The Department of Veterans Affairs’ outpatient clinic in Bend is cutting its urology services, and there are hints that more specialties could be on the chopping block in the future.

A VA spokesman described the move as part of a broader VA shift toward focusing on primary care and mental health services in its community clinics and shifting specialty care to either the VA’s medical center in Portland or to private, non-VA providers. It’s not clear, though, what that means for the clinic’s other specialty services, which include audiology, optometry, orthopedics and physical therapy, among others.

“We have a lot more requests for primary care and mental health, so we’re trying to match that supply and demand by putting resources where they’re needed,” said Dan Herrigstad, a spokesman for the VA Portland Health Care System. “That does not mean we’re taking away from any other services at this particular time anywhere.”

Smart use of resources

The change is part of the VA’s effort to “use the resources we have as smartly as we can,” Herrigstad said.

“With the demand we have in Portland, which is a lot greater because of the population, et cetera, it just makes more sense resource-wise for urology to not send a provider there,” Herrigstad said.

Since early 2013, the VA has been sending a urologist from Portland to Bend four Fridays per month, Herrigstad said. About 150 patients use the urology services in Bend, and they receive approximately 500 urology appointments per year, Herrigstad said.

Herrigstad explained it’s a three-hour drive to Bend and the doctor normally leaves Thursday and stays overnight. Sometimes, the doctor even has to return to Portland on Saturday.

“So, one, we take the time away from the individual and their travel back and forth,” he said, “and then it’s one day there and of course the resources to get them there, stay overnight.”

Bend’s is the only outpatient VA clinic in Oregon that offers urology services, which will end Feb. 21, 2017. In fact, the clinic still offers a broader array of specialty services than any other outpatient VA clinic in the state. Herrigstad said that’s because the drive to Portland from Central Oregon is much more difficult than from, say, Salem.

“Bend is just geographically a little bit more of a challenge,” he said. “So certainly it makes sense to provide those services over there.”

The VA also stopped sending dermatologists from Portland a few years ago.

Ron Eckfield, a 71-year-old Navy veteran who lives in La Pine, has gone to the Bend clinic annually for a checkup with a urologist. Luckily, tests have shown he’s healthy since his bout of prostate cancer in 2010. Until this point, Eckfield said he’s had no bad experiences with the VA. He said the people there are great.

“But this canceling of the urology services at the clinic really set me off,” he said.

Eckfield said there is no way he could afford to drive to Portland, which is a nearly four-hour drive from La Pine.

“For me, that would mean the cost of the fuel of course and probably an overnight stay in Portland somewhere,” he said.

‘An insult to veterans’

Veterans who received urology services from the VA clinic in Bend have two possibilities. They can either travel to the VA medical center in Portland for urology services or, if they’re deemed eligible, they can get care at a private provider locally through a program like the VA’s Veterans Choice Program or its Patient-Centered Community Care (PC3) program.

Patricia Parker, the CEO of Bend Urology, said her clinic is contracted with both VA programs.

“We would welcome seeing those patients in our clinics,” she said.

Representatives with another urology practice in Bend, Urology Specialists of Oregon, did not return calls seeking comment.

Lots of local veterans have described struggles with getting care approved through the Choice Program, however, and it’s unclear how well the program is currently working. Veterans are eligible for Choice if they have been told to wait more than 30 days for an appointment, if they live more than 40 miles away from a VA facility or face an excessive travel burden. The VA can make exceptions if the facility nearest to a veteran’s home doesn’t offer the service they need.

“The Choice Program doesn’t always work as promised,” said Bill Gregoricus, a 68-year-old Vietnam veteran who lives in Bend.

When Gregoricus needed a urological procedure back in late 2014, the VA told him urologists were not traveling from Portland to Bend.

Following what he described as “a lot of work,” he finally got approved to see a urologist in Bend through the Choice Program.

Lyle Hicks, a 64-year-old melanoma survivor, drives to Portland from his Bend home every six months to have his skin checked by a dermatologist at the VA medical center there.

The VA used to send a dermatologist to Bend regularly, but, like with urology, it stopped doing that. Instead, two primary care doctors at the Bend clinic have become certified to perform minor dermatology procedures, Herrigstad said.

Still, Hicks, a Vietnam veteran, is worried they could miss something.

“They set it up where they can have somebody here to take pictures if they saw something, but they’re not going to know what to look for,” he said.

In June, Hicks said he drove to Portland for a check up. The doctor found something suspicious, so he had to drive back to Portland shortly after for surgery to have the lesion removed. He applied for the Choice Program, but was told he’s not eligible because he lives so close to the clinic in Bend.

Gregoricus said he was saddened to learn the clinic was cutting urology, especially given how common urological problems are among the aging men he knows.

“To think that it’s become inconvenient for them to send a doctor down to Bend is almost ludicrous given what it takes to go to Portland,” he said. “It’s an insult to veterans in general.”

— Reporter: 541-383-0304,

tbannow@bendbulletin.com