VA will leave a small contingent of clinicians at Hilo to offer continuRy and continued outreach to the PTSD patients there and to augment the current mental health services within the community based outpatient clinic. However, we must look at using the expertise of our highly spoclalized staff to help us meet the challenge of our Iraq and Afghanistan veterans. At the same time, VA in Hawaii is committed to ensuring that these new initiatives tlo not come at the expense of our ability fo care for veterans with long-term PTSD. 6. Mow will the proposed program In Oahu dNfer? VA is considering a REDESIGN OF services, not a REDUCTION IN services. VA would redesign the Current program at Hllo into a PTSD program that will treat both short-term (outpatient) and long-term (outpatient and inpatient) PTSD sufferers. VA hopes to open the new program sometime in January 2008, and io bring as many of the current employees over as will relocate to Oahu. Additionally, VA hopes to collocate wRh the Atmy and help treat active duty troops. The current Hilo program has been running on a cohort model that has been geared towards patients with long-term PTSD. There have been problems with continuity of care for patients who have graduated from the program who still require specialty PTSD services. We are actively reevaluating how best to provide follow up care and continuity of care for patients treated under this model. Liaison with the National Center for PTSD-the expertise anti resources of the National Center for PTSD, Pacific Islands Division, have not been optimally utilized in their clinical, research, and educational role at our station. Again, the na[(onal Center is located in Oahu. Are there other btenaflts of moving the Hllo program to Oahu? Collocation on Oahu would allow VA to recruit the most talented professionals from a naUOnal pool much more easily than when the program was located at Hilo, whore, recruitment was always a big challenge. furthermore, staff from the Oahu general mental health program and the specialty mental health programs (Substance Abuse Treatment Program, Mental Health Rehabilitation Program and Day Hosptal Program) to augment outpatient PTSD services. Because clinicians from the entire mental health program could augment services for the PTSD program, collocation will allow the creation of a PTSD Specialty Staff Pool, compnsed of staff from the residential and outpatient and specialty stall necessary for development and operation of a broad spectrum of PTSD services. This pool will also be able to provide specialty PTSD services via telemedioine to neighbor islands, Guam and American Samoa. Another major advantage of collocation will be the ability to create a new PTSD Intensive Outpatient Program (IOP) /Day Hospital tar patients who need short-term, intensive PTSD services rather than residential treatment. This type of care is ~deaily suited for both veterans and for DoD personnel. Page 2 of 5 Pages 1 (~J ~p61'~lu 07(15/2005 14 29 FAM 808 433 X355 COS OFF_CE 8. What fa the IOPlDay Noapltal program? Intensive outpatient treatment (IOP) or PTSD pay Wospital will be outpatient•based, high-intensity treatment delivered primarily through group therapy. It will emphasize preventive aspects of health care and education with an emphasis on speclalry needs for PTSD patients such as anger management, stross management, symptom manatee erttent, and substance abuse treatment. The program will be conducted " on weekends and evenings in urban ionolulu to maximize accessibility to veterans who are working, In ' school, or are active dirty on temporary assignment to receive mental health services. It would run on a "cohott' model. The length of each cycle would need to be determined based on program content. 9. Where would the program be located in Oahu? VA is exploring a number of options at this time, including Tripler Army Base and other DoD facilities. The VA Pacrfic Islands HeaRh Care System has applied for construction funding for a new building in Oahu to house the PTSp progrems. Indications are vary strong that ihls project (totaling $7 million) will be funded for construction in fiscal year 2007. This program would allow our PTSD specialists to collocate with Army specialists. VA would be able to re-direct over a half million dollars annually, currently needed for the lease at Hilo, Into hiring doctors, psychologists and nurses to treat veterans. 10. What is the statiatlcal breakout of the Hilo program? Of the 830 vetefane treated in the Hilo program, the vast majority are from the Vietnam War. The Korean War vets and the WWII vets are a much smaller user group and we do not anticipate an Increased need for services from this group. The distribution of vets seen at Hilo IS as follows: Oahu: 16% Blg Island total: 28°~ Hilo: 13% Kona 15% Maui and Molokai: 16% Kauai: 5% Guam: 13% Samoa: 10% Mainland: 12% (Mainland veterans are taken only on a space available basis) Over the last 5 years, the trend has been an increasing number of veterans from Samoa and Guam, where there are fewer mental health services available. Historical use of the Hllo program by Oehu veteran9 has bean less because of the readily available outpatient services in Honolulu. VA's long-term plan continues to be directed toward enhancing PTSD services within our CBOCs to improve access. 11. Mow many Hawaii adlve duty, Reserve and National Guard have deployed? Active Dutyfrom Hawaii • 10,000 members of the Arms 25`" Infantry Division stationed at Schofield have returned home, the last of them this month • B00 Marines stationed at MCe Kaneohe are on the way home, some are home already, and most should arrive in June 2005. • Air Force has small numbers of detachments deployed, usually for afour-month tour. • Navy has about 1,500 to 2,000 deployed on ships and submarines at any one time, and a few shore based small unfts Page 3 of 5 Pages 07/15/2005 14 29 FAX 808 433 X355 COS OFFICE 0 ~07/n10 ReseryeMational Guard from Hawaii • Hawaii's 29'" Infantry Brigade, of which the 442"tl end t00'" are a part, deployed in country in March. Their number is about 3,100. The makeup is troops from around the Pacrfic Basin as well _ as Hawaii antl California, About 2,500 are from Hawaii, Guam, American Samoa and other ~ islands. The 29" was activated for 18 months and should return to Hawaii around March 2006. ' • A Reserve PAO group was activated and left far Iraq this week. A total of about 30 • Army Civil Affairs Detachm®nt was aMivated but has not received orders to depart yet: Total about 90. • The 411'" Engineer Battalion, Army Reserves has returned home this past month, about 400 people total. Page 4 of 5 Pages S3j~~08Jo1n 07/15/2005 14.29 FAX 808 433 r'355 COS OFFICE General VA Mental Health Information VA runs 144 national specialized PTSD programs, including outpatient, inpatient and residential care programs. In FY 2004: 244,232 patients with PTSD were treated in general outpatient mental health settings, an additional 13,000 were treated by. PTSD specialists working in gcneral mental health clinics, and 65,000 wore seen in specialized PTSD Clinical Teams (PCTs). An eddftional 21,000 were seen in non-mental health settings such as primary care. VA has treated 6,400 veterans of Operation Iraqi Freedom and Operation Enduring Freedom for PTSD. VA and DoD conducted a joint conference in March of 2005 focused on Initiatives that will ease the transition from soldier to veteran for returning OIF/OEF troops VA placed Social Work case managers in major DoD hospital facilities such as Walter Reed, Madigan, and Bethesda to facilitate the transition of OIF/OEF Veterans to VA. VA, in conjunction with DoD, established a Clinical Practice Guideline for the treatment of PTSD. This is the first CPG for PTSD that was ever created. VA maintains the National Center for PTSD that promotes research and education on PTSD within VA and in collaboration with DOD. The NCPTSD web site www.ncptsd.oro describes the NCPTSD Divisions and their accomplishments and provides valuable Fact Sheets for clinicians, veterans, their families and the general public. The PaclFic Center for PTSD (Hawaii) focuses specifically on ethno-cultural issues. The NCPTSD created the Iraq Clinician War Guide in 2003 to assist VA clinicians in meeting the needs of veterans returning from Iraq and Afghanistan. VA will invest $5 million in new programs }or PTSD, $5 million in programs for OIF/OEF Veterans, and $5 million for substance abuse treatment programs through the implementation of PL 108-170 in FY 05. VA's 206 Readjustment Counseling Centers have added 50 Global War on Terror (GWOT) veterans as peer counselors to assist troops in transition from military to civilian life. Page 5 of 5 Pages 07/15/?005 14.30 FAK 808 433 X355 COS OFFICE f~~09/~~10 DEPARTMENT OF VETERANS AFFAIRS Pacific Islands Health Care System Spark M. Matsunaga VA Medical Center 459 Patterson Road Honolulu, Hawaii 96819-1522 NEWS RELEASE VA ! OOKS TO IMPROVE MENTAL HEALTH CARE FOR HAWAII VETERANS EMBARGOED UNTIL 6-28.05 June 28, 2005 Contact: Public Affairs Office Fred Ballard: 808-433-0049 Fred Ballard@med.va.gov Kern Childress: 650-444-6461 Kerri Childress@med.va.gov Oaha, Hawali -Oahu, Hawaii -The Department of Veterans Affairs Pacific Islands Health Care System (VAPIHCS) is plantting to collocate iu Post Traumatic Stress Disorder (PTSD) residential program at Hilo with its outpatient program at Oahu in Januazy 2006, providing more comprehensive and better mental health caze to more Hawaii veterans. The PTSD Residential Rehabilitation Program i.s a 16-bed treatment program for chronic (long-temp) PTSD, which has been located at Hilo for the past 10 yeazs and predominantly serves Vietnam veterans. Approximately 75 percent of veterans who have used the 10-week program came from outside the Big Island and only 13% come from Hilo. "Tt's imperative that veterans understand that moving this program will in no way diminish mental health care for Hawaii veterans." said Dr. Brian 7. O'Neill, acting director of the VAPIHCS. "Quite the contrary, by collocating the residential, or inpatient, program with the outpatient and with more extensive and accessible general medical caze, we will be able to provide a comprehensive, continuum of health care we have not been able to provide in the past." Additionally, the plan calls for expanded outpatient mental health programs for our Hilo veterans, including new substance abuse and speciahaed PTSD counseling. For our newest veterans from Iraq and Afghanistan, moving the program to Oahu will allow VA to provide better mental health care, both inpatient and outpatient. Preliminary studies have shown that more than 15 percent of [oday's combat veterans will suffer from some form of combat stress and come to VA for treatment. Acwrding to Dr. Andrew D. Bisset, director the Hilo PTSD program, "We know that these men and women typically suffer temporazy, rather than life-long PTSD. The best care for them is outpatient, which aims to integrate treatment with their families and communities. We also know that the majority of retummg combat veterans live in Oahu and combining the inpatient and outpatient program is the best solution for them and, in fact, all veterans." -more- x7/15/2005 14 30 FAX 808 433 9355 COS OFFICE i~x;nto The proposed move also will allow VA to partner with the Department of Defense and work side-by- side with active duty doctors to provide world-class PTSD treatment to active duty soldiers in Oahu. "Evidence indicates clearly that the sooner we can provide counseling to men and women who are suffering, the better the outcomes are for them," said Dr. Bisset. The lease for the facility that currently houses the Hilo inpatient program will expire Dec. 14, 2005. Cuurently, the lease is $585,000 per year. Despite efforts by VA's contracting staff, the departrnent was unable to renegotiate a lease at reasonable market rate. In fact, the vendor has indicated that extending the lease will cost more than $700,000 annually. "Phis alone would not have made us evaluate moving the program," said Dc O'Neill, "but combined with the ability to be[[er attract medical staff at Oahu and provide optimum health care to our veterans. it just seems the smart thing to do_ "1 think the easiest way to describe the move is to say the VAPIHCS wants to redesign mental health services at Hilo into a PTSD program that will treat both short-term (outpatient) and long-term (outpatient and inpatient) PTSD sufferers," said Dr. O'Neill. "We are committed to ensuring that we stand prepared to take on our newest veterans from Iraq while at the same time providing care for our heroes from World War II, Korea and Vietnam." --30--