Senators oppose plan to close four VA clinics

Report finds clinics in rural areas to be ‘unsustainable’

By: - March 16, 2022 4:30 am

Veterans Administration officials are recommending patients use this clinic in Santa Fe as an alternative in the event that the clinic 45 minutes north in Española is closed. (Photo by Austin Fisher / Source NM)

New Mexico’s U.S. senators are criticizing a report released by the U.S. Department of Veterans Affairs on Monday, which recommends closing four clinics across the state in Gallup, Las Vegas, Raton and Española.

The VA says once those community-based outpatient clinics close, health care in those areas would move to other community providers.

Sens. Martin Heinrich and Ben Ray Luján (D-N.M.) argue in a letter that the VA report doesn’t account for severe health care shortages in the state. They wrote that the VA’s recommendations “fail to fully account for the projected veteran demand, community care network inadequacy, and lack of access to telehealth services.”

“We believe that the proposed closures would hurt the service veterans receive and place a strain upon the other VA clinics and local providers in rural New Mexico,” they wrote to VA Secretary Denis McDonough.

Nearly half of the veterans in New Mexico are over the age of 65, according to the New Mexico Department of Workforce Solutions. They often have a hard time traveling many miles to get medical care, the senators wrote.

While there are 13 clinics scattered throughout the state, more serious conditions can only be treated at the Raymond G. Murphy VA Medical Center in Albuquerque. The medical center is nearly 93 miles one way from Española — one of the cities where a clinic will close — and an hour-and-a-half long drive.

In small communities throughout northern New Mexico, there are veterans who either cannot afford a car, or are too old or disabled to drive to Albuquerque for their medical treatment.

For decades, volunteers with Disabled American Veterans have been driving hundreds of thousands of miles back and forth to bring fellow veterans from rural counties like Rio Arriba and Taos to the medical center in the metropolitan area. They’ve struggled in the past to get funding to replace the vehicles they use.

The four facilities recommended for closure and the VA’s justifications:

The Gallup clinic “faces staffing challenges,” according to the report, and the VA expects enrollment there to decline by 6.5% in the next seven years.

The VA proposes starting a “strategic collaboration” with the federal Indian Health Service to provide primary care and outpatient mental health care at the Gallup Indian Medical Center nearby.

But the VA’s report states that the Gallup Indian Medical Center lacks infrastructure and equipment to treat many patient needs. It says IHS has agreed with the Navajo Nation to look for new sites to replace the VA Gallup clinic.

When compared with national benchmarks, McKinley County, where Gallup is located, is short by 11 primary care physicians and 358 registered nurses and clinical nurse specialists, according to the University of New Mexico Health Sciences Center.

The Las Vegas clinic is projected to see enrollment fall by 2.3% in the next seven years. The report indicates “community providers” in Las Vegas and surrounding areas will serve people there.

San Miguel County, where Las Vegas is located, is short seven primary care physicians and 117 registered nurses and clinical nurse specialists, according to UNM.

The Raton clinic will experience a larger drop in enrollment — 9% over the next seven years according to the VA. Just as in Las Vegas, unspecified “community providers” will fill the gap left by closing the Raton clinic.

Colfax County, where Raton is located, is short by 70 nurses, according to UNM.

The Española clinic is expected to lose the most patients, the report states, with 11.5% fewer veterans enrolling there. Again, community providers in the area are expected to serve veterans instead. The report notes that there is another clinic in Santa Fe, which is a 45-minute drive away.

Rio Arriba County, where Española is located, is short by six primary care physicians and 225 nurses, according to UNM.

Any changes to the VA’s health care system must be reviewed by the president, Congress, and the Asset and Infrastructure Review Commission.

The VA’s report segments the country into 23 “markets.” The VA says in its market recommendation for New Mexico that it will make sure people will not be left without care while it closes facilities.

The facilities in the Albuquerque area serve veterans from most of New Mexico and part of southern Colorado, according to the report.

The agency says the Albuquerque area has decreasing enrollment and demand for inpatient medical, surgical and mental health care. In 2019, there were 69,090 people enrolled in the VA program in the Albuquerque area.

The agency is projecting enrollment to decrease by 3.8% over the next seven years. The changes are largely driven by the population of veterans aging and predictions about when people will leave the military, the report states.

In that same time frame, the VA is also expecting demand for care related to spinal cord injuries and disorders to drop by 27.7%.

The department is anticipating a rise in demand for long-term care and outpatient care, including primary care, mental health, specialty care, dental and rehabilitation therapies.

The VA also divides outpatient care sites into “sustainable” and “unsustainable” categories. Neither the report nor the attached reading guide define what those terms mean.

“Unsustainable sites will be closed with care transitioned to community providers in order to maintain or improve Veteran access,” the report states.

The senators wrote that the recommendations are based on data that “continues to underestimate the severe health care shortages in New Mexico and the exacerbating impacts of COVID-19 on the health care market.”

UNM researchers found that because of the pandemic, the health care workforce in the state has faced furloughs and layoffs, reduced clinic hours, and hiring freezes.

Heinrich and Luján are urging the VA to meet with veterans service organizations, medical providers and communities in northern New Mexico to fully understand what the proposed changes would actually do.

They’re also asking the VA to hold in-person listening sessions, to take another look at the existing health care networks, and to consider that New Mexicans have inadequate access to the internet needed for telehealth care.

Telehealth in more rural areas is not a great substitute because of the state’s notoriously poor broadband access and infrastructure issues, they wrote.

About 22% of New Mexicans do not have access to reliable broadband infrastructure and nearly 70% have to rely on just one internet service provider, according to the White House.

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Austin Fisher
Austin Fisher

Austin Fisher is a journalist based in Santa Fe. He has worked for newspapers in New Mexico and his home state of Kansas, including the Topeka Capital-Journal, the Garden City Telegram, the Rio Grande SUN and the Santa Fe Reporter. Since starting a full-time career in reporting in 2015, he’s aimed to use journalism to lift up voices that typically go unheard in public debates around economic inequality, policing and environmental racism.