Caring at Togus

Veterans Administration officials agreed to a 120-day plan last month to significantly improve the delivery of care to Maine veterans. The first interim deadlines for the plan arrived last week with some encouraging results, but how well Togus veterans hospital meets these conditions may be overwhelmed by the VA longterm plans for the facility.

The plan to improve the Togus Veterans Administration hospital is important because the facility has fallen behind in service that veterans deserve, because VA budgets indicate that the level of funding for Togus could continue to fall and because, despite budget cuts and the fact that the number of hospital beds there has fallen from 800 to 106, Togus will be expected to serve an increasing number of veterans. Among the promises in the VA plan are that the waiting time for physicians — now as long as six months — will be reduced to seven days; new primary care teams will be given autonomy to improve scheduling; and positions that have been vacant for too long will be filled.

The first deadline for meeting some of these goals was Oct. 15. By that date, Togus was supposed to have created the primary-care teams, created space for a primary care area by moving specialty clinics to other available space and decreased the waiting time for access to care. The good news is that these changes have been undertaken — the primary-care services are being created, additional space at Togus has been dedicated to primary and new temporary staff has been hired.

The less comforting news is that some of these resources have been acquired at the expense of secondary care at Togus. And the proposed budgets in the House and Senate suggest the total VA health care budget will remain flat and will be reduced by $52 million for this region. If the cut is passed on to Togus, Maine will find itself short of money to make the temporary physicians a permanent part of the services. The threat is that Togus will fall further behind and surrender more areas of special care — from dentistry to vascular surgery.

The problem of depleted service is hard to pin down, but emerges anecdotally all too often. One 100-percent disabled veteran, for instance, who suffers from a variety of ailments related to spinal meningitis and is also unable to produce saliva recently was supposed to have been given a prescription for artificial saliva. Instead he was mistakenly given a lidocaine solution, a local anesthesia, to swish around in his mouth. It caused him acute breathing problems and his mouth went numb. This prescription was not filled in Maine, but in the name of efficiency, sent to a consolidated pharmacy in Brockton, Mass.

Another Maine vet, who had lost his left leg in Vietnam and his right leg through medical complications recently was found to have a large tumor that needed immediate treatment. He could not get help here and was forced to go to Boston for radiation therapy. Not only did he have to give up the company of his family, friends and church for weeks, but the van sent to deliver him to Boston was not handicapped accessible, making for a miserable start to a difficult journey.

These and other stories build a case, one small example at a time, of staff stretched too thin, of budgets cut too deeply, of lives treated cavalierly. Many of the veterans who go to Togus have no alternative. Without this facility, they would simply have no health care. The initial improvements to Togus are encouraging, but the way back to a permanently improved facility is long and depends on the full commitment of the VA to keep Togus something more than a clinic for Massachusetts facilities. So far, there is only scant reason for hope.