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Wednesday, 23 June 2010 14:41

Franklin clinic demonstrates V.A.’s great leap forward

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The Veterans Administration’s community-based outpatient clinic in Franklin will be just two years old in August, but it’s already operating at capacity.

The clinic’s three full-time doctors have full dockets, and to them, that’s a sign the V.A.’s new service delivery model is working.

The Franklin community-based outpatient clinic is the only place the over 10,000 veterans from the far western counties in North Carolina and north Georgia can get basic services without driving all the way to the Charles George V.A. Medical Center in Asheville.

Kathy Spence, an Air Force veteran who lives in Clayton, Ga., comes to the Franklin clinic at least once a month for a variety of ailments from Parkinson’s to fybromyalgia. Previously, she’d drive two hours both ways to the V.A. Medical Center in Asheville.

“It makes a big difference for me,” said Spence. “Everybody here is friendly. If you have a question, they work on it as quickly as possible and when I talk, they hear me. They all treat me like a human being.”

Dr. David Ramsey, the clinic’s director, said the community-based outpatient clinics are the future of the V.A. medical system, and with two wars still going, he expects to see more of them in Western North Carolina.

“We do have two wars going on. We do have folks who will be returning, and it’s likely that we’ll be having more community-based outpatient clinics, but we’ll need to start thinking about how to handle these numbers,” said Ramsey.

The Franklin clinic is designed to provide integrated outpatient services for veterans in Western North Carolina so they don’t have to schlep back and forth to Asheville for all of their needs. But the benefits go beyond that.

“One thing I’ve seen is it’s a small community. Veterans know other veterans, and once they’re comfortable the word will spread,” said Dr. Mike Newberry, the clinic’s full-time psychiatrist.

Newberry and Ramsey are part of a new breed of V.A. doctors. Both men have experience with the military but spent decades in private practices. Their career shift to treat veterans was a calling, but they quickly found the V.A. was on the cutting edge of new health care models, like integrated medicine.

“If I’m with someone and all of the sudden they’re not feeling well, all I have to do is walk them down the hall,” said Newberry, the psychiatrist. “It’s a great way to practice medicine.”

The team approach — which stresses communication between providers rather than compartmentalized fields of medicine carried out in separate offices — is a national trend.

“You’re not a lone provider on the frontier anymore,” Ramsey said.

In addition to three full-time doctors, one of whom is a psychiatrist, the clinic has a full-time psychologist, a registered nurse, and two social workers. It offers an eye clinic, primary care, mental health services, and a remote lab.

“Putting all of those services together is a huge number of visits saved for the veterans,” Ramsey said.

In addition to saving veterans the travel time, the clinic also offers a more intimate environment.

“It does make it a more comfortable place to come,” said Newberry. “They don’t like big crowds, big buildings and lots of noise.”

The local setting made a real difference when a suicidal veteran called the clinic in the midst of making an attempt on his life but would not reveal his identity. Doris Elders, part of the clinic’s staff, recognized the man’s voice, called 911 and saved his life.

“It connects the veterans more to the providers and less to the facility,” said Ramsey.

For Ramsey, who has only been with the V.A. for two and a half years, part of his job is showing the veterans that the system has changed.

“The V.A. has improved so much in the past 15 years, and unfortunately some of the veterans have been in the system longer than that and almost felt like they were serving the V.A.,” Ramsey said. “Sometimes you have to let people know that they’re number one.”

Larry Funke, a 60-year-old Vietnam veteran from Murphy, never dealt with the old V.A. Funke said he hadn’t seen a doctor in 35 years when he was hospitalized for heart failure in 2006. He still travels to Asheville for many of his specialized treatments, but the Franklin clinic allows him to travel shorter distances for his checkups.

“Everybody I’ve ever dealt with in the V.A. has been wonderful people,” Funke said.

Another aspect of the V.A.’s shift in service delivery is the move towards a web-based platform. My HealtheVet, a new program, allows vets to access their records, schedule appointments and monitor their treatments via the web.

The program builds on the V.A.’s use of computerized medical records, which are far better than paper charts still used in most private practices and can track patient data from state to state.

With a new generation of tech-savvy veterans, the Web-based approach may be the future of the system, but in the western counties the bulk of the population is still Vietnam-era and older.

“Moving the V.A. into the next generation, we also have to keep hold of the previous generations,” Ramsey said. “We have OEF vets using I-phones and older vets who don’t have computers.”

Serving a unique population

Veterans are a particular kind of medical population. According to Ramsey, they have a suicide rate seven times greater than the general population and a rate of diabetes three times as great.

Both of those numbers can be linked to high rates of alcohol abuse. Ramsey said the V.A.’s record of treating the veteran population speaks for itself.

“We have generally a sicker population, but we have better outcomes than any other healthcare system in the country,” Ramsey said.

Sandra Melter, the clinic’s administrator, knows the veteran population firsthand. Her brother was a Vietnam veteran who died of cancer as a result of his exposure to Agent Orange, and his experience has shaped her life.

“It leaves a lasting impression on you that you never get over,” Melter said.

Melter’s husband was a World War II veteran who fought in the Pacific, and while he didn’t speak a lot about his wartime experience, it was part of their marriage.

She uses her experience as motivation to provide better care to the veterans she deals with on a regular basis.

“They are different from everybody else, and I have the greatest respect for what they went through for us,” Melter said. “Most of them are always in some kind of pain, and you have to realize they might not be happy all the time. The veterans have so much support right now, but they may not always know it.”

As a psychiatrist, Newberry sees the challenges young returning veterans face when they re-enter society. Post-traumatic stress syndrome leads to substance abuse, but the veterans avoid seeking mental health services for fear it will hurt their job prospects, Newberry said.

The nightmarish caricature of the V.A. system paints a picture of a veteran negotiating a Kafka-esque bureaucracy equipped with a file folder and an ID number, wandering the halls of an endless antiseptic hospital building begging some brown shoe doc to legitimize his claims.

The reality now is that more doctors, nurses and administrators are coming to the V.A. from the private sector because it offers meaningful work, stable employment, and good benefits.

That fact — along with the addition of the smaller community-based clinics — has made the V.A. experience a lot like what you would find in a civilian doctor’s office.

After spending two decades in private practice in Sylva, Ramsey, who grew up an Army brat, saw the V.A. as a great way to end his career.

“I wanted to help the people I grew up around,” Ramsey said.

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