Haunted by images of his dead and wounded comrades in Iraq, Andrew Bell turned for help to the VA Pittsburgh Healthcare System.

Mr. Bell, 41, of Carrick, said the care he has received for post-traumatic stress disorder has helped him cope with the past and begin to plan for the future.

	Andy Starnes, Post-Gazette Andrew Bell, 41, an Army veteran from Carrick, stands beside a display case of memorabilia he brought back from Iraq. He said that putting the case together had theraputic value and helped him cope with the memories of dead and injured comrades from the Iraq war. Click photo for larger image. Listen In Listen to excerpts of comments about medical services at VA Pittsburgh Healthcare System: Dr. Jeff Peters, psychiatrist and VA Pittsburgh's vice president for behavioral health Army veteran Andrew Bell, of Carrick, suffering from post-traumatic stress disorder Army veteran Clifford White, of Wilkinsburg, suffered broken arms

While Mr. Bell is satisfied with his treatment, problems reported at other Veterans Affairs facilities and at Walter Reed Army Medical Center have raised concerns that some veterans, here and elsewhere, may not receive timely or appropriate care.

VA Pittsburgh officials contend that returning war veterans are promptly referred for treatment. But others say access to care can be a problem, particularly for older veterans. Still others note that bureaucratic red tape can significantly delay the processing of veterans' disability claims.

U.S. Reps. Michael Doyle, D-Forest Hills, Jason Altmire, D-McCandless, and Tim Murphy, R-Upper St. Clair, said older veterans are having problems getting admitted to VA medical facilities locally and nationwide.

"The problem is, these guys have been shortchanged financially for many years," Mr. Altmire said. "The VA has been underfunded and forced to cut corners, and there are repercussions."

Mr. Doyle, a member of the House Veterans Affairs Committee and its health care subcommittee, said House Democrats have vowed to provide additional funding to the veterans health care system.

"Supporting the troops is not just putting weapons in their hands, but taking care of them and their families when they come home," Mr. Doyle said.

Mr. Murphy said some veterans have had trouble getting care even though VA funding has increased 90 percent in the past decade.

"The good news is, it's a place people want to go to," he said of the VA's health care system. Like Mr. Doyle and Mr. Murphy, he praised the quality of treatment.

"But the difficulty is, the beds aren't there," Mr. Murphy said.

He said he has asked VA officials to schedule health clinics in the South Hills so older veterans have better access to basic medical care.

Steve Dennison, service officer for the American Legion in Pittsburgh, said he receives about 10 calls a week from veterans having problems getting admitted to local VA hospice or treatment programs.

	Dr. Jeff Peters
	Clifford White

"Nine times out of 10, [VA officials] say, 'We don't have the right bed or any bed for them,' " he said, claiming the VA has reduced the number of beds because of budget constraints. "Getting people in the VA that deserve to be treated is the main concern and main problem."

He said problems described in a letter he received four years ago from then Secretary of Veterans Affairs Anthony J. Principi still exist.

In the letter, Mr. Principi said a "tremendous growth in demand for health care services coupled with finite resources has prevented VA from providing timely access to quality health care to all enrolled veterans." In January 2003, more than 200,000 veterans were on waiting lists to be scheduled for an appointment, the letter noted.

But VA officials said the agency has done much to reduce waiting lists. Currently, they said, 95 percent of the 39 million appointments made annually occur within 30 days of when either the patient or patient's physician desired an appointment.

VA Pittsburgh officials said the number of veterans served locally has grown from 53,642 in fiscal year 2002 to 57,606 last year. Outpatient visits also increased during that period, from more than 408,000 to nearly 481,000, and the budget has increased from nearly $267 million to $352 million.

David Cowgill, a VA Pittsburgh spokesman, also challenged Mr. Dennison's concerns about end-of-life care, saying the system's 76 beds for those needs and another 336 long-term care beds are never fully utilized.

"We always have beds available and do not turn patients away who meet the admission criteria," he said. "If we had a greater demand, we could add staff and use more beds. But there has not been a demand."

VA officials also emphasized that much is being done to ensure that returning war veterans receive the care they need.

Returnees get top priority
VA Pittsburgh has made prompt care and treatment of veterans returning from Iraq and Afghanistan "a top priority," said Ron Rabold, vice president of community-based care.

He noted that for those veterans, VA Pittsburgh maintains a clinic where they are screened and referred for additional treatment if needed.

Brandon Floder, 24, a Navy veteran from North Huntingdon, said he learned of the clinic from a career counselor and has been pleased with the care he's received.

Dr. Jeff Peters, a psychiatrist and VA Pittsburgh's vice president for behavioral health, encouraged returning veterans to call the clinic at 412-365-5150. He noted that they can receive care at no cost to them for at least two years after they leave active duty status.

Veterans who have served in Iraq or Afghanistan typically are seen in the clinic in 30 days or less, he said, even though the number of those veterans served has grown from just one patient in December 2003 to more than 1,000. Additional staff have been added as demand has increased, he said.

In addition, many who seek help for suspected post-traumatic stress disorder or other behavioral issues can be seen on a walk-in basis, Dr. Peters said.

"No private practitioner in the area can offer that kind of same-day, walk-in service," he said.

About one-third of veterans who are screened here show signs of behavioral health problems that range from mild to severe, similar to trends nationwide, he said.

While concerns have been raised nationally about a shortage of mental health and brain injury specialists, Dr. Peters said that problem is not evident at VA Pittsburgh, perhaps because it is a large center that handles a variety of complex medical conditions.

VA Pittsburgh includes three divisions -- a hospital in Oakland, the Heinz division in O'Hara and the Highland Drive division in East Liberty -- as well as five community-based outpatient clinics.

Dr. Peters acknowledged that patient care problems can occur, but said that can happen at any of the nation's medical centers, not just at VA or military health facilities.

Individual examples of problems exist "at every hospital in the U.S.," he said. "I don't think any of us are perfect, and I think sometimes things fall through the cracks despite good intentions.

"What's helpful is to know what happened so that people can try to prevent, as much as possible, from it ever happening again."

Tom Benedict, program director for the Veterans Leadership Program of Western Pennsylvania, which serves veterans and their families, said VA Pittsburgh provides "a great service to our folks. We don't hear of many problems."

In recent months, the local VA health care system has been noted for leading a national effort among VA facilities to control potentially deadly infections caused by an antibiotic-resistant strain of bacteria known as MRSA. The system also will benefit from a $200 million construction project aimed at improving and consolidating services.

Clifford White, 27, of Wilkinsburg, said that after he broke both arms during a motor vehicle accident in Iraq, personnel at Walter Reed initially sought to discharge him from an inpatient unit before he was able to handle his personal care needs. He had no complaints, however, about follow-up care he received at VA Pittsburgh.

Kathleen Janoski, a Brookline resident and former Navy chief petty officer, said she has received care at VA Pittsburgh since 1999 and is very satisfied with her treatment.

"I think the big problem with the VA is disability claims," she said, noting more than seven years passed before her claim and related appeals were resolved.

"There is a backlog as far as applications for compensation," said Michael Murphy, an executive assistant for veterans' services in Allegheny County.

Last week, President Bush created a federal task force to examine ways to cut through red tape affecting recent combat veterans who are seeking services and benefits.

Veterans Affairs Secretary Jim Nicholson announced that the VA is hiring 100 patient advocates to help severely injured veterans and their families navigate the VA's systems for health care and financial benefits.

VA officials said claims of newly returned combat veterans will be moved to the front of the line when they apply for disability compensation. And the VA is working to implement a program where, when those veterans file claims, the department makes a presumption of validity and begins payment quickly.

In addition, the VA is taking steps to improve care for the most seriously injured veterans by increasing the number of "polytrauma" centers.

Officials also emphasized that they are following through with earlier measures to safeguard computer records containing veterans' personal information. The VA was criticized last year after computer data containing information about veterans in the Pittsburgh area and elsewhere disappeared.

Mr. Bell said he came to the VA Pittsburgh system for treatment about two years ago. A 10-year Army veteran, he had left the military in 2004 because of his war experiences.

After returning home, he said he initially had "a lot of nightmares, a lot of sleeplessness" and other health problems.

As part of his recovery from post-traumatic stress disorder, he has arranged a display at the VA Pittsburgh's Highland Drive division that holds his military insignia, boots, photos and other mementoes from his time in Iraq. He called the display, which he visits frequently, a kind of shrine to friends who died in battle.

Though his treatment is continuing, Mr. Bell said he is looking forward to participating in a training program that will help him learn a trade.

He said the local VA system was "responsive immediately" when he sought medical help. "To be honest with you, I wouldn't be breathing right now if it weren't for the VA."