NANTUCKET — For the first time in a decade, eligible military veterans on Nantucket soon might receive a broad range of medical care on the island rather than embarking on daylong odysseys to VA facilities in Hyannis and Providence.
Following an urgent appeal from top state officials, the US Department of Veterans Affairs has begun work on contracting with Nantucket Cottage Hospital for services that could include primary care, specialty visits, and emergency treatment, VA officials said.
Such a contract would remove an expensive, time-consuming burden for eligible patients among the island’s 624 veterans, state and local officials said. Some are forgoing physicals and lab work, and many have not enrolled for VA care because the travel is too onerous, Nantucket veterans said.
“Guys aren’t going because it costs too much, and they have to give up a whole day of work,” said Bert Johnson, a decorated Vietnam War veteran who lost his peripheral vision and the mobility in his left leg after a rocket explosion.
The geographic hurdles might explain why only 12 Nantucketers, or 2 percent of the island’s veterans, regularly use the VA medical system, officials said. Paul Rieckhoff, who founded Iraq and Afghanistan Veterans of America, said that number “is alarmingly lower than almost anywhere else in America. The bottom line is that too many of our members are struggling to get care.”
Eligible Nantucket veterans, who qualify for care because they meet income or disability standards, now must travel to a VA outpatient clinic in Hyannis or the VA hospital in Providence, which has a service area that includes the island.
The VA expects to have a formal proposal readied within six months for the contract bidding process, according to a letter dated Friday from Dr. Michael F. Mayo-Smith, director of the VA New England Healthcare System. The cost of the proposed contract is unclear.
Smith wrote to hospital officials after Coleman Nee, the state’s secretary of veterans services, and Cheryl Bartlett, Massachusetts’ public health commissioner, urged Mayo-Smith to contract with Cottage Hospital and ease travel burdens for VA-eligible veterans. Most of those veterans told Nee and Bartlett in a meeting this spring that they must leave the island for care “unless it is a matter of life or death,” the state officials said.
Mayo-Smith said the contract will resemble the system in place on the neighboring island of Martha’s Vineyard. In 2012, the VA contracted with Martha’s Vineyard Hospital for services including primary care and lab work. In addition, a VA physician visits the island once a month.
Dr. Margot Hartmann, president of Cottage Hospital, said in an interview that she welcomes a partnership with the VA, although the hospital has yet to receive the letter from the federal agency regarding the proposal. She added that the 19-bed hospital, which admits more than 600 patients and records nearly 50,000 outpatient visits a year, will continue to provide emergency care to veterans regardless of their ability to pay.
Ralph Hardy, the island’s veterans agent, said a VA contract would be a boon for Nantucketers reluctant to travel off-island for such routine procedures as physicals or blood work.
Johnson, the Vietnam War veteran, who has glaucoma, is an exception. But when he leaves Nantucket twice a year for eye exams, the round trip to Providence can seem like a forced march.
There’s the 7:45 a.m. fast ferry to Hyannis, which takes an hour, followed by a 90-minute drive with his wife behind the wheel of a rental car. Afterward, the Johnsons and their service dog weave through traffic to catch the 6 p.m. boat to Nantucket. If the timing breaks right, they might be home by 7:30.
Hardy said some Nantucketers do not use the VA system because they view the care as welfare.
“They think they’re taking it from somebody else who needs it more than they do,” Hardy said. “They should take the benefits. They earned them.”
Jim Richard, a 65-year-old Marine veteran who was wounded in Vietnam at the battle of Khe Sanh, said he had put off medical care for years. “If we could get something and get the word out, that would be great,” Richard said.
Rieckhoff, whose Iraq and Afghanistan veterans group is based in New York, said the VA needs to be more aggressive in enrolling Nantucket’s veterans.
VA officials said they visit the island about twice a year, but argue that Nantucket presents unusual challenges.
Only 148, or 24 percent, of the island’s veterans are eligible for VA care, compared with 72 percent across New England, said Mike McNamara, outreach specialist for the VA New England Healthcare System.
McNamara speculated that many Nantucket veterans exceed the maximum income for VA health benefits. An island veteran with two dependents, for example, cannot make more than $86,100 a year to receive care, McNamara said.
The prospect of more paperwork and red tape also is a concern, McNamara said.
VA medical benefits are “only for the veteran, so they still need to have some kind of health care” for their spouse and children, McNamara said. For that reason, he said, some veterans do not pursue VA care because they “don’t want to have two doctors and two sets of appointments.”
As the VA puts together its plan for service on the island, a contract could be complemented by newly enacted federal legislation, which allows veterans who face geographical hardships to use local health care, which would be subsidized by the VA.
“We don’t know what that will look like exactly, but we’re optimistic that it will improve access,” said Maureen Heard, spokeswoman for the VA New England Healthcare System.