Wednesday, Sept. 13, 2006 | When Sharon Freeburn tried to make a follow-up appointment last month at the Naval Medical Center in Balboa Park it was supposed to be for a routine visit. But she’s found that scheduling that appointment has since turned into a routine of its own.
During her first failed attempt, Freeburn, the wife of a retired lieutenant commander with 17 years in the Navy, was told that her doctor’s September schedule wasn’t available yet. Freeburn kept calling once a week, but the answer remained the same.
Finally, she was told that her doctor, a civilian contracted to provide care at the naval hospital, was in the midst of contract negotiations and wouldn’t be taking appointments until they were complete.
“I’m supposed to be going back for high blood pressure,” Freeburn said. “This is not helping.”
Freeburn isn’t the only patient having trouble landing a date with a doctor at the naval hospital.
The deployment of roughly 600 medical personnel from the local naval hospital to the wars in Iraq and Afghanistan and tsunami relief efforts in Southeast Asia, coupled with an ongoing transition between private companies that help staff the hospital, has left the primary military hospital in the region short-staffed and patients in limbo. While hospital officials say the staffing crunch is temporary, advocates for military families and retirees who depend on the hospital for medical services say it’s part of a larger national trend -and an infringement on a promise made to service members.
“The war is certainly taking its toll as there are more and more medical resources that have to be expended,” said Joyce Raezer, director of government relations for the National Military Family Association, a nonprofit advocacy group for military families. “There are just more and more demands on the military direct care system and the resources have just not kept up with the demands.”
At the naval hospital those demands come from an estimated 108,000 active duty and retired service members and their family members who have chosen to enroll as primary patients at the facility. Hospital officials estimate a total of 250,000 people in San Diego County with similar ties to the military are eligible to receive care there.
But the staffing shortage is forcing those in need of preventative or routine medical care to seek attention elsewhere or, in Freeburn’s case, wait more than a month for an appointment at the naval hospital.
Capt. David Tam, deputy commander of the naval hospital, said the contract transition involves approximately 700 civilian employees – physicians, nurses, technicians, therapists and other medical support staff – who are hired by third party contractors to work in the hospital. Figures compiled by the hospital in May put the total number of civilian contract medical workers closer to 1,000 – more than 15 percent of the hospital’s total workforce.
Two of the four contracts between the Department of Defense and those third party vendors recently expired and two others are set to end by Oct. 1. In the meantime, the Navy has inked new deals with one former and three new contractors to provide civilian staffing services.
Those companies have started negotiating with some of the existing civilian staff, as well as posting ads on medical career web sites. While several of the new contractors declined to comment on the status of those efforts, James Chestnut, who oversees the contracting for the Navy, said hiring civilian staff through third parties has been common practice at the hospital for nearly 20 years, and the current staffing difficulties are part of a normal transition.
Chestnut declined to provide the number of positions that currently need to be filled or the percentage of employees that have already been hired. He said any numbers he could provide wouldn’t accurately project the situation because the process is ongoing and those numbers change daily. “As the contracting officer, the one with my name on the contract, I am confident and comfortable that [the positions] will be filled,” Chestnut said, adding that contractors typically are given 60 days to fill vacancies.
Tam said that between 10 and 15 doctors, some of whom have been with the hospital for years, and an unknown number of nurses and support staff are no longer working pending the outcome of the negotiations.
Tam acknowledged that the deployments and the contract transition have reduced the hospital’s patient capacity but he said care for the non-emergency sick or injured hasn’t been interrupted and appointments are typically available for those patients within 24 hours, in compliance with government guidelines for military hospitals.
Yet for patients like Freeburn, who are seeking preventative or less urgent care, Tam said the hospital is currently “triaging available appointments” and offering alternatives, including appointments at one of the naval hospital’s 10 branch facilities in the county or a paid visit to a civilian doctor.
“Every patient who can’t get an appointment here, we’re offering them appointments at clinics or civilian care,” Tam said. “It turns out that a vast majority of our patients are willing to wait.”
Tam didn’t know how many patients are waiting or how long they have to wait. He said he hopes the situation will improve dramatically in the coming weeks as more civilian staff becomes available.
Under government guidelines military hospitals are supposed to provide patients who aren’t sick or injured with an appointment within 30 days, Tam said. That period has already passed in Freeburn’s case, but she doesn’t mind waiting for her blood pressure screening because it’s not a critical issue.
Instead, Freeburn is more concerned that others in the military community could have seemingly minor undiagnosed medical concerns that may become serious if untreated over time and can’t afford the delay.
While Freeburn said she was never offered the opportunity to visit a branch clinic or visit a private doctor when attempting to make an appointment, she said she still would have opted to see her regular doctor at the naval hospital.
“I’m going for follow-up care, I need continuity of care,” Freeburn said. “At my age that’s important.”
Freeburn isn’t the only voice in the military community expressing those concerns.
Raezer, from the National Military Family Association, said limited access to care and regular doctors are two trends that are on the rise in American military communities around the world.
She said that historical underfunding of military medical facilities as well as staffing deficiencies, including recent changes to the way the department of defense hires civilian employees through third party vendors, have resulted in a declining availability of healthcare to military personnel and their families.
“It goes back on a promise made to the people who joined the military… the people who stayed in the military long enough to retire and their families, and the survivors of those who died in the military, that they would have access to this high-quality healthcare benefit,” Raezer said. “What we hear is it’s not getting any better.”