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Old and in the wrong place: Why Hampton VA hospital’s future is in question
Daily Press - 7/10/2022
It’s old and hard to reach for many area veterans, and significant numbers of its beds are unused. After 80 years at the southern tip of the Peninsula, the Hampton Veterans Administration Medical Center is facing an uncertain future.
Earlier this year, the VA’s study of its nationwide health care system recommended replacing the Hampton center with new centers in Norfolk and Newport News, while sending more veterans for medical and surgical inpatient care to the Naval hospital in Portsmouth and moving spinal cord injury cases to Richmond’s VA center.
Big increases in Hampton Roads veteran patient numbers and the area’s unique geography were major factors.
For example, the study does not recommend replacing the hospital in Fayetteville, North Carolina, even though the number of VA enrollees is expected to grow even faster and the building is older than Hampton’s.
Modernizing it would cost about half of the bill for Hampton, the study found. It does, however, recommend moving primary care, outpatient mental health, outpatient specialty care, and urgent care services provided at the Fayetteville VA hospital to nearby VA facilities, including a new health care center at Jacksonville and proposed community clinic in New Bern.
In San Antonio, where VA patient numbers are rising fast, and southwest Virginia, where numbers will decline, the study recommends replacing existing facilities because space on the current campuses is tight and modernization costs high, as is the case for Hampton.
In central Georgia, where the Dublin VA hospital is almost as old as Hampton, the study recommends replacing it with a new hospital in Macon — 55 miles away, where about half its current enrollees live. Although much smaller than Hampton, modernization costs are 25% higher for a facility that has no single-occupancy rooms or bathrooms, with poor plumbing and an outdated heating, ventilation, and air conditioning system that has exceeded life expectancy.
“The commission is about getting veterans care right,” said John Byrne, education director of the Concerned Veterans of America.
He said the commission’s recommendation, such as those for Hampton, aim at modernizing VA facilities and getting them in the right places with the right services for veterans.
The alternative from opponents of the recommendation, he said, “is simply to throw more money at the VA and count on it to do what’s needed.”
Hampton’s VA hospital serves a relatively large number of VA health care system enrollees, from the Eastern Shore south to the Outer Banks and from James City County east to Virginia Beach — about 87,000.
But the three places with the largest numbers are Virginia Beach, Chesapeake and Norfolk — and when Portsmouth and Suffolk are added, the total comes to roughly 50,000 who have to cross the Hampton Roads Bridge Tunnel or the Monitor Merrimac in order to get to the hospital.
The South Hampton Roads cities are also where the biggest growth in new patients is likely.
The VA study forecasts a nearly 49% increase in Chesapeake enrollees over the next 20 years, 31% in Virginia Beach, 25% in Norfolk and 34% in Portsmouth.
In contrast, the Peninsula, with just under 26,000 veterans enrolled, should see its numbers rise by 17%, well below the Hampton center’s forecast overall growth of 23.5%.
The center was built in 1940, and doesn’t meet current standards for floor-to-floor heights, corridor widths, column spacing and utility infrastructure.
The the VA’s Asset and Infrastructure Review Commission study said the physical problems it found would cost about $179 million to address.
The problems include a very old sewer system, limited parking and challenges working on its electrical systems because circuits running off various circuit breakers are not standardized, the study’s facility conditions assessment found
“Very old pipes, dead-legs and asbestos” along with difficult access are problems for maintaining and repairing plumbing, while a lack of standardization, difficult access, pneumatic controls make maintaining heating, ventilation and air conditioning a challenge.
The masonry construction of its buildings mean it is difficult to install or update new systems for medical gases, while it can be hard for patients and staff to find their way around the hospital’s many buildings and confusing layout.
“Frequent flooding and severe access challenges for a large portion of the veterans it serves due to heavy traffic in the bridge and tunnel infrastructure” are also major problems, the study said.
The hospital’s inpatient beds are not particularly stretched, the latest VA Office of Inspector General audit found.
On average, 20 of 33 medical beds are occupied, as are 22 of its 40 psychiatric beds, six of its 29 rehabilitation beds and 37 of 64 spinal cord beds, the audit found. Only a 55 of 168 domiciliary beds — a service reserved for disabled veterans — and 56 of 122 nursing home beds are occupied on average.
The hospital has struggled for years to cope with longer-than average waiting lists and challenges to hire staff.
Data compiled for the VA’s nationwide study showed waiting times for mental health appointments average 5.2 days for Hampton, compared to a national average of 3.6 days. The average wait for primary care appointments at 7 days compared to 4.1 days nationally, and the waiting time for specialty care appointments of 6.6 days for Hampton compared to 5.3 days nationally.
New patients wait even longer. Waiting times for new patient appointments for primary care were 33.7 days in Hampton versus 22.6 days nationally, and 27.2 days for specialty care versus 21 days.
The study found unacceptably high readmission rates of nearly 13% within 30 days. The rates for cardiorespiratory patients, and cardiovascular patients were higher, at 18% and 15%. Rates of avoidable post-acute care problems and care transition were also at unacceptable levels, the commission study said.
The audit, meanwhile, reported that veterans complained about communication, cleanliness, and food choices while in the hospital.
Veterans complained of difficulty reaching staff because phone calls did not transfer properly, while some specialty areas had only one provider, the inspector general’s audit found.
In a follow-up audit, the inspector general reported a delay in one patient’s cancer diagnosis after several Hampton staff members failed to tell the patient about abnormal test results over a nearly two-year period. A vascular surgeon failed to communicate and act on a 2019 computerized tomography scan result on which a radiologist highlighted a potentially malignant lesion in the patient’s prostate.
The patient’s primary care provider didn’t tell the patient about an abnormal PSA test and did not order the necessary follow-up tests and consultation with a urologist. A nurse practitioner didn’t investigate the patient’s urologic complaints during phone call to check on him after a visit to the hospital.
The Hampton center ranked among lowest 20% of VA centers for coverage of mental health population as same day appointment and care coordination for veterans in its patient centered medical home program, the audit found.
The auditors’ review of medical records found in nearly one in five cases, there was no evidence patients received for medication management, as required for an anti-viral drug, while the surgical work group did not always meet monthly, as a VA directive says those groups should.
More than a third of patients were not screened for suicide risk when at the emergency room, the audit found.
The commission was established by legislation in 2018 that focused on easing veterans’ access to care outside VA facilities. Its job is to recommend ways to restructure the VA’s health care system in response to changes in veterans numbers in different parts of the country and their evolving medical needs.
For Hampton Roads, in addition to a new southside VA hospital, which would take over inpatient mental health services from Hampton as well as outpatient services, a community living center and residential rehabilitation services for veterans in South Hampton Roads was recommended.
A new Newport News medical center would take over outpatient services, a community living center and residential rehabilitation services for the Peninsula. Current research programs at Hampton would move to the Newport News facility.
The Portsmouth Naval Hospital would take over acute medical and surgical inpatient care now done at Hampton, along with emergency services; in addition, these services would also be provided at civilian hospitals, under the commission’s plan.
The plan itself faces significant political opposition — a group of senators have vowed to block it.
The VA, meanwhile, said it is still committed to modernizing its system.
Dave Ress, 757-247-4535, firstname.lastname@example.org
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