As the Department of Veterans Affairs calls staff working in telehealth into offices across the country, a widespread concern about lack of space has emerged. The change will compromise medical ethics and patients' privacy, clinicians and advocates at multiple VA locations told NPR.
Telehealth has become common in recent years among medical professionals — especially for mental health therapists — and the VA hired many clinicians on a remote basis. The practice allowed the VA to expand its reach of mental health services into rural areas.
Now, many say, leadership at the VA has described a working arrangement in which they will still be doing telehealth from open spaces in VA facilities. The VA leaders describe the proposed arrangement like a call center.
"What we've heard is that there's not even enough room for each person to come in one day a week, let alone five," says H, a mental health clinician who asked to be identified only by her initial, for fear of losing her job. "We've been told they're cleaning out closets, they're looking into purchasing headsets."
H and other mental health providers interviewed for this story say they don't see a way – even with the best headsets available – to provide patient privacy while practicing telehealth from an open space.
In an email response, VA spokesperson Peter Kasperowicz called privacy concerns "nonsensical."
"VA is no longer a place where the status quo for employees is to simply phone it in from home," Kasperowicz writes.
A federal law known as HIPAA, which stands for the Health Insurance Portability and Accountability Act, protects patient privacy, and clinicians say meeting it is the minimum they need to see from the VA. "People need to know that they have privacy and confidentiality, both from a HIPAA standpoint, but in order to do high quality psychotherapy work, both parties need to be fully concentrated and not worried about censoring themselves," says H.
It is not only mental health clinicians who have concerns.
"There's a lot of talk about sexual health," says Paige, a physician at the VA, who asked to be identified by her middle name, for fear of being fired. Paige says there are many different kinds of clinicians throughout the department who regularly need to have delicate conversations with patients.
"Those are not things that any of us wanna talk about, with another person nearby," she says.
Kayla Williams, a senior policy advisor for an organization called VoteVets, says this policy change is not in line with the historic ethos of the agency to take good care of veterans.
"Unfortunately, the emphasis in this current moment does not seem to be on providing that highest quality care, but figuring out ways to cut the size of the department," Williams says.
The VA has cut hundreds of probationary positions – then reversed some decisions – while VA Secretary Doug Collins forecasted tens of thousands more additional jobs would be eliminated. Williams says that between the job cuts and the back-to-office order, VA workers are dispirited.
"I hear from someone almost every day who tells me that they and their colleagues are crying," says Williams.
VA spokesperson Kasperowicz said in his email response that the organization would make space accommodations in order to ensure veterans' access to care would remain uninterrupted and HIPAA compliant.
Veterans are disproportionately likely to die by suicide, compared to the rest of the population. The VA increased mental health staff by more than 50 percent in recent years, in response to the recognition of a growing need. But data show the estimated wait for a mental health care appointment can still be as long as 45 days.
Clinicians say the VA's reassurances are little comfort. Some worry they could lose their medical license for providing care in these conditions. They also wonder, if this boundary was crossed, what would be the next one.
H, the mental health professional, says she is concerned the change will lead to more loss of staff — and ultimately compromised care — for veterans. She says she is worried her colleagues will "simply will leave the VA," she says, "because that's not a workable solution."
Have information you want to share about the ongoing changes across the federal government? Katia Riddle is available through encrypted communications on Signal at Katia.75
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