Guarded Condition

Or that the bucolic setting of the Canandaigua VA Medical Center is better suited for those whose conditions call for less aggressive treatment.

Or that “due to technology and national and VA health care trends, VA has changed from a hospital-based system to a primarily outpatient-focused system,” as the Department of Veterans Affairs states.

“Somebody is blowing smoke,” said Carey, a single father of two who for five years has depended on regular stays at the Canandaigua VA’s acute psychiatric unit to keep his illness in check.

The fate of the Canandaigua VA Medical Center is still a concern for patients like Carey, the institution’s community, and for political supporters. Ever since the government announced in August 2003 that it would close the VA as part of a cost-cutting move, and ever since it reversed itself and then said in December 2005 that Canandaigua would become a VA “Center of Excellence,” skeptics haven’t escaped the feeling that the story could still have a bad ending.

When the Department of Veterans Affairs announced Oct. 20 that the hospital’s remaining eight beds in its acute psychiatric unit would move to other VA facilities, doubts — and concerns for patient care — grew. Even high-ranking politicians like New York’s two U.S. senators, who claim to have had a role in saving the VA, are raising red flags.

“There are still too many unanswered questions for the VA to be moving forward so quickly and closing these psych beds,” Sen. Hillary Clinton, D-N.Y. said in a release.

‘An insult’

Clinton and other VA supporters like to point out there’s a war going on. And with a war come more veteran patients.

“Providing central New York veterans with access to world-class mental health care is one of Canandaigua’s critical capabilities, and it is becoming increasingly important as more service members return from Iraq and Afghanistan suffering from post-traumatic stress disorder and other mental health problems,” Clinton wrote VA Secretary Jim Nicholson. “I urge you to delay any decision regarding the acute inpatient psychiatric beds at Canandaigua until a final, complete decision is made on the future of the facility.”

Nicholson responded in a letter to Clinton Thursday, saying the plan for the eight-bed unit “is still under development.”

But VA employees say a closure plan is under way.

“We are still preparing to close,” Allen Chopik said Friday. Chopik is a registered nurse for the unit and is chief steward for the Canandaigua VA’s union of professional staff. The only unsettled issue is whether the unit will stop taking patients Nov. 1 or Nov. 7, Chopik said.

After an internal memo about the plan to close the acute-bed unit was leaked to the press earlier this month, VA officials promised a new 22-bed unit “providing improved mental health care for nursing home patients” would eventually be opening.

The move fits the CARES (Capital Asset Realignment for Enhanced Services) plan announced in 2004, which calls for acute beds to move to VAs in Buffalo and Syracuse, said VA spokeswoman Karen Fedele.

“The Buffalo and Syracuse VA medical centers have greater specialty care, both medical and psychiatric, which benefit our patients,” she said.

But Carey and others aren’t buying that, any more than they find relief in the government’s promise that the Canandaigua VA will become a Center of Excellence for mental health.

“It’s a rosy designation,” said Army veteran Moses Gilbert of Victor. The bottom line is that veterans are being denied necessary services here, he said. Particularly in the middle of a war, to be reducing services — “it’s deceitful, disrespectful, an insult,” Gilbert said.

'You feel like you are cattle'

From its heyday in the 1950s, when the sprawling complex off Fort Hill Avenue had 1,750 beds and focused on inpatient psychiatric care, the hospital had shrunk to 275 beds when its closure was first announced. Federal government cutbacks gradually shrunk the size of the staff between 1995 and 2000 from 1,200 to 800.

Officials said a shrinking veterans population that was increasingly migrating south, along with a crushing federal deficit and spiraling costs, were unrelenting forces that required the government to rethink it strategy for veterans’ care.

But the decision to keep some VA services at the Canandaigua campus was hailed as a victory for local veterans — and for the politicians who came to Canandaigua’s aid. But 10 months after the “Center for Excellence” announcement, it’s still not clear what such a center is. And new questions keep popping up.

The planned closing of the acute care unit is an example of how unsettled the VA’s issues are. Lawmakers on both sides of the aisle — including Clinton and Rep. Randy Kuhl, R-Hammondsport — have voiced opposition to closing the unit before the Canandaigua VA’s long-term fate is settled.

Carey says his experience illustrates the plan’s shortcomings.

In July, he was sent to the Buffalo VA for two weeks. It was an experience he doesn’t want again.

“I only saw a doctor once,” said Carey, a former Victor resident who now lives in Pittsford. “You feel like you are cattle, being driven through.”

The unwelcome shift to Buffalo came, he said, because the meager eight beds in the acute psychiatric unit at the Canandaigua VA were full.

In early 2004, the VA had close to 50 beds for acute psychiatric patients. By last year, Chopik said that number had dropped to 12, and this past spring, 10 staffed beds dropped to the eight.

“Systematically, they’ve been chopping and cutting,” said Korean War veteran Ralph Calabrese, who maintains the Center of Excellence designation is “a smokescreen.”

'More frustration'

During his military service in the 1980s, Carey served in the U.S Coast Guard, policing international waters between Mexico and the United States. Among the experiences that still haunt him: removing bodies from the ocean. Some were fishermen who drowned. Others were men murdered by drug lords. The first time he pulled in a body, the heel feel off in his hands. “I ran, screaming and yelling.”

After that, he said he continued his duties without apparent distress. It was years later, after he completed active duty in 1985, that those memories and others contributed to his troubles, said Carey, who also has bipolar disorder and physical disabilities from a motorcycle accident while on military patrol during the 1984 Summer Olympics in Los Angeles.

“When I feel really good, I go off my medication. Then all hell breaks lose. It messes me up psychologically,” said the former heavy equipment operator and Victor volunteer firefighter. Then he resorts to drugs and alcohol.

Carey’s son and daughter, ages 19 and 21, attend Monroe Community College.

“When I am on the medication, I am a pretty good person and father,” said Carey.

He needs help getting through his issues, which the VA system promises to former military personnel in its charter. But in Buffalo, “they slug you off,” said Carey. At the Canandaigua VA, “they give you extraordinary care.”

VA officials in Buffalo were not available to discuss the specifics of Carey’s care. But Chopik said it’s not unusual for patients to resist changes in their doctors or in the settings for their care.

“They feel alienation” in a different place, said Chopik. “There is more stress, more frustration.” The experience can delay recovery, he said, and drive some patients to leave during treatment.

'Dribs and drabs'

Meanwhile, the Center of Excellence designation remains somewhat of a mystery.

Rep. Jim Walsh, R-Syracuse, is chairman of the House Appropriations Subcommittee on Military Quality of Life and Veterans Affairs. Last year the congressman pressed for Canandaigua to be one the three VAs in the nation to receive the Center of Excellence designation, a title that has also been given to VAs in San Diego, Calif., and Waco, Texas.

Walsh said in a phone interview Wednesday that he talked with VA Secretary Nicholson last month and Nicholson said details of the Center of Excellence plan would be announced “after the first of the year, when we’ve got the Center of Excellence defined and the shape it will take.”

Walsh added that he, too, disapproves of the acute unit being closed before full details about the Canandaigua VA are decided.

“You hate to have these things come out in dribs and drabs,” said Walsh.

But he also said closing the unit doesn’t mean the VA won’t deliver. “They are not backing away from the Center of Excellence.”

The thinking is that Buffalo and Syracuse “are more in tune with acute care,” said Walsh. The pastoral setting of the Canandaigua VA and its history of taking care of long-term and rehabilitation patients fits, he added. The Center of Excellence “will provide treatment and better understanding of post-traumatic stress disorder and how best to treat those people who are remote from acute-care facilities.”

Walsh said the University of Rochester will likely be working with the Canandaigua VA in the Center of Excellence initiative, “for the synergy of a local teaching hospital.”

In a press release earlier this year, Nicholson explained the Center of Excellence by saying the Canandaigua VA “will be charged with defining best practices for the treatment of post-traumatic stress disorders and determining the best practices for rural outpatient treatment follow ups. Canandaigua will provide clinical and research innovation to explore and explain the science behind disease processes, establish best practices, and share that information with the clinical community and others.”

For patients like Carey, those promises don’t mean much when you’re in the throes of a crisis, and when the government you served ships you off to a hospital in another part of the state because the VA in your community is no longer equipped to help.

“What’s next?” said Carey.