Tribune News Service — Elizabeth Goolsby was the punching bag for a troubled VA in the latter half of last year.
At seven town hall meetings held since September, Goolsby - the director of the Fayetteville Veterans Affairs Medical Center - calmly stood before crowds of sometimes angry veterans.
At the height of the national VA scandal - and after Fayetteville was revealed to have the longest wait times for veteran health care in the nation - she took the abuse, the calls for her job and the criticism of her staff.
But the most recent meetings, held in a small auditorium on the third floor of the Fayetteville Veterans Affairs Medical Center last month, took on a different tone.
There still were complaints. But there also was some praise for the work to address the problem and improve care for veterans.
After a tumultuous year, local VA officials believe they are getting their arms around many of the problems exposed last year.
Last week, U.S. Rep. Renee Ellmers, whose district includes much of Fayetteville, complimented local VA leaders for their "true, honest effort to listen to the needs of the veterans" and for making access to care a high priority.
The VA leaders can point to an incremental improvement in wait times, new construction that will create more space and a congressional delegation determined to help find solutions. But in 2015, the challenges are still significant. It still takes too long to get an appointment. Getting quality staff is such a problem that Goolsby still doesn't know when the emergency room in Fayetteville will reopen. And more and more veterans are being added to the patient rolls.
Goolsby said current wait times are about 28 days for primary care, 18 days for specialty care and seven days for mental health care.
Those averages still are well-above the national average. But Fayetteville also is no longer the worst in the nation.
That distinction, according to the latest data available, now belongs to the VA based in Hampton, Virginia.
Later this year, the Fayetteville VA is expected to open a new, more than 250,000-square-foot health care center in West Fayetteville and new clinics in Jacksonville and Sanford, Goolsby said. It will expand care at an existing clinic in Goldsboro, break ground on a new Community Living Center - that will to free up space for more specialty care services at the VA's main campus on Ramsey Street, open a new temporary mental health annex, and open a rehabilitation center through a partnership with Womack Army Medical Center.
The projects will not only help officials provide better access to care, they also will increase the capacity of the VA and better position it for the future, Goolsby said.
"It's a good thing. It's for our veterans, and anything that we can do to provide care for them," Goolsby said. She said the health care center and clinics in Jacksonville and Sanford should open in the fall.
They follow other recent additions to the Fayetteville VA system.
The Goldsboro clinic, now set to expand, opened in 2013. The Wilmington Health Care Center replaced a smaller clinic about the same time.
Goolsby, who became director of the Fayetteville VA in 2009, said VA staff have become experts at cutting ribbons and breaking ground for construction during her tenure.
The Fayetteville VA had just five sites to deliver care in its 21-county region when Goolsby started her job. It currently has 14 sites and by the end of 2015 it will have at least 18.
And there are plans to add a new wing to the Fayetteville VA Medical Center on Ramsey street in 2016.
Goolsby stops short of saying the construction will solve the local VA's problems.
Yes, the new space will allow for more patients and more programs, she said. But it's unclear how much space will ultimately be needed to serve local veterans.
"Is there a stopping point?" she asked. "It's somewhat of an unknown."
The troop drawdown will continue to add patients to the VA system. In the last three months alone, more than 3,200 veterans have signed up for care through the Fayetteville VA, she said.
The Fayetteville VA's region includes Seymour Johnson Air Force Base in Goldsboro, Camp Lejeune in Jacksonville and Fort Bragg, the nation's largest military installation.
Cumberland County alone is home to 171,000 veterans, officials have said.
By early December, the local VA was seeing a patient growth rate of 9 percent a year, Goolsby said.
Goolsby said the local VA - once it reaches its planned capacity - must start to think "beyond bricks and mortar."
All 21 counties in the Fayetteville VA region are considered rural, she said, and the VA is emphasizing programs that deliver health care to veterans in those rural areas without opening far-flung clinics.
Those programs include mobile health care units, health coaching and programs that allow patients to communicate with their health care providers on minor issues from their home computers.
"We can't continue to build brick and mortar and have them so dispersed," Goolsby said. "But when you think about what kinds of things you can do with technology . a veteran does not have to be in a brick-and-mortar building to have access to care."
The national VA system, Fayetteville's VA and Goolsby were all under a barrage of criticism in June.
A national scandal was raging, fueled by claims of secret waiting lists and patient deaths in Arizona.
Then-VA Secretary Eric Shinseki was ousted, and an audit of wait times across the VA revealed that Fayetteville patients waited an average of 29 days for primary care appointments - the longest wait in the country.
New patients were waiting an average of 83 days for primary care appointments and thousands were waiting to be accepted into the system.
Officials said the delays were caused by an overstressed system. Local veterans told the Observer that the issues were far from new.
VA patients reported high turnover among their health care providers and said they were routinely told to visit local emergency rooms for minor medical needs and to fill prescriptions.
They said the Fayetteville VA was understaffed and ill-suited to deal with a huge and growing veteran population.
"It's simple: There's too many of us out here and too few of them in there," said retired Army Lt. Col. Robert Anderson, a Vietnam War veteran who serves on North Carolina's Military Affairs Commission.
The problems were acute enough to prompt a visit from Sloan Gibson - then the acting secretary of Veterans Affairs. Gibson pledged an additional $7.4 million for the local VA, earmarking the money to help officials pay for care elsewhere in the community and to cover overtime and hiring costs.
Officials also announced longer operating hours and the deployment of a mobile care unit during the visit.
"We've got a lot of good people here. They're working hard to take care of veterans," Gibson said at the time. "The biggest constraint that we've got here in Fayetteville is space."
U.S. Sen. Kay Hagan, a North Carolina Democrat who called on Gibson to make his visit, called the VA audit results "appalling and disturbing."
Ellmers, a Republican, said local veterans put their faith "in a system that doesn't work and one that has deep-seated obstructions which have prevented them from getting the care they earned."
But politicians also pledged their support.
Congressional representatives made numerous visits to the Fayetteville VA.
Sen. Richard Burr, a North Carolina Republican, sponsored several pieces of VA legislation. Hagan pushed for the approval of leases for two temporary clinics that were caught in bureaucratic red tape.
New laws made it easier for veterans to seek care outside the VA system in lieu of timely appointments and made it simpler to fire VA officials. New money was made available to the VA.
Speaking at a ribbon-cutting for new, temporary mental health space, Rep. David Price, a Democrat whose district reaches Fayetteville, said veterans issues were nonpartisan and that Congress acted much quicker than its typical snail's pace.
"The priorities are pressing at the VA ," he said. "We all know there are immediate needs."
Plans for the community clinics, new health center and rehabilitation center were well in the works before the national scandal.
But the wait times did spur the approval of two temporary clinics - one each in Fayetteville and Jacksonville - meant to relieve pressure stressing the local VA during construction.
Those clinics were opened in October and November. The nearly 4,000-square-foot Fayetteville clinic, located on Breezewood Avenue, is capable of treating 3,600 patients.
"It's a start," Fayetteville VA's chief nurse, Debra Young, said after giving a tour of the clinic shortly after its opening. "We are making every effort to deliver access and provide quality care."
Last week, Price praised local and national officials for their efforts.
"I commend director Goolsby and (VA Secretary Robert) McDonald for pursuing innovative solutions to these challenges, both at the Fayetteville VA and nationally," Price said in a written statement. "Projects like the new mental health expansion facility and the outpatient clinic opening next year will help ensure that Fayetteville's veteran population has access to world-class care."
Ellmers said she's seen a shift in attitudes when it comes to the Fayetteville VA and said officials have responded to the care crisis as best as they could.
Ellmers said Congress has appropriated billions of dollars to help the VA, including $209 million earmarked for improving access to care in December.
"There's much more work that needs to be done," she said. "We will be monitoring how this process plays out."
One key area where work remains is in addressing persistent staffing problems.
While the Fayetteville VA has lacked the space for all the employees it needs, it has also had trouble recruiting physicians to the area.
Staff issues led to the closure of the Fayetteville VA's emergency department, which had to be converted to an urgent care clinic in September.
VA employees, represented by the American Federation of Government Employees Local 1738, protested that closure and other staffing issues in late October.
Goolsby said the VA has been unable to completely staff the emergency department with its own doctors. Instead, it has used VA physicians, contract physicians and others from the community who work on a fee-basis.
But under that arrangement, the VA didn't have a consistent pool of contracted physicians and was not able to safely staff the emergency room.
In the wake of the closure, several veterans reported instances where they had to wait for hours for care in the understaffed emergency room and, in several instances, sought care when no doctors were on duty.
The emergency department will not be reinstituted until there have been two months of steady staffing. Goolsby said there is not a timetable for when that will happen.
"I'm very comfortable that we are moving in that direction," she said. "We are committed to opening it back up again just as soon as it's safe for our patients."
Staffing problems also are being addressed through collaborations, such as the shared rehabilitation center with Fort Bragg's Army hospital and partnerships with Methodist and Campbell universities.
Methodist will start its physical therapy program in the fall, Goolsby said, and the VA will be involved.
Likewise, Campbell medical students will serve as residents at the Fayetteville VA.
Nationally, VA officials say the department needs to be more competitive in recruiting doctors. Goolsby, who is planning on a lot of hiring this year, agrees.
In addition to jobs already being advertised, Goolsby said the Fayetteville VA expects to add more than 150 staff for the west Fayetteville health care center and the clinics in Sanford, Goldsboro and Jacksonville.
Since June, Goolsby has made a point of listening to local veterans.
The VA's patients range in age from 19 to at least 101, Goolsby said. They include survivors of Pearl Harbor and infamous fighting on the island of Guadalcanal in World War II, former prisoners of wars and some of the original "Beckwith Raiders" - the elite Army unit now commonly known as Delta Force.
"They all communicate differently," she said.
In addition to holding the seven town hall meetings, Goolsby hosts small group sessions with veterans every other month.
"We've been able to keep our fingers on the pulse," she said. "They are not shy about telling us what they think."
In public meetings, Goolsby frequently gives out her email and encourages veterans to contact her directly.
At the first of the town halls at the peak of the scandal, emotions ran high in the small auditorium on the third floor of the VA medical center as a standing-room-only crowd voiced anger at officials, including Goolsby.
At one point, veterans were shouting one another down. Goolsby promised to do better.
More recently, veterans have complained about the quality of their care, confusing VA websites and rude staffers. They also said it still is difficult to be treated at the VA.
Others have defended the Fayetteville VA, saying that some patients are rude to staff who are only trying to do their jobs.
"There is no health care system that does not have problems," one veteran said, noting the Fayetteville VA had more patients than it was designed to handle. "It's a work in progress. It will always be a work in progress."
Goolsby said the medical center was setting up a call center to help patients in a more timely manner in response to complaints about communication problems.
Early this year, she also will add a veterans advisory council of about 20 members.
Over the past few months, Goolsby said much of that outreach has turned positive.
"We are their VA. We are there for one reason only," she said. "Most of us went into health care because we want to take care of patients."
Patients aren't abandoning the VA, she said, despite the VA's Choice Care program created by Congress.
The program allows veterans who live far from VA care or who have long waits to turn elsewhere for medical help on the government's dime.
Goolsby said only a "handful" of local veterans had requested to join the program.
"Most of our veterans are saying, 'If I have to wait a few more days, I'd rather have my care at the VA,'" she said.
In October, the Fayetteville VA will celebrate its 75th anniversary of serving the community's veterans.
The medical center, then known as the Fayetteville Veterans Administration Hospital, opened in 1940 at a cost of about $1.5 million. It originally had 307 patient beds and 120 employees and treated 2,100 patients in its first year.
The anniversary celebration will happen the same month as the opening of the new health care center in west Fayetteville.
Goolsby said she has anxiously watched the construction of the center. The Monday after Christmas, crews in hard hats and reflective vests were busy at the site, despite damp weather.
The health care center is part of a building boom that has been bolstered by plenty of support, Goolsby said. She praised the help the VA has received from Washington, local leaders and veterans groups.
But she said that support has come during 13 years of war, at a time of unprecedented patriotism that has coincided with the longest period of conflict in the nation's history.
She said she's worried the support won't keep pace with those newer veterans.
"As the war fades, as other issues are on the front page of the newspaper more often, I hope that we don't forget those warriors who are our veterans," she said. The VA spent years preparing for aging Vietnam veterans, she said. Now there is a large population of veterans whose average age is 30.
"They're going to be our veterans for the next 50 to 60 years, and I hope our sense of patriotism doesn't fade just as they are beginning to need us," Goolsby said. "We need to make sure we are paying forward in order to provide them with the best quality care."
Military editor Drew Brooks can be reached at brooksd@fayobserver.com or 486-3567.
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©2015 The Fayetteville Observer (Fayetteville, N.C.)
