Veterans Administration is Seriously Considering Major Reduction in Services at the Manhattan Veterans Hospital

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Veterans Administration is

Seriously Considering Major Reduction in Services at

the Manhattan Veterans Hospital
Policy Summary

From: Representative Carolyn B. Maloney (D-NY)

Re: Efforts to Save the Manhattan VA Hospital
The Veterans Administration proposes studying the feasibility of consolidating services at the Manhattan and Brooklyn VA Hospitals, potentially leaving a small fraction of services at the Manhattan location. The study has been contracted to PricewaterhouseCoopers and is already underway, with questions emerging about the degree of input that will be allowed from New York veterans and other stakeholders in the medical facilities.
Primary impacts that could occur based on the study are: all in-patient services could be transferred from the Manhattan facility to the VA Hospital in Bay Ridge, Brooklyn. Many out-patient services, including dialysis, joint surgery and vascular surgery, could be transferred to facilities in the Bronx and East Orange. The remaining services could either be retained at the existing location or moved to another location in Manhattan.
If all the in-patient services are moved to Brooklyn and many of the out-patient services are transferred to other facilities, what is the likelihood that the VA would continue to maintain services at the existing location? Veterans are justifiably concerned that this study heralds the end of high quality, comprehensive care for veterans at the Manhattan VA Hospital.
Why it would be a catastrophic mistake for the VA to dismantle the Manhattan VA Hospital:
1. Demand for Services Exists
With 1.3 million veterans in the NY Metropolitan region, the Manhattan VA Hospital currently has a waiting list for patients seeking to use its services. People travel to the Manhattan VA Hospital from as far away as Philadelphia, because of the high quality of care it provides. By 2012, the New York Metropolitan region is expected to have a shortfall of 17 beds.
Recent income eligibility changes have made it harder for veterans without service related disabilities to access care at veterans hospitals. Accordingly, declining demand has been artificially created. Even so, nationwide, 100,000 veterans are waiting for care at VA facilities. As veterans begin to return from Afghanistan, Iraq, Liberia and other hotspots, there is likely to be new demand for care at VA facilities.
2. High Quality Comprehensive Care
Situated in the corridor of Manhattan known as bedpan alley, the Manhattan VA Hospital is truly a crown jewel in the VA Hospital system. Because of its proximity to NYU Medical Center and Bellevue Hospital Center, the Manhattan VA Hospital has been able to enter into affiliation agreements, whereby doctors affiliated with those two hospitals treat patients at the Manhattan VA Hospital. In large part, as a result of these affiliations, the Manhattan VA Hospital has been able to provide an outstanding quality of care to veterans.
The hospital has been designated a center of excellence in six tertiary care specialties -- cardiac surgery, neurosurgery, cardiac-vascular surgery, comprehensive rehabilitation services, HIV/AIDS care and dialysis. Further, the Manhattan VA Hospital offers other specialty programs that are renowned for quality and innovation, including programs relating to treatment of amputees. The Prosthetic and Orthotic Lab is the only laboratory in the region authorized to fabricate definitive artificial limbs.
3. Superior Accessibility
The Manhattan VA Hospital is located near where the veterans live and, unlike some other locations, is extremely convenient for those veterans who live at a greater distance and need to use its services. The Hospital serves veterans from throughout the New York Metropolitan Area, including parts of new Jersey, Pennsylvania and upstate New York. For example, in 2002 more than 50 patients came from New Jersey and Long Island for neurosurgery, and nearly 200 came for cardiac catheterization from those communities. Staten Island residents made 11,000 outpatient visits to the Manhattan VA Hospital last year. Veterans choose to come to this facility, because it is easily accessible by mass transit and offers some of the best physicians in the nation.
New York City has the lowest level of car ownership of any region in the nation. The 2000 Census found that 54% of city residents do not own cars. Manhattan has the fewest cars with only 22% of households owning cars. Bronx and Brooklyn follow with only 40% and 46%, respectively, of households owning cars. Only in Staten Island and Queens do a majority of households own cars, and even there substantial minorities do not.
The location of the Manhattan facility is important – it is near several subway and bus lines, and is easy for non-car owning veterans to reach. Residents of Queens, Staten Island and some parts of Brooklyn would have to come through Manhattan to get to the Brooklyn facility. By contrast the Brooklyn facility is located two miles from the nearest subway station. To get there by mass transit from Manhattan, a veteran would have to take a subway and a bus, a trip of considerably longer than an hour. Even by car, the trip would be more than an hour. The problem is particularly acute for disabled veterans who have a difficult time in getting around the city. In truth, veterans would be more likely to make the lengthy trip to the Bronx, which is near the subway, rather than go to Brooklyn.
Roughly 250 NYU Medical Center-affiliated doctors (e.g. NYU Medical Center and Bellevue) provide medical treatment at the Manhattan VA Hospital. Few of these highly specialized physicians, with thriving Manhattan practices and classes to teach at the medical school, would be able to travel to Brooklyn.
4. Educational Training and Research
Currently, at any given time, there are 125 NYU medical students doing a rotation at the Manhattan VA Hospital. Every NYU medical student is required to do at least one rotation at the Manhattan VA Hospital. There would be no place for these students at the Brooklyn and Bronx facilities which are served by students from SUNY-Downstate and Mt. Sinai School of Medicine, respectively.
$14 million in research on illnesses affecting veterans is being done at the Manhattan VA Hospital. That research, which is being conducted largely by NYU Medical Center affiliated doctors, would be terminated if the Manhattan VA Hospital is closed and the veterans are no longer accessible to the researchers.
5. Washington Overrides Local Recommendations
In its recommendations, the VISN3 submission expressly stated that all existing facilities should remain open because of the complexity of transportation in New York City, as well as existing demand. VISN3 noted that there would be an expected shortfall of 17 inpatient beds by in the New York region by 2012.1 Notwithstanding VISN3's clear recommendation, the central VA called for a study as to the feasibility of transferring inpatient beds to Brooklyn, shifting outpatient care specialties and having the remaining outpatients use the existing facility or some other facility in Manhattan.
6. Soldiers Wounded in the Iraq War are Being Treated at the Manhattan VA Hospital
The Manhattan VA Hospital has already begun to treat soldiers who were wounded in the confrontation in Iraq. Clearly, the soldiers were sent to the Manhattan VA Hospital because its talented and caring medical staff have the experience to address their medical needs.
In conclusion, the Veterans Administration will argue that it is not explicitly stating that the Manhattan VA Hospital will be closed. True. On the other hand, if you transfer out all the inpatients, shift many of the outpatients to other facilities and move the rest to another location, you really have closed the hospital. Veterans living in the New York Metropolitan area will no longer have access to high quality, full service medical care in a convenient location in Manhattan, if the VA’s proposals go through. Our nation made a commitment to provide high quality care to veterans who bravely served our country. Shifting care from the Manhattan VA Hospital would seriously undermine health care for veterans in this region.

1 VISN3 acknowledges that by 2022, the region was expected to have too many beds, but cautioned that the projections did not take into account factors such as veterans of a new war. The data was collected prior to the current hostilities in Iraq.

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