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Witness Testimony of Lisa Freeman, Director, VA Palo Alto Health Care System Veterans, Health Administration, U.S. Department of Veterans Affairs

Good Afternoon Congressman Denham and Congressman McNerney.  I appreciate the opportunity to discuss the VA Palo Alto Health Care System’s (VAPAHCS) efforts to provide the best care possible to our Central Valley Veterans as well as all Veterans in our catchment area from Sonora to Monterey.  I want also to address the excellent collaboration we have with our Vet Centers at Redwood City, San Jose, Capitola and Modesto.

Let me begin by giving you an overview of VAPAHCS, one of the largest and most complex VA health care systems in the country.

Overview

VA Palo Alto Health Care System consists of three inpatient divisions located at Palo Alto, Menlo Park, and Livermore, in addition to seven Community-Based Outpatient Clinics (CBOC) in San Jose, Monterey, Capitola, Fremont, Stockton, Sonora, and Modesto.  Our primary hospital is located at Palo Alto and, like most VA hospitals, is a teaching hospital, providing a full range of patient care services, as well as education and research.  Comprehensive health care is provided through primary, tertiary and long-term care in areas of medicine, surgery, psychiatry, physical medicine and rehabilitation, neurology, oncology, dentistry, geriatrics, and extended care. 

VAPAHCS has more than 800 operating beds, including three community living centers (nursing homes) and a 100-bed homeless rehabilitation center on the Menlo Park campus.  VAPAHCS is home to a variety of regional treatment centers, including a Spinal Cord Injury Center, a Polytrauma Rehabilitation Center, the Western Blind Rehabilitation Center, a Geriatric Research, Educational and Clinical Center, a Homeless Veterans Rehabilitation program, and the Men’s and Women’s Trauma Recovery Programs.  Many of these programs also treat active duty military Servicemembers under sharing agreements with the Department of Defense, under Section 1631(b) of Public Law 110-181.

Partnership with Vet Centers

Our VAPAHCS clinicians work hand-in-hand with the staff at the Modesto Vet Center.  In fact, we actually housed the Vet Center in our facilities while the new Vet Center was being built.  A large number of Veterans are seen at both VA sites– VA Palo Alto Health Care System and the Vet Center—which often leads to positive outcomes.  For example, recently one of our mental health social workers received a call from a Vet Center counselor, who said he was with a suicidal Veteran.  Thanks to the close collaboration and trust between the two facilities, literally within hours the Veteran was admitted at VA Palo Alto’s acute care mental health hospital.  Following his in-patient stay, the Veteran received follow-up services from not only a VAPAHCS clinician, but the Vet Center as well.  The Veteran continued his group counseling at the Vet Center and individual counseling from the VAPAHCS.  

Additionally, it is common for Vet Centers to refer Veterans to VAPAHCS for pharmaceuticals.  A robust consultation process also occurs between VAPAHCS and Vet Center clinicians regarding clients, when needed.

Another way the VAPAHCS and Vet Centers collaborate is in outreach.  It’s typical at community events to see both the Mobile Vet Center and VAPAHCS staff set up to enroll and serve Veterans.  Furthermore, outreach staff from VAPAHCS provide information about Vet Centers when they attend events and Vet Center staffs actively encourage eligible Veterans to enroll in VA health care.   

Telehealth in the Central Valley

To augment our direct clinical care, VA is expanding our “real-time” telehealth programs throughout the health care system and, particularly, in the Central Valley.  Along with telehealth programs for pain management, GI and rheumatology, in Modesto, we offer telehealth opportunities for Veterans in the mental health arena.  In fact, in fiscal year (FY) 2011, more than 80 percent of our telehealth encounters were for mental health.  We provide the entire range of mental health services, everything from medication evaluation and management to group therapy, and exposure therapies for post-traumatic stress disorder (PTSD).  We also offer Polytrauma Network Site initial traumatic brain injury evaluations at Modesto through real-time telehealth.

According to a nurse practitioner providing care to Modesto Veterans, on average, pain scales from Veterans attending the tele-rheumatology clinic have decreased dramatically, which indicates better pain management through telehealth.  Telehealth opens opportunities for Veterans, who often in the past, could not access the care because they had to travel long distances or who found it difficult to drive because of physical or mental impediments. 

Research at the VA Palo Alto Health Care System

Additionally, we maintain one of the top three research programs in VA, with extensive research centers in geriatrics, mental health, Alzheimer's disease, spinal cord regeneration, schizophrenia, rehabilitation, and HIV research.  Enhanced by our affiliation with the Stanford University School of Medicine, our research program provides a rich academic environment including medical training for physicians in virtually all specialties and subspecialties.  Over 1,300 University residents, interns and students are trained each year.

One area of note is the work we have done to significantly improve the quality of life for Veterans with eye and vision injuries incurred during their service in Iraq, Afghanistan and elsewhere.  Drs. Gregory Goodrich and Glenn Cockerham’s research efforts began in 2004, when they observed that Servicemembers exposed to combat blasts also had disorders of visual and binocular function, as well as occult ocular injuries. Many or most of these findings were not diagnosed in transit through the DoD and VA health care systems, and published scientific literature did not address this population or even discuss the visual system in traumatic brain injury.  Their seminal research not only led to the development of improved eye and vision injury detection, but also improved examination techniques and created innovative rehabilitation programs.

VA Expansion in the Central Valley

With a construction budget of more than $1 billion, VAPAHCS has launched an ambitious building project on its Palo Alto campus, including a new acute care mental health facility that will open this summer.  The plan also includes VA’s largest rehabilitation center, which will combine polytrauma and blind rehabilitation; additional research space; and additional lodging facilities for Veteran patients and family members.  The lodging was donated by the Pentagon Federal Credit Union Foundation. 

These projects are driven by increased Veteran demand, seismic-related upgrades, and the desire to provide state-of-art buildings, technology, and equipment to care for our Veterans.  The Palo Alto campus is also where our Modesto Veterans come for their extended clinical care, which cannot be provided at Modesto or Livermore.

We are investing money, time, and clinical skill in Modesto, where we have broken ground on a brand new CBOC that will more than double the square footage of the current clinic.   The 12 year, $10.3 million lease contract, awarded to California Gold Development Corporation from Sonora, CA, will also create at least 100 jobs during the site development, construction, and activation of this project.

The new clinic will be located at 1115 Oakdale Road, and will offer primary care, mental health services, limited specialty care, and ancillary and diagnostic services.  The 23,250 square feet clinic will be a Leader in Energy and Environmental Design (LEED) silver-certified building, substantially increasing the treatment capacity for the 7,000 Veterans currently served in the Central Valley and providing 150 parking spaces.  VA services currently offered in Modesto will remain operational until the expected completion of the new facility in spring 2013.

In 2013, we are also expanding our CBOC in Stockton, where we will add clinical programs such as physical therapy, occupational therapy, and specialty medical services with telemedicine technology.  

We have made significant progress towards the development of the new outpatient clinic and community living center as part of the Livermore Medical Center realignment.  In June 2009, VA selected HDR, Inc. of Sunnyvale, CA, to provide architectural and engineering services for the new clinic and community living center.  Programming and design of the new facilities is actively underway and will continue through 2012.  Additionally, on Sept. 7, 2011, VA officially completed the purchase of the 52-acre land parcel in French Camp adjacent to the San Joaquin General Hospital, which will be the site of the new facilities

Throughout our efforts, VA officials have made every effort to include Veteran stakeholders, both on the local and national levels, at each step of the process.  We encourage Congress, Veterans and other stakeholders to view the exciting developments planned for Veterans to visit our website at: http://www.paloalto.va.gov/construction.asp.

Thank you again for the opportunity to highlight some of the accomplishments of the Palo Alto Health Care System’s care for our Nation’s Veterans.  I will be happy to answer any questions you have.