Rao bulletin 1 June 2016 html edition this bulletin contains the following articles

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VAMC Grand Junction CO Update 02Inadequate Treatment Vet Died
A well-known veteran in Grand Junction received inadequate treatment at the local Department of Veterans Affairs hospital before he died, the agency's inspector general found. Vietnam War veteran Rodger Holmes had survived homelessness, recovered from alcohol addiction and volunteered as a Salvation Army van driver. But he suffered from liver disease, and his health deteriorated rapidly despite numerous visits to the Grand Junction VA medical center in 2014. He died that December. Three Colorado members of Congress, Sens. Michael Bennet and Cory Gardner and Rep. Scott Tipton, requested an investigation of the hospital's treatment of Holmes.
"We substantiated the allegation that followup care was inadequate and led to further hospitalization," says the inspector general's report released this week. "The hepatitis C care provider often did not provide the care or assess the patient thoroughly when seen. The circumstances of discontinuity of care and the lack of a thorough analysis of the patient's condition may have contributed to his progressive decline and slower recovery." The report stopped short of concluding that VA treatment killed Holmes, however, by finding that his final hospital admission was timely. One contributing factor to Holmes' treatment was a decision by the hospital's hepatitis specialist to reduce his hours. The inspector general report recommended that the hospital ensure "contingency plans for specialities" when too few specialists are available.
"If Rodger were with us, he would be thrilled with that change," said Chris Blumenstein, a social worker who quit the hospital to protest Holmes' treatment. "When staff is insufficient, there needs to be a plan for that. The clinics can't just wing it like they did with Rodger." Blumenstein challenged the report's finding that Holmes had recovered when he was sent home in September 2014, saying his friend was a very sick man when he and others launched a Saving Veteran Rodger Holmes campaign that fall. He plans to appeal on the grounds that the inspector general failed to hold the hospital fully responsible. The VA's medical director in Grand Junction, Marc Magill, disputed the finding that Holmes' treatment was inadequate. "We believe the review of encounters below supports appropriate clinical care was provided to this veteran," he responded. "The veteran's issues were appropriately addressed at each encounter, including medication adjustments, emergency room treatment and IV fluids, and hospitalization when appropriate."

He concurred, however, with the recommendation to make sure specialty care will be available as needed for veterans in Grand Junction. Medical center spokesman Paul Sweeney said the hospital has hired a cardiologist and neurologist and is contracting with other specialty care doctors. Hepatitis patients are treated through a telehealth program, he said, but the Western Slope still lacks a liver specialist. Jenny Davies, one of Holmes' supporters, recalled helping him start to use e-mail and Facebook in the campaign to save his life. "He was kind, funny and very humble about the whole thing — while he did want to improve his own health care, his feeling was that he'd already had a nightmare experience and this effort was to improve the care for all the veterans coming after him," she said. "Little did we know that all that mismanaged care was going to continue and he wouldn't survive." [Source: The Denver Post Editor | David Olinger | May 13, 2016 ++]

VAMC Long Island NY Facility Deterioration Impacts Surgeries
Usually, there are 10 operations a week scheduled at the Northport Veterans Affairs Medical Center on Long Island. But since mid-February, the hospital’s five operating rooms have stood empty and unused, shut down after sand-size black particles began falling from air ducts. The ducts are part of the hospital’s HVAC system. Providing heating, ventilation and air-conditioning, the system is integral to improving the hospital’s air quality and mitigating the airborne transmission of germs that could lead to infections. Patients in need of surgical treatment have been sent to other facilities, such as Stony Brook University Hospital a half-hour away, or to sister facilities like the James J. Peters V.A. Medical Center in the Bronx or the Manhattan campus of the V.A.’s New York Harbor Healthcare System, said Philip Moschitta, Northport’s director. Others are being referred to the V.A.’s Choice Card program, which allows some veterans to obtain taxpayer-funded care from private doctors, though it has been troubled by delays.
The Veterans Affairs medical system, the nation’s largest integrated health care organization, has been under scrutiny since 2014, when the department confirmed that numerous patients had died awaiting treatment at a V.A. hospital in Phoenix, where officials had tried to cover up long waiting times for 1,700 veterans seeking medical care. A study released by the Government Accountability Office last month indicated that the system has yet to fix its scheduling problems. Northport is a 502-bed teaching hospital that serves about 18,000 patients per year. Doctors there perform 633 inpatient and 1,822 outpatient surgeries a year. Some procedures that do not require a sterile room, such as colonoscopies or cataract surgeries, are currently taking place in other parts of the hospital, Mr. Moschitta said. “Cutting into the body, those types of procedures are not being done in those rooms at this time,” he said.
Two or three of the operating rooms were reopened for a few weeks in April, but they were again shuttered and sealed off with yellow caution tape because contamination returned. An environmental analysis of the air quality at the Northport hospital by Environmental Analysis Associates, a San Diego firm that specializes in the identification of indoor air-quality problems associated with dust contamination, found that the particulates came from oxidizing metal and crumbling concrete in the building’s duct system, which was built in the early 1970s. The report, which was obtained by The New York Times, linked the operating room contaminants to Northport’s decaying building. The kinds of particles deposited in the operating rooms were “typically associated with galvanized duct corrosion and metal piping/fittings,” the report said. It also mentioned that “low concentrations of fiberglass fibers” — irritants to the skin, eyes and upper respiratory tract — were detected.
Mr. Moschitta said the problems stemmed from rusted sound attenuators in the ducts, which reduce mechanical equipment noise. “As the forced air goes through the ducts, little fragments break off,” he said. “When you have a 45-year-old facility, things rust,” he added. The report also noted the presence of spores of cladosporium, a common mold that can grow indoors on surfaces when moisture is present and can cause allergic reactions and respiratory problems. Ronald Brattain, the chief of the hospital’s engineering service, said that the operating room air-supply ducts have been wet and regularly exposed to high humidity because they pull air from the outside, as is common in older V.A. hospitals. “The humidity that is in the air is drawn through the air handler, and so that by itself creates a moist environment,” he said.
The entire V.A. system has been plagued with crumbling buildings and deferred maintenance. According to the V.A., roughly 60 percent of its medical facilities are more than 50 years old. The department’s inspector general issued an audit report in 2014 warning that there was a $10 billion to $12 billion backlog in maintenance throughout the system, jeopardizing patient safety at a time when aging baby boomers and newly enrolled veterans of Iraq and Afghanistan increasingly sought care at V.A. hospitals. Mr. Moschitta said that one backup plan under discussion at Northport was to bring in mobile surgical units that would be parked outside the emergency room on the lawn, but those units rent for $70,000 to $85,000 per month.
Mr. Moschitta said he is confident the problem will be solved with the installation of high efficiency particulate air filters in each of the vents in the operating rooms, and that at least one of the surgical suites will be up and running in the near future. “Barring any mishap, we’re ready to go on June 1,” he said. “A lot of these facilities are vintage.” It is not only the operating rooms that have been affected at Northport. In the basement of Building 200, one floor down from the operating rooms, the air-conditioning broke down in March 2015, and since then particulates have accumulated in five ultrasound rooms and an M.R.I. area. Mr. Brattain said the problem was a rupture of the cooling tower on the roof. Since then, air-conditioning has been provided by temporary air-cooled chillers, which cost $30,000 a month each to rent, Mr. Brattain said, and two more will be brought in for the summer months. A new system is supposed to be installed in the spring of 2017.
An internal email from an engineer and safety officer at the hospital, obtained by The Times, details staff complaints about the particulates. “The dust is depositing on HVAC registers, ceilings, walls, and on medical equipment,” the email said. “Maintenance continues to clean the surfaces but, as the staff has observed, the dust reappears within a short time. At least three staff members have indicated their concern that this environment has affected them. They have been to employee health and to their individual physicians.” The email was sent in April to administrators at the hospital. In a statement, Mr. Moschitta said that he took “very seriously concerns about the air quality” in the M.R.I. area and the ultrasound rooms, and that he had asked for “air sampling to be conducted to ensure the safety of our patients and employees.” [Source: The New York Times | Kristina Rebelomay | May 19, 2016 ++]
VA HCS Palo Alto CA CVS MinuteCinic Pilot Program
A Veterans Affairs health system in Northern California has enlisted the help of the largest U.S. provider of walk-in medical care to expand treatment options for veterans. Beginning 24 MAY, veterans who have a minor illness or injury and are enrolled in the VA Palo Alto Health Care System may be able to seek care at a MinuteClinic, the walk-in health facility available at many CVS pharmacies. Under a regional pilot program, veterans who call the VA Palo Alto nurse advice line may be referred to a MinuteClinic. The VA Palo Alto Health Care System (VAPAHCS) consists of three inpatient facilities located at Palo Alto, Menlo Park, and Livermore, plus seven outpatient clinics in San Jose, Fremont, Capitola, Monterey, Stockton, Modesto, and Sonora.
Dr. Stephen Ezeji-Okoye, VA Palo Alto deputy chief of staff, said the $330,000 one-year pilot program could serve as a model for other VA facilities nationwide. The program, he said, is designed to give veterans access to medical treatment closer to home and when VA hospitals and clinics are closed or at capacity. “This really does help push VA’s movement to integrate care more seamlessly in the community,” Ezeji-Okoye said. “[VA leaders] are interested to see how this goes and what potential implications it might have.” Ezeji-Okoye said the new program for the 60,000 veterans enrolled in care at the VA Palo Alto Health System is not a response to the system's ability to meet access standards. Instead, he added, the MinuteClinic partnership will be an option for veterans to get care closer to home and on nights and weekends when VA care may not be available. “We see this as augmenting the care we provide,” he said.
There are 1,137 MinuteClinics in 32 states, according to MinuteClinic president Dr. Andrew Sussman. The facilities employ nurse practitioners and physician assistants who treat minor medical issues such as ear and throat infections, sinus issues, sprains and minor injuries. According to Sussman, 14 MinuteClinics in the region will participate in the program. “We see this as a collaboration with the existing system and helping provide another choice for patients to go to for their care. We are proud to be working with VA," Sussman said. Raising concerns last month among veterans service organizations, a blue-ribbon commission studying the future of VA health care planned to recommend that veterans receive the bulk of their health care through private physicians paid for by VA. Currently, veterans who live more than 40 miles from a VA facility, or cannot get an appointment at VA within 30 days, are supposed to be referred to the private health system through the Veterans Choice program.
Both Ezeji-Okoye and Sussman said the MinuteClinic agreement is not part of the Veterans Choice program or any larger effort to outsource veterans to private health care. "Partnering with the community really allows us to be able to provide more convenient and more accessible care. Really, it’s a question of how we fold community care into VA. It's really an extension of VA care,” Ezeji-Okoye said. Veterans enrolled in VA care at Palo Alto or its affiliated hospitals and clinics who want to use the benefit must get a referral from the nurse advice line. No copayment will be needed at the time of care, and veterans can order any VA formulary medications prescribed by a MinuteClinic provider at the clinic’s CVS store. VA officials said MinuteClinic has agreed to send any medical records generated by the visit to VA to ensure they are included in the veteran's health history. [Source:
welcome to the va palo alto health care system menlo park division livermore division

Palo Alto Division Menlo Park Division Livermore Division

* Vets *

As I See It ► MOAA | Adding Insult to Injury
Over the past decade-plus of war, we’ve heard time after time about the difficulties severely wounded, ill, and injured servicemembers encounter across a variety of fronts. There seems to be a never-ending supply of stories about insensitive people and unresponsive bureaucracies making life even tougher for those whose military service already cost them significantly in terms of quality of life. The good news is well-meaning people at all levels have been making sincere efforts to improve the situation. Many aren’t making progress as fast as we would hope, and many problems remain to be overcome. But in most cases, active efforts are under way to address the most significant administrative problems.
Two statutory issues, in particular, are proving more problematic. The first involves the deduction of VA disability compensation from service-earned military retired pay. Congress has provided some significant relief on that front, prioritizing the most severely disabled and the combat-disabled. MOAA believes strongly in the principle that no disabled retiree, regardless of disability percentage, should have to fund his or her own disability compensation by forfeiting an equal amount of service-earned retired pay. But we find it particularly inequitable one group of severely disabled retirees was excluded from any relief: those who were medically retired for noncombat disabilities with less than 20 years of service.
Under current law, a 20-year retiree with a 10-percent combat-related disability (rightly) suffers no retired-pay offset. But someone who suffers a noncombat service-caused injury that leaves him a 100-percent disabled quadriplegic and is medically retired with two to 19 years’ service must forfeit most or all of his military retired pay under the current VA offset law. That’s plain wrong. Sen. Harry Reid (D-NV) will offer an amendment to the FY 2017 Defense Authorization Bill to correct that when the bill comes to the Senate floor, with MOAA’s strong support.
The second statutory inequity stems from the requirement for severely disabled military retirees (including many in their 20s) to enroll in Medicare and pay Medicare Part B premiums of $105 a month. Had these members not had the misfortune of becoming 100-percent disabled in service, the military would have fully covered their health care until retirement, and they wouldn’t have had to enroll in Medicare until age 65. MOAA believes 100-percent service-disabled retirees should be exempted from paying Medicare enrollment fees until age 65 or DoD should provide them an allowance to offset the fee. Both options have proven problematic, mainly for funding reasons.
MOAA understands funding for defense is not unlimited. What we don’t understand is, of all the things DoD spends money on, why preventing 100-percent disabled retirees and military widows (i.e. SBP DIC Offset) from having to pay extra for having suffered those conditions doesn’t make the cut. [Source: MOAA Leg Up | Col. Steve Strobridge, USAF (Ret) | May 20, 2016 ++]
http://www.moaa.org/uploadedimages/content/take_action/the_bottom_line(1)/as_i_see_it_1900x800.jpg strobridge author size
Military Handbooks ► 2016 Editions Available for Downloading
Your 2016 Military and Federal Handbooks are available in both free and paid versions. To access the free versions click on the following:
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  • http://federalhandbooks.com/explore-our-handbooks/long-term-care-handbook/download

[Source: Military authority Family of Sites| May 20, 2016 ++]

Vet Charity Watch Update 59 2% of NVVF 2014 Donations Went to Vets
At first glance, the National Vietnam Veterans Foundation is a roaring success. According to its tax filings, the charity has received more than $29 million in donations from generous Americans from 2010 to 2014 for what it calls on its website http://nationalvietnamveteransfoundation.org "aiding, supporting and benefiting America's veterans and their families." But look a little closer on those same filings and you can see that nearly all of those donations have been cycled back to telemarketers, leaving less than 2 percent for actual veterans and veterans' charitable causes.
That's why Charity Navigator, one of the nation's largest and most influential charity watchdog organizations, has given the charity a "zero" out of four stars for those same four years. "It's a zero-star organization and you can't go lower than that," says Michael Thatcher, Charity Navigator's CEO. "They don't have an independent board of directors, they actually don't even have a comprehensive board of directors -- only three members on the board at this point in time and some of them are family. So one can say, is this representative of an independent board? It's not." The charity's most recently filed tax return, for 2014, lists a catalogue of expenses paid for by donations: including $133,000 for travel, $21,000 for unnamed "awards", $70,000 for a category described as "other expenses" and even a little more than $8,000 for parking.
The CEO and founder of the National Vietnam Veterans Foundation, himself a veteran, is J. Thomas Burch, who is also a federal employee working as an attorney for the Department of Veterans Affairs. Burch is deputy director in the VA's Office of General Counsel, where he pulled down $127,000 in salary in 2014. That's the same year he drew a salary of $65,000 as head of his "zero-star" charity. A VA spokesman told CNN Burch's position at the veteran's charity is not a conflict of interest "per se". But the spokesman added the VA is now "reviewing" the situation and that the agency's Office of Inspector General is handling that review.
When contacted by CNN, Burch asked that we not contact him at his job at the Department of Veterans Affairs, but he refused to answer phone calls placed to his home. CNN tried to confront Burch as he drove home from work in a black Rolls Royce, but upon seeing a CNN camera crew, Burch gunned the Rolls Royce down his suburban Washington, D.C. Street and disappeared. The charity's vice president, David Kauffman, said in an email that the NVVF was responsible for "feeding homeless and unemployed veterans by donating to food banks, sent personal care kits to hospitalized veterans and donated blankets, hats and gloves to homeless centers." According to the charity's tax filings, though, it accounted for about $122,000 in cash donations to veterans, out of more than $8.5 million raised in donations in 2014. That is less than 2% of the charities cash donations being used to support veterans and their families. [Source: CNN Investigations | David Fitzpatrick & Drew Griffin | May 17, 2016 ++]
Vet Charity Watch Update 60 ► WWP’s 80.6% Funding Assertion
U.S. Sen. Charles Grassley kept the pressure on Wounded Warrior Project by sending a letter this week saying he has “serious questions” about the Jacksonville-based group’s often-repeated assertion that 80.6 percent of its funding goes to veterans services. “The trust WWP has engendered amongst the donating public requires it to be as transparent and open as possible with respect to its spending practices,” Grassley (R-IA) wrote in a letter sent 16 MAY to Wounded Warrior Project Chairman Anthony Odierno.
Grassley, chairman of the Senate Judiciary Committee, has long taken an interest in investigating tax-exempt groups to determine how they use their donations. The committee has been drilling down into Wounded Warrior’s finances since March, and Grassley sent a fresh set of questions in this week’s letter. Wounded Warrior Project said in a statement it will provide whatever information Grassley needs. “We continue to maintain a productive dialogue with Sen. Grassley’s office and look forward to answering his request for a more detailed explanation of how our programs and services provide essential support to Wounded Warriors,” the statement said. Figures for how much Wounded Warrior spends on veterans services have been all over the map, depending on whether they came from the group itself or organizations that evaluate charities.
Charity Navigator says 60 percent of Wounded Warrior’s spending goes to services. Charity Watch puts it at 54 percent. The Better Business Bureau’s Wise Giving Alliance put the figure at 80 percent, but the BBB is seeking more information in light of financial questions that have been raised in media reports. Grassley challenged whether Wounded Warrior Project has spent as much money on veterans programs as it says it has. He wrote in his letter that Wounded Warrior says it spent $242 million on veterans programs in the 2013-14 fiscal year, but “it appears that $150 million of it was not actually spent on veterans by WWP and a large portion of it was in-kind donations. This calls WWP’s claim that it spends 80.6 percent of its donations on veterans programming into question.”
Wounded Warrior has consistently stood by the 80.6 percent figure. In March, the organization issued a prepared statement that summarized findings from a board-ordered review of the nonprofit’s finances. Wounded Warrior said the 80.6 percent figure comes directly from its most recent audited financial statement based on established accounting principles for how to allocate expenditures. Grassley’s letter said he wants to determine whether $80.7 million worth of free media and advertising donated to Wounded Warrior in 2013-14 was used to inform veterans about program services, or if the purpose was to boost fundraising. He also requested examples of fund-raising solicitations that contained an education component. Wounded Warrior’s financial statement shows it spent $68.5 million on direct mail, online and television campaigns. Of that amount, $40.9 million was shown as program services, rather than fund-raising, because it had an educational component. Grassley wants Wounded Warrior to “describe in detail the benefit conferred to veterans” to justify labeling such expenditures as program expenses.
He also is seeking information about spending from a Long-Term Support Trust Fund established by Wounded Warrior. Grassley wrote that Wounded Warrior transferred $9.1 million in fiscal 2013 and $28 million in fiscal 2014 into the trust fund. He said it appears Wounded Warrior is counting those transfers as program expenses on behalf of veterans. But in fiscal 2014, the only payment from the trust fund was $134,721 to Barclay’s for managing the trust, Grassley wrote. “It would be helpful if WWP could describe, in detail, what benefit is provided to veterans by the Long-Term Trust,” Grassley wrote.
Grassley’s letter sheds more light on how Wounded Warrior arrived at a figure of $26 million for how much it spent on conferences and events in fiscal 2014. Earlier this year, Wounded Warrior pushed back on media reports that suggested the $26 million was wasteful spending on employees by saying that 94 percent of that spending went to program services for veterans and their families. Wounded Warrior provided documents to the Senate Judiciary Committee showing the charity hosted 3,246 events fiscal 2013 and 4,485 events in 2014. Grassley said the “vast majority” of those events involved veterans going to watch sports events such as MLB baseball, NBA basketball, and NHL hockey games. He wants Wounded Warrior to explain how many of the sports events involved in-kind contributions such as donated tickets. He wants similar information on other alumni programs that Wounded Warrior sponsors for veterans to socialize with others. Grassley also wants an explanation for what Wounded Warrior did to help 1,500 veterans to obtain Veterans Affairs benefits. [Source: NCOA Press Release | Jon Ostrowski | May 4, 2016 ++]


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