ELIZABETHTOWN - Dozens of veterans joined nine Essex County supervisors in an open forum May 7 to express their opposition to the proposed relocation of the Elizabethtown Veterans Administration clinic.
More than 200 people, mostly veterans and their family members, filled the gallery in the Essex County Board of Supervisors chambers and spoke passionately against removing VA clinic operations from Elizabethtown Community Hospital.
The satellite clinic, established at ECH in 1988 as one of the first in the nation, operates under the auspices of the Stratton VA Medical Center in Albany, but its relationship to its parent facility has grown sour as of late.
"We have come to an impasse such that the Elizabethtown Community Hospital hasn't been able to provide [a full-time] physician," explained Stratton VAMC director Mary-Ellen Piche, "and at a cost that will meet their costs."
Piche said a request for proposals was currently out, giving possible contractors the chance to offer to house the clinic, with preference given to facilities in Saranac Lake or Lake Placid. A clinic with full-time presence split between those communities and Elizabethtown would also be considered.
Proposals are due by May 15, with hopes of opening a new clinic by Aug. 1.
The Lake Placid and Saranac Lake region has a higher, denser population, Piche said, and so they expect as many as 1,000 new veterans to enroll if the clinic is established there.
"Our primary goal is to deliver the best care for as many veterans in the North Country as we possibly can," she said.
"If you move this clinic away from Elizabethtown, you will fail that goal," said Ticonderoga supervisor Robert Dedrick, noting that relocating the clinic would require many veterans to make at least an hour-long drive taking them through the Cascade Lakes region.
"From mid-fall all the way to mid-spring it is very treacherous driving, and you're going to ask our veterans to drive all the way to Saranac Lake?" Dedrick asked, echoing the sentiment of many veterans present.
Thomas Scozzafava, supervisor of Moriah, claimed the highest percentage of Essex County veterans reside in the southeastern part of the county.
"If you move it to the northwestern end of the county, there are going to be a lot of veterans that will go without health care," he said.
Besides Elizabethtown, the nearest VA clinics to Essex County include Malone and Plattsburgh to the north and Glens Falls to the south.
Elizabethtown supervisor Noel Merrihew III, who also sits on the board for ECH, expressed concern that a more distant clinic would discourage veterans from seeking treatment until their conditions became more severe.
"The benefit I believe we have been able to provide is preventative medicine," he said. "And that's something we need to keep in mind."
Brett Thompson, a member of American Legion Post 278 in Schuylerville, presented a petition signed by 826 veterans in favor of keeping the VA clinic stationed at ECH; a number roughly equal to the veterans currently enrolled at the Elizabethtown clinic.
"When the government takes something from you, you never get it back," said Thompson. "Let me give you an example; sight, the ability to hear, legs, arms, life."
Other clinic needed, too
Frank Karl, a former commander of Veterans of Foreign Wars post 3357 in Saranac Lake, said he's been working with Congressman John McHugh's office to have a VA clinic established in Saranac Lake.
Karl showed a list of more than 4,000 veterans from the Tri-Lakes area. He said many of them travel to VA clinics in either Malone or Plattsburgh to receive care rather than take the difficult drive to Elizabethtown.
"We've been working for some time, not realizing there was any danger to the Elizabethtown clinic," he said. "Your clinic should be here, and we need one over there, and need it badly."
Piche said the Albany VA only had authorization for one clinic in the area, and two separate full-time clinics would not fit in to their budget.
"We would love to have one of these clinics in every community," she said, "but we know that's not practical."
Leaving the door open
"I want to assure you that the board of directors is fully supportive of keeping the clinic here in Elizabethtown," said ECH board president Ulrich Hoffman, a Korean War veteran.
According to ECH administrator Rod Boula, the hospital lost $59,000 last year because its contract with Stratton VAMC did not provide enough reimbursement to meet its costs of operating the satellite clinic.
Negotiations for a contract that meets the hospital's costs fell through, and ECH has been operating the clinic without a renewed contract since November.
"All we want to do with the clinic is break even," said Hoffman. "I'm sure this can be worked out."
Boula said the hospital would be submitting two responses to the RFP; one that mirrors its current operations, and another that would offer services through its Wilmington satellite clinic part of the week.
Scozzafava proposed the possibility of allocating county funds to make up the $59,000 difference if it would allow the clinic to stay at its current location.
"There's still the issue of whether Elizabethtown Hospital can provide a full-time physician," Piche responded.
Since its inception, the Elizabethtown clinic has been operating with one part-time physician, Dr. Herbert Savel, who oversees a staff of physicians assistants at the hospital.
According to Piche, the VAMC in Albany has made it a goal to offer one standard of care at all of its 11 satellite clinics by requiring a full-time, VA accredited physician to be among the staff provided by the facility.
Though they've had over a year to recruit a full-time physician, ECH has failed to do so, she said. In addition, the clinic has been short-staffed by one physician's assistant as well.
"We had a PA, and you didn't like him," said ECH board president Ulrich Hoffman. "Then you changed the rules and said we had to have a full-time physician."
Most veterans scoffed at the rule-change, praising the individualized care they have received from Savel and the physicians assistants.
"I've gotten better service from the PAs at this clinic than I did in 15 years of active duty," said Ron Lozito, a veteran that served in Korea.
Boula acknowledged that getting a full-time physician to staff the VA clinic would not be likely. Still, he was skeptical that a facility in the Tri-Lakes region would have any less difficulty.
Essex County Manager Dan Palmer was among many who said the requirement placed an unnecessary burden on the VA clinic at ECH.
"Albany makes determinations that are for the broad majority, but this doesn't work for us here," he said. "It may be the best practice in Albany. It may even be the best practice in Saranac Lake, but it is not the best practice in Elizabethtown."
Though Piche wouldn't comment on whether or not the VAMC in Albany would reconsider the policy, she did say Boula's proposal for keeping the clinic at ECH would be taken into consideration.
"If he can make it work, we'll entertain it," she said. "We will consider every response to this [request for proposals]."
Michael Backus, field representative for McHugh, was present at the meeting, and said the congressman was aware of the importance of the issue and was committed to serving veterans in the North Country.
"We will do everything in our power to make sure you have medical services provided to you in your community," he said.
Piche, too, acknowledged that the public's views on the issue would be taken into account.
"It certainly gives us a lot of things to think about on that two hour ride back to Albany," she said.