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Washington, D.C. – U.S. Senator Mike Enzi, R-Wyo., addressed concerns regarding health care services for Wyoming veterans at a VA Capital Asset Realignment for Enhanced Services (CARES) Commission hearing today in Cheyenne.

The hearing is the result of a Sept. 26 letter Enzi wrote to the VA to request a hearing be held in Cheyenne, where changes to veterans health services are being proposed. Commissioners have invited select representatives of veterans' groups, federal, state and local officials, hospital employees and others to testify at the hearing.

Enzi, unable to attend the hearing, recorded a statement for the event. Enzi also plans to make himself available to answer CARES commissioner questions via conference call if necessary.

Enzi's statement follows.

Statement of U.S. Senator Mike Enzi
VA CARES Cheyenne hearing
October 23, 2003



First, I would like to thank the CARES Commissioners for holding this hearing today. I know that it was not on the original schedule and I appreciate the hard work of the CARES and Veterans Affairs staff in coordinating efforts to hold this hearing in Cheyenne.

As most everyone knows, the VA recommended a change for the Cheyenne Medical Center in its draft proposal for the CARES Commission. Unfortunately, few people seemed to understand exactly what change was proposed and how it would affect the veterans of Wyoming. I have heard from veterans across the state worried about the future of their health care services. Would they need to drive to Denver for every check up? Would families be unable to visit sick loved ones because of the distance to the Denver center? Would a veteran unable to travel to Denver be ineligible for any medical treatment in Wyoming?

These questions and the widespread misunderstandings are part of the reason I requested the CARES Commission hold a hearing here in Cheyenne. This is not just an opportunity for the veterans of Wyoming to have their concerns aired. I hope it will also be used to clear up any and all misunderstandings that might exist about proposals affecting Cheyenne. I don't believe that anyone at the Department of Veterans Affairs is out to get the veterans of Wyoming. I don't think anyone in Wyoming should believe that either.

The Cheyenne Medical Center is a small hospital facility. There is no denying the fact that the number of beds and the number of patients pales in comparison to hospitals in Washington, DC or New York City. Being a small hospital, however, does not mean it should be closed. Wyoming is a frontier state, and many of our citizens must travel long distances to visit their doctors, clinics and hospitals. Even in the private sector, services in some places of the state are too few and too far between.

The use of the term "Critical Access Hospital" in the VA recommendation clearly created a critical situation in Wyoming. I can't speak for every veteran, but I do know that the use of that term led many to believe that the changes at the Cheyenne center would be drastic, based on the experiences in some Wyoming communities whose hospitals converted to "critical-access" status.

The Cheyenne center provides good medical treatment for the veterans of Wyoming. Cheyenne currently has no waiting list for medical treatment and consistently meets the Centers for Medicare and Medicaid Services national averages for lengths of stay. The Center serves a considerably older population of veterans, but that may not always be the case. We have a number of Wyoming citizens currently serving in Guard, Reserve and active duty units who will be back in Wyoming and will expect the type of quality of medical care received by those who served before them.

Veterans in Wyoming are very concerned that reducing or limiting medical treatment in Cheyenne would require them to travel to the VA facility in Denver. Travel to Cheyenne is already a burden for many veterans. Asking them to add on another 90 miles to travel to Denver would increase that burden significantly, particularly in harsh weather conditions.

Veterans have also expressed concern about contracting. If veterans services are to be contracted with local providers, such as United Medical Center in Cheyenne, I expect that there will be a clear agreement made between the facilities. Veterans worry about the paperwork required when they have treatment at a non-VA facility. If changes are made to the Cheyenne services and the services are contracted locally, I expect that local providers and the VA will work closely to ensure that veterans' health care is not delayed by paperwork or any unwillingness of either party. To ensure this, I also would suggest that the VA provide a liaison representative for veterans who receive care at these local non-VA facilities.

The lack of sufficient surgical volume is the main reason the VA has given for proposing to close the surgical intensive care unit in Cheyenne. I recognize that for some medical procedures, studies show a positive relationship between the volume of procedures performed and the quality of the outcomes for those procedures. I don't dispute the result of these studies.

However, studies like these are conducted in a vacuum, isolated from real-world considerations like access to care. Such studies would be more persuasive to me if they suggested closing a surgical unit at one hospital and transferring the cases to a hospital 9 miles away. But what we're talking about here is transferring the cases 90 miles away!

I'm not convinced that the process the VA used to develop the recommendation to close the surgical unit in Cheyenne gave enough weight to factors like reasonable access to services for veterans and their families. I'm not alone in being concerned that the needs of veterans in the remaining communities on the American frontier are being sacrificed to the need for VA officials in Washington to have a one-size-fits-all plan that avoids making the tough judgment calls that may be merited by local circumstances. I want to give the CARES Commission and the VA every opportunity to address these concerns, which is why I asked the VA to hold this hearing today.

I once again thank the entire CARES Commission and their staff for putting this hearing together. I believe that the testimony you hear today will reinforce the important role the Cheyenne VA Medical Center plays in this community and throughout the state, and I expect that you will give full and fair consideration to the viewpoints of Wyoming veterans who depend on the VA for quality health care services.