The military veterans’ medical center at Togus is facing a projected $14.25 million shortfall in its budget for the fiscal year that ends Sept. 30, according to an internal document delivered to the Bangor Daily News last week.

Officials at Togus and at the Department of Veterans Affairs in Washington, D.C., say it’s too early to discuss the implications of the deficit, but the document proposes some dramatic changes in the mental health care, specialty medical services and medication coverage veterans receive.

“We see no acceptable options for maintaining mandated medical services and improving access to those services within projected budgets,” the white paper reads.

The document goes on to propose a number of cost-saving measures, many of which would negatively affect the level of care available to current and future vets.

The document identifies Togus’ “fee program” – which pays non-VA physicians and hospitals to provide services that either are not available at Togus or have long waiting lists – as one of the most extensive in the nation, costing the center more than $1 million per month. The paper suggests reviewing eligibility standards for these services, which include hospitalization, radiation therapy, physical therapy, cardiology, audiology, gastroenterology and medical imaging.

“Although efforts to control costs are ongoing, the continued growth of the fee program will far exceed our efforts to control costs,” the document says.

The paper also suggests saving money by switching veterans to less expensive medications. In some cases it recommends changing from a brand name to a generic drug, but in other cases different formulations altogether might be substituted.

“Some changes, although appropriate, will be difficult to accomplish, for example switching from [the painkiller] OxyContin to morphine or methadone,” the document acknowledges.

Staffing changes at VA clinics in Calais, Rumford, Saco and Bangor also are proposed, including not filling existing vacancies and replacing pricey temporary staff with lower-paid VA employees. But the paper also recognizes that efforts to recruit qualified regular employees have been frustrated by a shortage of applicants.

Specialty services such as physical rehabilitation and audiology already are operating with less staff than needed. “Without contract or additional audiology staff, we will not be able to meet the demand resulting in long waiting lists, poor quality of service and poor customer satisfaction,” according to the paper.

Proposed changes in the mental health program include: reducing supervision of services, downgrading one position from a psychology technician to a clerk, and replacing contracted psychiatrists with regular VA doctors.

Togus spokesman Jim Doherty said late last week that federal funding for veterans’ medical services is characterized by negotiation and reallocation and that the white paper was intended as an internal planning document only.

“Based on further reviews, there will likely be some additional resources allocated, and therefore it would be premature to discuss the allocation at this time,” said a statement issued from Doherty’s office. Doherty referred all further inquiries to the Washington offices of the VA.

VA spokesman Terry Jemison said Thursday that the federal agency is committed to meeting the health needs of current and future veterans. “In general, we’ve increased the budget year after year,” he said.

Veterans’ benefits are administered through regional Veterans Integrated Service Network offices, or VISNs. Maine falls within VISN 1, which is based in Bedford, Mass. Actual federal funding to VISN was $1.1 billion in fiscal year 2004, according to Jemison. The federal fiscal year runs from Oct. 1 to Sept. 30. VISN 1 directors provided $139.6 million of the $1.1 billion to Togus. For this fiscal year, the VISN has been allocated $1.2 billion, and has designated $147.3 million for Togus.

Jemison pointed out that nationally, the number of veterans enrolled in the VA’s health care program has risen from 5 million to 7 million since President Bush took office. Over the same period, he said, the number of veterans waiting for more than six months for a health care appointment has dropped from more than 300,000 to about 31,000. The VA is looking for ways to improve services so injured veterans returning from Iraq, Afghanistan and other combat zones can be assured of a smooth transition into their home communities.

“I don’t think there’s any doubt that Togus VA will ensure that no veteran will be turned away for any budgetary reason,” Jemison said.

Maine’s congressional delegation responded to the possibility of a large deficit at Togus with pledges of support. U.S. Rep. Michael Michaud, the ranking member of the House veterans’ affairs subcommittee on benefits, said Tuesday that the situation is “unacceptable.”

“We made a promise to the men and women who put on the uniform to protect our country and that is a promise that must be kept,” Michaud said in a prepared statement. “It is unacceptable for us to fail to provide for our current veterans – we are asking brave men and women to risk their lives in Iraq, Afghanistan and elsewhere as we speak, and they should expect the highest level of care when they return.”

Michaud said he would work closely with the other members of the Maine delegation and with Togus officials to see that quality health care remains accessible to veterans.

Sen. Olympia Snowe also expressed support for veterans. “I stand ready to assist Togus in any way I can in the future, and I will contact the VA in the coming days to make sure Maine’s veterans don’t suffer as a result of the hospital’s budget shortfall. … Especially now, with troops returning from Iraq and Afghanistan, it is of paramount importance that quality, accessible health care be available and within reach of veterans’ homes, families and friends,” Snowe said in a prepared statement to the media.

Joe DeGrasse, team leader at the Vets Center on Harlow Street in Bangor, observed Tuesday that veterans’ waiting lists for medical services have decreased substantially recently, largely because additional administrative staff at Togus have been hired.

Although his funding for providing mental health and support services comes from a different branch of the VA than does Togus’, DeGrasse said his experience is that funding from the federal agency rarely keeps up with demand.

“We’re starting to see more vets returning from Iraq … we’ll be increasing our caseload. We’ll have the same budget and see more people. As they see our productivity go up, we’ll get more funding. It takes two or three years. Meanwhile, we make do with what we’ve got.”