Psych staffing a concern at VA

The unit threatened for elimination has lost a psychiatrist, and officials aren't sure she'll be replaced.

By JULIE SHERWOOD / jsherwood@mpnewspapers.com

CANANDAIGUA - Staffing at the VA Medical Center's acute-psychiatric unit is being closely monitored by a union leader now that a hiring freeze is in effect.

A psychiatrist retired Friday and VA officials have not decided whether to replace her - the freeze excludes positions "critical" to the patients' welfare, leaving the door open to refilling the vacancy.

Staff levels have fluctuated in recent years due to budget cuts from Washington, and an unfilled position would not be out of the norm.

However, all eyes are on the acute-psychiatric unit as its very existence is in jeopardy. A federal commission in February called for transferring the hospital's 20 acute psychiatric beds to other state hospitals. Secretary of Veterans Affairs Anthony Principi is expected to rule any day on the recommendation.

Staffing at the unit "is still tight and getting tighter," said Colleen Combs, president of the VA's professional workers' union, American Federation of Government Employees. "It has to do with Washington and the current administration."

A registered nurse at the VA, she has seen hiring freezes before during her 25 years there.

"In the past, it has been a two-year wait for a replacement" at times, she said.

Even before the Bush administration, going back six or more years, positions for professional staff went unfilled for as long as two years, she said. As a union president she is kept abreast of monthly budget reports and, currently, "our budget is really bleak. There's a big deficit, especially for 2005."

The psychiatrist who retired last week is Dr. Gemma Marcelo.

"We'll need to evaluate whether to replace her," said Sharlene Sacco, VA behavioral health care manager. A board of representatives from all the hospital's departments will decide that, she said.

Sacco's department includes 138 of the hospital's 275 beds and 87 employees who work with in-house psychiatric patients, 30 of whom work in the acute-psychiatric unit.

She agreed with Combs that hiring freezes and decisions about refilling positions are nothing new at the VA. Typically, the acute-psychiatric unit averages from 12 to 15 patients a day, said Sacco. The numbers are always fluctuating, she said, due to factors including whether the VA takes patients from other hospitals. No psychiatric patients have been turned away since the start of the recent hiring freeze, she said, though patients have been sent elsewhere in the past when the VA lacked personnel. Last year, for example, it took six months to replace a doctor, and during that time some patients were sent to VA hospitals in Buffalo and Syracuse.

"You can only do so many patients per psychiatrist," said Sacco.

Korean War veteran Ralph Calabrese, chairman of the local Veterans' Advisory Committee, said Monday that he fears the hospital may be already turning away patients from the acute-psychiatric unit.

However, VA spokesman Dan Ryan reiterated Sacco's report that no patients have been turned away since the freeze started last month.

The freeze, though, has affected the workload of staffers, said union official Combs, who represents about 200 workers such as RNs, doctors and social workers. She said that every time the hospital loses key staff - even if they are eventually replaced - it suffers.

"We need to recruit and hire" for critical positions - "to do what we can to continue to take care of these patients," said Combs.

Combs said that before Marcelo's retirement, five doctors treated psychiatric patients, with three caring for outpatients and two working with those in-house. With the loss of a doctor, duties have been shifted, and now one of the doctors has to share time between the two areas.

Combs said that while the loss may be temporary, past experience dictates that the wait for a new doctor could be anywhere from six to 24 months.

"We are trying to come within our budget," said VA spokesman Ryan. The hospital received its spending figures for the current fiscal year from the government Jan. 31 and was looking at a possible deficit of about $2 million in its $72 million budget before it implemented a hiring freeze in February.

"We will continue to provide the best care we can for our veterans," he said. "Positions will be filled if they are essential."

Kathleen Hider, spokeswoman for the upstate VA network, said Tuesday that the hiring freeze at the Canandaigua VA has nothing to do with the process set forth by the Capital Asset Realignment for Enhanced Services (CARES) Commission, which recommended to Principi that the psychiatric beds be moved.

Calling the hiring freeze "a local issue," Hider said the Canandaigua VA is not alone in its decision to downsize staff. Other VA hospitals in the upstate network are taking the same approach to cut costs, she said.

"This is standard operating procedure," she said, adding "all critical positions are filled as soon as possible."

Combs said that the combination of budget deficits, questions about staffing and uncertainty about the future of the 71-year-old hospital is discouraging.

"We are constantly living under an umbrella of the unknown," she said

 
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