AUGUSTA – Hoping to correct chronic budget problems at Maine’s only veterans hospital, the state’s congressional delegation warned federal officials Wednesday that further reductions in funding would compromise health care for Maine veterans.

Over the last 18 months, the Veterans Affairs Medical and Regional Office Center at Togus has been flooded with demands for services. New veterans are signing up for health care at a rate of more than 500 per month, an 18 percent increase over the number of patients who visited Togus last year. The escalating caseloads are creating longer delays, resulting in a six-month wait for veterans seeking nonemergency services.

Many of the veterans’ health care problems could be solved with a reliable annual funding system, according to VA critics.

To make it through each year, Togus officials have to ask for more money than what has been budgeted. And during negotiations earlier this year for fiscal year 2002, Togus officials were warned to prepare for a budget that would be 3 percent less than the roughly $80 million the facility received last year.

But President Bush recently signed a final $51 billion 2002 federal budget for Veterans Affairs which contains $21.4 billion for veterans’ health care – $1.05 billion more than last year’s allocation.

While the Maine facility is likely to see some increase in appropriations, the precise level of funding for Togus still is being calculated.

Nevertheless, the state’s congressional delegation remains somewhat circumspect over the hospital’s financial condition. In a joint letter to VA Secretary Anthony Principi, Sens. Olympia Snowe and Susan Collins and Reps. John Baldacci and Tom Allen said ensuring the highest quality health care for Maine’s veterans is a priority for the delegation.

“For the past several years, the Togus hospital has experienced chronic budget shortfalls despite continued increases in veterans health care funding nationally,” they stated in the letter to Principi. “These shortfalls have contributed to a tremendous backlog in ambulatory care treatment at Togus, seriously compromising the quality of health care that Maine veterans receive. The budget shortfalls have been particularly frustrating since we have advocated for and approved significant funding increases for veterans health care over the past several years.”

Funds for Togus and all other veterans hospitals nationwide are distributed through 22 Veterans Integrated Service Networks. Sixteen of the networks are operating at a deficit, suggesting to the delegation that the distribution system has problems that are not restricted to Maine or to New England.

“The fact that six VISNs do not have shortfalls, however, has made it apparent that the shortfalls in [New England’s] VISN 1 and at Togus are due at least in part to an inadequate allocation system within the Veterans Health Administration,” said the delegation.

Veterans agree with the delegation’s assessment of the Veterans Equitable Resource Allocation program, which determines how much money each network receives. Ron Sailor, a Windham resident who serves as the state agent for the American Legion in Maine, said anxiety intensifies stress levels for his members and for the staff at Togus.

“Some of the doctors over there want to know why they can’t have a budget to do what they feel is their job,” Sailor said. “It goes on and on. But if that’s the game they want to play, then that’s the game that we play. The VA sets the rules – we don’t.”

Sailor and leaders with the Veterans of Foreign Wars association said they had been led to believe by VA officials that if they could increase the level of participation for Togus services among the state’s 149,000 veterans, the facility would receive increased funding. Both organizations initiated an aggressive recruiting campaign 18 months ago and are credited in large part for the huge spike in new patients at Togus. Seven thousand new patients enrolled at Togus in the last year, and new patients continue to flock to the facility at a rate of more than 500 per month. During the last fiscal year, the hospital has served 27,000 patients.

Togus officials maintain that the facility’s high standards of care are one explanation for the increased demand for services. But the aging profile of Maine veterans along with the requirement that veterans receive their care at Togus in order to qualify for low-cost prescription drugs also are influencing factors.

Unfortunately, hospital officials concede, the increased caseload at Togus and its five outreach clinics in the state has served to exacerbate delays for veterans waiting to see doctors. The new glut of patients also frustrates the staff, whose limited numbers remains an issue complicated both by budget needs that exceed projections and by the pool of available workers. Jim Simpson, a Togus spokesman, said the hospital has been required to seek supplemental budget requests for the last three years and may have to do so again next year in order to pay the bills at the 67-bed hospital and 100-bed nursing home.

Persistent uncertainty over funding at the facility does little to enhance recruiting efforts in a state already plagued by a shortage of professional medical staff, hospital officials said. A few months ago, Togus was operating under a hiring freeze because of budget constraints. Now a new, less restrictive policy is in place that requires hospital officials to justify their hiring requests before a governing board. Maine’s two senators and representatives are unhappy with the policy they said will continue to make chronic backlogs and waiting times for appointments inevitable.

“Approximately 70-80 positions are open at any given time at Togus simply due to increased demand and regular turnover,” the delegation said. “This situation must not be allowed to deteriorate to the point where it will be difficult or impossible to reverse. We believe Togus must be given the flexibility to hire the additional personnel necessary to provide the care veterans deserve.”

Raymond Lupo, a former VFW state commander from Hampden, said the veterans organizations have done the work asked of them and he now insists it’s time for the VA to deliver on past promises.

“I have a phobia with Togus coming in with deficits every year,” Lupo said. “I can’t understand why the administration at Togus can’t go ahead and look at the last two previous years, see what they used and come up with a realistic budget for the coming year. They average from 300 to 500 new enrollees every month. They’re supposed to get this money back at Togus, but they don’t. The money goes back to the division in Boston and then Boston divvies it up between the other VA hospitals in New England. We don’t get our fair share.”

The fairness issue is nothing new to Susan MacKenzie, chief operating officer for New England’s VISN 1, one of the VA’s 22 funding distribution centers. While it may appear that her network is treated less generously than others, she said the system has withstood the scrutiny of independent audits.

“There have been multiple reviews of this system nationally,” MacKenzie said. “The Rand Corporation and several national consulting firms have reviewed it and have determined that this capitation system is a valid, equitable system to allocate resources.”

Although there are “adjusters” in the system, MacKenzie said they do not reflect the huge increase in patient demands for services because prospective budgets for Togus are based on the facility’s workload that existed at the facility two years ago. The lag time in assessing patient data tends to paint an unrealistic picture of the budgetary needs at Togus resulting in annual supplementary budget requests.

The fact that the supplemental budget requests were routinely approved is “recognition that Togus was experiencing these workload increases,” Simpson said.

MacKenzie said the exact amount of funding for Togus this fiscal year probably will not be known for three weeks. Regardless of the allotment, however, she maintained that the facility will receive “dollar-for-dollar” reimbursement for its expenses even if it requires another supplemental budget next year.