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VA Investigation Finds Hundreds of Alaska Veterans Traveling to Lower 48 for Health Care Treatment

WASHINGTON, D.C. - A VA investigation conducted at the request of U.S. Sen. Lisa Murkowski, R-Alaska, found that nearly 600 Alaska veterans, during a one-year period, were required to travel to the Lower 48 to receive health care services, even though the treatment may be available privately in Alaska.

A Department of Veterans Affairs Inspector General's report examined the referral of Alaska veterans for treatment at VA facilities in the Lower 48 from October 2008 through September 2009. The good news was that 96 percent of the 15,170 Alaska veterans who actually received health care services from the Alaska VA system received all of their health care in Alaska. But  591 of Alaska's veterans were required to travel to the Lower 48 to use their earned VA healthcare benefits for specialty care - about half on more than one occasion. Most of the referrals were to the Seattle VA Medical Center, the Puget Sound VA Medical Center or the University of Washington Medical Center.

Murkowski, a member of the Senate Appropriations VA Subcommittee, requested the Inspector General review in response to complaints from Alaska veterans and their families that the VA was requiring veterans to travel Outside for health care services that could not be provided in federal facilities, even though those services might be available from private practice physicians and community hospitals in Alaska.

The report said that 63 percent of the Alaska veterans referred for care Outside lived in Anchorage or the Mat-Su Valley, 16 percent in the Fairbanks North Star Borough and 8 percent in Fairbanks. Only 46 of the 591 veterans referred for care Outside lived in Juneau, Ketchikan or Sitka, where the VA maintained no health facilities in 2008-2009.

"What is astounding to me is that nearly two-thirds of the veterans who traveled Outside for medical care live in Anchorage or the Valley, within driving distance of the most sophisticated medical facilities available in Alaska," Murkowski said. "I was surprised to discover that nearly a quarter of the remaining veterans who asked to travel lived in Fairbanks and Kenai, which are home to sophisticated community hospitals.

"Whenever possible, the VA should strive to care for veterans in their home communities. When that's not possible the VA should acknowledge that it is much less stressful to ask veterans on the road system to travel to Anchorage for care that may not be available in their own communities than to put them on an airplane to Seattle or Portland."

The Inspector General reported that about 19 percent of the total outpatient visits Outside were for orthopedics, 13 percent for neurosurgery, 12 percent for cancer treatment, 9 percent for neurology and 6 percent for ear, nose and throat issues. The top specialties for inpatient referrals were neurosurgery, orthopedics, spinal cord injury, cardiology and vascular. A smaller number of veterans were referred Outside for general surgery, urology, plastic surgery, pain management, urology, rheumatology, gastroenterology, prosthetics and endocrinology.

The Inspector General's report reached no conclusion about what percentage of the care referred Outside could have been performed in Alaska. Based upon a review of physician licensing records, the report noted that all of the specialties for which Alaska veterans were referred Outside were represented in the Anchorage or Mat-Su medical communities, with the exception of spinal cord injury. Many of the specialties were also represented in Fairbanks and Kenai, as well. The report failed to note that some Alaska medical specialists regularly travel from Anchorage to see patients on the road system.

"I was disappointed that the Inspector General did not delve deeper into what percentage of the care that Alaska VA refers Outside is indeed available in Alaska," Murkowski said. "I hoped that the Inspector General's staff would conduct one-on-one visits with the Alaska State Medical Association, our hospitals and Community Health Centers to pin this down. Nevertheless, the report provides a good foundation for further conversations with VA senior leadership about bringing more VA care home to Alaska."

At a VA Appropriations hearing earlier this year, Murkowski questioned VA Secretary Eric Shinseki and Undersecretary for Health, Dr. Robert Petzel, about why the VA sends Alaska veterans Outside for care that may be available in Alaska. Both said they would examine the issue and see if the VA could provide better community level access to health care.

The Inspector General's report concluded that the VA faces legal obstacles in purchasing care for Alaska veterans in Alaska, citing a VA general counsel opinion that has not been provided to Murkowski despite repeated requests.

Murkowski said she hopes to hear a stronger commitment from the VA to treat Alaska veterans in Alaska when Shinseki makes a planned visit to the state next year. If that commitment is not forthcoming, Murkowski plans to pursue a legislative solution to the problem.

The full report is published on the Internet at www4.va.gov/oig/54/reports/VAOIG-10-01509-241.pdf.

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