Editor’s Note: This story by Nora Doyle-Burr first appeared in the Valley News on March 22.
A new report recommends that the White River Junction VA Medical Center close its emergency department and instead open an urgent care service.
Emergency services for veterans would be diverted to community providers in the region, according to the report, “VA Recommendations to the Asset and Infrastructure Review Commission,” released this month from the U.S. Department of Veterans Affairs.
The report said that the VA recommends that an emergency department log at least 13,000 “encounters” annually to sustain it, but the White River Junction VA had fewer than 6,000 in fiscal year 2019. That number is sufficient to sustain an urgent care service.
“Converting the existing emergency department to an urgent care center and relocating emergency department services to the community provides the appropriate level of care for the Veterans seeking same day access,” the report said.
According to VA.gov, emergency departments are intended to treat life-threatening injuries or symptoms, such as head injury, severe chest pain, seizures or loss of awareness, heavy uncontrollable bleeding or moderate to severe burns. Meanwhile, urgent care services are intended for broken bones, scrapes and minor ailments.
The market assessment initiative was designed to provide analysis and insights to inform recommendations to the Asset and Infrastructure Recommendations Commission, Katherine Tang, a spokeswoman for the White River Junction VA, said. The assessments use information such as geography and demographics; current and future market demand; veteran access; quality of care; facility conditions and health care resources that exist in the broader market. The analysis includes site visits and more than 1,800 interviews with field staff.
In addition to closing the White River Junction VA’s emergency department, the report also recommends consolidating leadership teams from the White River Junction and Manchester VAs, and reducing the number of residential rehabilitation treatment program beds in White River Junction from 14 to 12. It also suggests developing a facilities plan to consolidate services and eliminate outdated buildings.
To move forward, the recommendations contained in the report require presidential and congressional approval. Vermont and New Hampshire’s congressional delegations seem unlikely to support it.
In a letter dated March 14, the four senators representing the Twin States expressed their concerns about the changes recommended.
“We believe that VA services in our states should be bolstered, not reduced,” the letter signed by Sens. Jeanne Shaheen, D-N.H.; Maggie Hassan, D-N.H.; Bernie Sanders, I-Vt.; and Patrick Leahy, D-Vt. “The current recommendations risk moving towards privatization and decreased access to VA care for veterans.”
Similarly, Dr. Remington Nevin, an Army veteran and White River Junction-based epidemiologist, said he is concerned that if the White River Junction emergency department closes, other VA services also will end.
“As a significant percentage of a hospital’s inpatient and (intensive care unit) stays originate from admissions through the emergency department, its closure would in due course almost certainly lead to further reductions in staffing and to the elimination of many other services,” Nevin said.
He said he saw a similar strategy employed by the military to convert some Army medical centers to outpatient clinics when he was in the service.
“Initially the emergency department was closed or converted to an urgent care clinic, and then as fewer severely-ill patients were seen there who required surgery or hospitalization, the inpatient medical and surgical wards and intensive care units were gradually phased out or closed,” he said.
Tang, the spokeswoman for the White River Junction VA, said that the Asset and Infrastructure Review Commission will hold public hearings, visit VA facilities, meet with employees and partners, and listen to veterans before submitting final recommendations to the president.
“The recommendation of closing the White River Junction VA’s Emergency Department and any other recommendation made at this point in time is just that, a recommendation that will be thoroughly reviewed and analyzed,” she said.