The Durango Veterans Affairs Clinic provides primary medical care to almost 2,000 men and women who range in age from World War II veterans to 22-year-olds just returning from Afghanistan. But that is only a portion of the 10,000 or so veterans in La Plata, Archuleta and Montezuma counties who could be benefiting from the services.
The clinic wants more veterans to sign up for VA health care, because when they do, it can provide more resources.
“A lot of veterans don’t sign up because they think they’re saving the resources for those who really need them,” said Dr. Luke Casias, medical director of the clinic, who leads a staff of 11. “But the VA works by head counts, not number of visits, so even if they just sign up and come in for one wellness visit, they help us get more resources for the veterans who have to come for six and seven visits.”
Those new signups will have access to a remodeled clinic that has several rooms dedicated to telemedicine consults, offices for social-work assistance, post-traumatic stress disorder support groups, one-on-one counseling and psychiatric treatment, and a staff of nurses who can triage acute walk-in cases.
“We’re full primary-care service for female veterans, too,” Casias said. “We offer Well Woman examinations, birth control, mammograms, pregnancy care and so on.”
Female veterans deal with PTSD, too, he said, and either live or teleconferences with gender-specific psychologists or psychiatrists are available on site.
The clinic has significantly improved Army veteran Ron Melius’ life, he said.
Melius received care at the VA Hospital in Fargo, North Dakota, for decades. After he moved to Pagosa Springs, he sought care at the Durango clinic, where Casias diagnosed a problem Melius has struggled with since he was stationed in Germany in the 1970s. Melius had surgery in Albuquerque and is now healing.
A model that (mostly) works
Casias has worked in private and public practices. He now works for the government through a contractor, Valor/Concentra.
“In private practice, I saw 30 patients a day, and it was mostly about a specific ailment, a hurt wrist or whatever was bothering them. But now, in the medical-home model, I’m invested in all aspects of their care,” he said.
At the VA clinic, Casias generally sees about 11 patients each day and can spend more time with each.
“It’s more true personal care, because we’re talking about all of their health and well-being,” he said. “I may check a recent stent, evaluate medications, remove a mole, inject a shoulder, screen their PTSD. That would require four visits in the outside world. It’s part of the VA’s cost-containment and also doesn’t require the patient to make more than one visit.”
Casias’ biggest challenge is veterans who receive care in both the private sector and the VA, called dual care, because keeping complete records is difficult.
“Particularly once they hit Medicare age, and I’d say about one-third or more of our patients in that age group see subspecialists and receive other care both here and that way,” he said. “Faxes don’t get sent; there’s a delay in getting records. A large number of them only want to use the VA as a pharmacy, but we’re averse to that, because we want to treat all of you.”
The medicine situation presents a challenge.
“At least half, if not higher, of our veterans have suffered from or currently have drug or alcohol issues for self-treatment of mental disorders such as PTSD,” Casias said. “We’re really worried about the significant risk of death from medication interaction or overmedication if we don’t know all the meds a person is taking.”
More than health care
Jessaca Cassady, a new social worker at the clinic, goes beyond what the VA offers to help veterans.
Cassady said the clinic treats a large number of geriatric veterans, so she helps coordinate home health care and nursing homes and with powers of attorney and wills.
Cassady, who has been on the job for about four months, has been working with between 50 and 80 veterans a month.
“What the VA offers is limited,” she said. “I help veterans connect to community resources at the (Veterans of Foreign Wars), American Legion, (Benevolent & Protective Order of) Elks. We have a lot of homeless veterans, so I’ll connect them with the (Volunteers of America), which has several veterans programs.”
One of her favorite stories is of a Vietnam War veteran who had been living in Pagosa Springs.
“He was struggling with alcohol issues and PTSD,” Cassady said. “He lost his housing and ended up at the (Durango Community) Shelter here. Working with VOA, we connected him with a per diem program, got him housing with services to assist with his problems, and because he had a lot of physical ailments, got him on Medicaid, too. He needed a lot of care coordination.”
Was it worth the work?
“Oh, yes,” she said with a big smile. “He’s doing really well now. He’s got his own place and says he’s looking forward to giving back to the community that helped him so much.”
abutler@durangoherald.com
To sign up
The easiest way for veterans to sign up for medical care is to go through the Veterans Services Offices in La Plata, Montezuma or Archuleta counties. The Durango VA clinic is at 1970 East Third Ave., Suite 102. It is open from 8 a.m. to 4:30 p.m. Monday through Friday; it is closed for lunch from noon to 1 p.m. each day. Appointments are required, but you must first be enrolled in VA health care to receive services. For more information and to make an appointment, call 247-2214.
