VA urgent care facility will stay open 24/7 for at least the time being

  • The Manchester Veterans Affairs Medical Center is seen July 17, 2017, the same day a group of veterans met with the hospital's new leader, Alfred Montoya, who is currently director of the VA Medical Center in White River Junction, Vt. Director Danielle Ocker and Chief of Staff James Schlosser were removed from their positions following a report in the Boston Globe that alleged the hospital was endangering patients. NICK REID

Monitor staff
Published: 9/25/2018 5:54:39 PM

Many things are in flux at the Veterans Administration Medical Center in Manchester, but overnight hours at the urgent care facility aren’t among them – at least, not yet.

“This is just like I do every situation where I look at how we can improve care ... we start having discussions to say, ‘what would serve veterans?’ ” said Alfred Montoya Jr., director of the medical center.

The idea that the VA is looking at a number of possible changes, among them whether to close the urgent care facility in Manchester during some late-night hours, came up at a recent regular meeting between VA staff and staffers of U.S. Rep. Annie Kuster, who serve on the House Veterans Affairs Subcommittee. That and news of meetings by senior staff members at the medical center has led to rumors that the urgent care facility might end its long-standing policy of never being closed.

Montoya said Monday that while the facility’s hours are among the many factors being examined, the state VA has not even begun the process of deciding whether to change hours.

“No decision has been made whatsoever, and before one would even be made, we would go out and socialize with our veterans, talk with our veteran organizations ... We have to be transparent in this process,” he said.

The veterans administration facility in Manchester has been an urgent care facility, rather than a full emergency department, for some two decades. It is open 24 hours a day, seven days a week, and serves an average of 25 to 50 veterans a day, with Mondays usually the busiest day, Montoya said.

Things are much quieter between midnight and 6 a.m., however. “We see a little over one veteran a night, 1.1 on average,” Montoya said.

That may not sound like much, but John Esposito, administrative head of the facility for night and weekend hours, said it’s an important service.

“We see more veterans during the night hours than we did three years ago – there’s a real demand for this service. If a veteran is in a mental health crisis, we can immediately plug you in via what is essentially a Skype-based system, with a VA psychologist trained to work with veterans,” said Esposito, who talked to the Monitor because of concern about rumors of overnight services ending.

“If we send them to a local emergency room, ... there’s no follow-up. ... They’ll kick him out, send him home with some medication, and say ‘hey, follow up with your insurance’ or VA ” Esposito said. “This isn’t about job security – we would be doing a strong disservice to veterans if we (close overnight).”

The overnight shift is staffed by one fee-based physician, a couple of staff nurses and an administrating officer. Montoya said that if the overnight service were to shut, the nurses and administrator would be moved to daytime positions, meaning cost savings would be small.

On most weekdays during the daytime, the center is staffed with four or five medical doctors, four or five registered nurses, and two medical support associates.

The overall budget for the VA facility in Manchester is about $200 million.

Montoya said one factor that might contribute to not keeping the center open past midnight is concern that veterans treat it as an emergency room at night, if they have trauma and it’s hard to connect with their regular supports. Since the facility lacks surgery facilities or more extensive medical equipment, the veterans might have to be referred to an emergency room, and that could slow the treatment for those who have come a long way to the state’s only VA medical facility.

“I’ve heard anecdotally of veterans who drive several hours to get down here in the middle of the night when they may have passed several emergency rooms on the way down,” he said.

The center’s website notes: “If you experience life-threatening symptoms, like chest pain, difficulty breathing, significant bleeding, severe pain, dizziness, weakness, severe vomiting, stroke symptoms or head injury you should be seen in your local Emergency Department.”

(David Brooks can be reached at 369-3313 or or on Twitter @GraniteGeek.)
David Brooks bio photo

David Brooks is a reporter and the writer of the sci/tech column Granite Geek and blog, as well as moderator of Science Cafe Concord events. After obtaining a bachelor’s degree in mathematics he became a newspaperman, working in Virginia and Tennessee before spending 28 years at the Nashua Telegraph . He joined the Monitor in 2015.

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