How Freeville clinic gets veterans health care right

Editor's Note: The following is Part IX of "Hope on the Homefront," a 10-part series by our media partner, the Ithaca Voice, on the struggles of the area's veterans.

Read the introductionPart I; Part II; Part IIIPart IVPart V; Part VIPart VII; and Part VIII. Additional features and columns running as part of the series can be found here.

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FREEVILLE, N.Y. — Most Ithacans know nothing about the veterans’ clinic in Freeville. Just eight miles from downtown Ithaca is the US Department of Veterans’ Affairs’ outpatient healthcare facility.  It provides primary care to an astonishing 2,165 vets in Tompkins County.

The Ithaca Voice has saved this story until the end of our “solutions” series looking at the problems that face Tompkins vets. This is because what is happening in Freeville – under the guidance of Cheryl Wyak, the nurse who runs the clinic – is probably the most hopeful story of veterans care we have come across.

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Cheryl Wyak (Dave Burbank/Ithaca Voice)

The Voice has been working on our Hope on the Homefront series since February. During that time, again and again, veterans we have spoken to have said that they feel their health care in this area is being treated with the appropriate respect and attention it deserves. Not that the service is perfect, but that as far as humanly possible the team at the Freeville Clinic do the very best they can.  This is quite at odds with the national headlines over VA wait times and other systemic failures.

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But there are places where the system put in place to meet the medical needs of our veterans is working.  The Freeville Clinic hopes to be one of them.  And the people who run the clinic hope theirs will be a model repeated across the rest of the country.

The Freeville model

The first rule at the Freeville clinic is simple: no veteran is ever turned away. If a veteran is in crisis and calls the clinic he or she is never put on hold — the staff is trained to keep that person on the phone talking, until they are either seen at the facility or an outreach worker meets with them.  There is an internal office messaging system that allows medical staff to communicate with each other, while staying on the phone with the veteran.

National headlines about VA health care wait times and other failures have been, says one VA insider, an “embarrassment” and “shameful.”

One of the stories that made national headlines was about a veterans crisis line that had - at some point - directed veterans in crisis to an answer machine message.

Wyak leads a team of 15. Every person on that team is trained to deal with a mental health emergency.

“We all specialize in psychiatric health here,” says Wyak. “We are all trained to take mental health patients.

“We have a mental health social worker who can see somebody right then and there if someone needs immediate care. She's very good about making it the very next appointment time, which is usually the same day.

How does the Freeville clinic handle other acute cases? “We have a set template in our schedule that includes free appointment spots, so that we put acute patients in that spot,” says Wyak.

What if someone walks in and they are clearly in distress or need of help?

“They would be seen immediately.” she says. “Technically we're not a walk in clinic, but again, we don't ever turn anybody away.”

Reducing distance, travel time for veterans seeking health care

Wyak’s grandfather was a veteran.  During World War II, his face was damaged in a bomb explosion and he lived ever since with partial blindness. He passed away two years ago.

“He did quite a number of tours,” she says. “He was a big part of my life as a child: I want to do right for the veterans and I want to make him proud. Every day I come to work and I think about that.”

The Syracuse VA Medical Center is the “mother ship” for Tompkins County and 13 other counties across the area. The Syracuse hospital is supported by seven community-based outpatient clinics - all based on the same model as the one in Freeville.

Retired Lieutenant Colonel Robert McLean has been the Public Affairs Officer at the Syracuse VA Medical Center since 2012. He served as a Marine for 25 years, has something of a presidential air about him and is the kind of person you would want fighting in your corner.  In May, he came to Freeville from Syracuse to show the Voice the facility.

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Retired Lieutenant Colonel Robert McLean. (Dave Burbank)

One of the main criticisms that face veterans service providers such as the VA is the centralized nature of the services. If a vet doesn’t live in a big city, close to a VA hospital, how does the he or she get the health care they need?  It is a problem that Jack Downing at Soldier On pointed out in his editorial for the Voice.

“We want to bring the health care - to the extent that we can -  to the veteran,” says McLean. “We cannot eliminate, but we can certainly reduce the amount of time and distance that a veteran will have to travel to get health care. It's a hub and spoke point of view.”

A system that's 'specific to the patient'

Each veteran is assigned what Wyak calls a “teamlette" which works as follows: each veteran’s teamlette will have a provider, an RN (registered nurse), an LPN (licensed practical nurse), and a medical clerk.

A psychiatrist visits the Freeville clinic once a week. A pharmacist is in the clinic twice a week.

“We have a social worker full-time for mental health. We have someone in charge of vocational rehabilitation. We have also an outreach social worker that goes out into the community.” His name is Benjamin Evans and he also met with the Voice to talk about his work in Tompkins County.

“It's error proof,” says Wyak of the teamlette structure. “It's specific to the patient and it works.”

The clinic also uses a “telehealth” system, which means that veterans and specialists based in Syracuse can communicate via Skype from special booths at the clinic.  This cuts down on travel time to the central hospital.

“There's no question, and it's very clear at the VA, that it's been a very difficult period,” says McLean, when we talk about the national headlines pointing to scandalous wait times for veterans at other hospitals and clinics across the country. “A lot of those challenges that some of the VAs around the country have faced, we have not had similar issues here. I think there's a number of reasons for that. First and foremost it is because of people like Cheryl who are really dedicated.

“At the main medical center, and by extension our clinics, we are among the highest-performing medical centers in the country in terms of patient satisfaction. It comes down to providing the right care, with the right people, at the right place, at that right time for our veterans. We work very hard to do that, which is not to say that we don't have some challenges.”

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The VA healthcare system is the largest integrated healthcare system certainly in the United States and maybe the world. It has 153 medical centers - and probably close to 8,000 points of care in the country when you count all the clinics. It's an enormous system that takes care of over 8 million veterans as a whole.

“When we walk through the door here, we leave our own problems at the door,” says Wyak. “We are 100 percent dedicated, and every single staff member here is the same exact way. Not every day is a great day, but we always have the look on our face like it is. We are here to serve our veterans, and that's what we do.”

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