TAMPA — James A. Haley VA Medical Center officials say "zero patients" were rejected for a program allowing veterans to get outside care when Haley doesn't offer a service or is too busy.
Despite taking emergency measures to close a deficit that once reached $47.5 million in 2011, Haley officials said the so-called fee basis program and patient care generally were unaffected during the most recent budget year.
"Veterans who may qualify for care provided by the fee basis program have not been denied care as a result of any budget constraints," Haley spokeswoman Carolyn Clark wrote in an e-mail Friday.
But interviews last week with veterans who get care at Haley or its outlying clinics, as well as internal Haley documents obtained by the St. Petersburg Times, appear to contradict claims that fee basis service is unaffected by budget cuts.
Marine Corps veteran Paul Cardillo, 70, said Haley this year canceled a preapproved, postoperative appointment scheduled at a non-Haley clinic for a bad shoulder.
"I got a call saying due to financial problems, they're canceling my authorization," said Cardillo, of Lutz.
Marine Corps veteran Charlie Kelley, 67, of Tarpon Springs said he got an identical call about an Aug. 10 fee basis appointment — a one-year followup exam for knee-replacement surgery.
Army veteran Bill Dennis rushed to an emergency room at a non-Department of Veterans Affairs hospital after an abnormal heart rhythm. He was admitted for three days.
But when it came time to pay the fee basis bill in full, Haley refused, saying Dennis should have gone to Haley after the first day, when he was stabilized.
"You stay in the hospital until the doctor says it's safe to leave," said Dennis, 60, of Spring Hill.
Navy veteran Ken Seymour, 71, of Tarpon Springs said a Haley physician authorized him to get a second opinion about cancer surgery outside the VA. But last month Haley wouldn't pay the $158 bill, he said.
Haley officials declined to discuss the finances of its fee basis program in detail or discuss if its spending restrictions were lifted when the new budget year began on Oct. 1.
"Tampa is committed to providing the highest quality of care to our veterans," Clark said. "If a veteran is eligible for certain medical care, the Tampa VA or one of our clinics should provide it as the first option. If we are unable to provide that care, then we may consider fee basis as an option."
But she added: "Fee basis care is not an entitlement program or a permanent treatment option."
Efforts to cut costs to balance its budget were stepped up at Haley during the summer.
On July 15, a memo was sent to all service chiefs in the hospital outlining "emergency measures" to close a deficit, including cutting back on fee basis treatment.
On July 20, Haley's fiscal services department sent a memo to the hospital's new director, Kathleen Fogarty, bringing her up to date on the precarious financial situation.
Actions planned to reduce costs included reducing fee basis situations. The memo said, "Fee basis expenditures will be limited to those only authorized as emergency."
Clark declined to discuss the July memos.
Seymour, the veteran who couldn't get Haley to pay $158 for a second opinion, said the hospital's deficits sometimes leave patients wondering if treatment decisions are based on cost or medical necessity.
Seymour said he has received excellent care at Haley from doctors, nurses and others whose professionalism and skill are second to none.
But a Haley surgeon this year refused to operate to remove a malignant tumor in Seymour's abdomen because the cancer was too advanced. The hospital instead prescribed pain medications.
Seymour got a second opinion from a non-VA doctor who did not hesitate to schedule surgery, calling it a "reasonable" option to save Seymour's life, records show. It's scheduled for late October at Tampa General.
But Haley still won't pay for it, so Seymour contacted the office of U.S. Rep. Gus Bilirakis.
Fogarty, Haley's director, responded in a letter to Bilirakis on Oct. 3 after he asked Haley for more information.
The letter said "surgical care through the fee basis program is restricted to procedures not available in the VA system. Since surgery is available here and deemed unsuitable for Mr. Seymour's condition, fee basis will not be approved."
Seymour said he can't help but wonder if cost factored into the VA's decision.
"I've received excellent care at Haley," he said. "But all of a sudden, I'm up against a brick wall."
William R. Levesque can be reached at firstname.lastname@example.org or (813) 226-3432