Animosity among staffers, distrust from veterans and improper record keeping that may have delayed or prevented clients from receiving disability benefits have plagued a Department of Veteran Affairs facility in Bend since it opened in 2010.

The Central Oregon Vet Center, which counsels combat veterans and veterans who were sexually assaulted in the military, failed its regional office’s clinical inspections — those that assess its quality of service and client records — in each of the past six years.

Its staff of five is the smallest of the five Vet Centers in Oregon and currently serves roughly 230 veterans in an area that extends east to the Idaho border and south to Christmas Valley.

“It’s absolutely sickening,” said Cody Standiford, who worked for the Vet Center for eight months before leaving in late 2014. “The management of that Vet Center had known from the day they opened their doors that they are not performing. They’re failing clinical inspection after clinical inspection after clinical inspection. And yet, nothing is ever done to address it.”

But things appear to be changing for the better since the arrival, early last year, of Amanda Juza as the Vet Center’s new director. She started by getting patient records in order and meeting with employees individually to ensure they understood their duties.

“In terms of continuity of care, in terms of providing the best care for veterans, absolutely our records need to be up to date and they need to be accurate and timely,” said Juza, an Army veteran.

That’s no small task. A 2016 inspection report echoed deficiencies from previous investigations and noted that counseling notes hadn’t been completed for more than 300 patient visits. Half of the client files reviewed didn’t have the military discharge paperwork used to prove eligibility. Seventy-five treatment plans were overdue.

The report was blunt: Juza had “inherited counselors who weren’t doing their jobs.”

No records for claim

Standiford, a veteran who currently works for the nonprofit Central Oregon Veterans Outreach, first learned about problems at the Vet Center while handling veteran’s issues in Congressman Greg Walden’s Bend office.

Multiple veterans told Standiford they were struggling to get their claims for service-connected disability approved through the VA because the Vet Center could not provide records of their counseling, he said.

“We couldn’t prove that the veteran actually went to or received treatment on the dates that they claimed because if it’s not in the record, it didn’t happen,” he said.

Standiford began working at the Vet Center as an office manager in March 2014. His suspicion prompted a deeper dive into the facility’s records, turning up more than 200 patient visits over the course of six months in 2014 that were accounted for on paper log-in sheets but not documented in electronic records. He said many of those patients had been seen by Gary Hunter, a counselor who also directed the Vet Center.

Hunter, who continues to work at the Vet Center as a counselor, declined to comment for this article. Juza would not offer details about why Hunter was allowed to remain a counselor.

Evidence of disability

Instructions for filing a claim for disability benefits with the Veterans Benefits Administration directs veterans to provide all relevant evidence in their possession, including treatment records and medical evidence. Vet Centers are not involved in the process beyond providing records.

The Center always gives clients their records when they ask for them, Juza said. She said it’s also possible to get disability benefits for PTSD without having received counseling, although she couldn’t explain more about the process.

David Kaplan, chief professional officer for the American Counseling Association, a membership association for the counseling profession, said when he was in private practice, he provided treatment records for veteran clients for use in disability assessments.

Juza said she does not recall speaking with veterans whose lack of records prompted the rejection of their disability claims. The Bulletin could not confirm any claims of veterans being denied benefits as a result of bad record keeping.

Starting over with vets

Once Juza took over, new counselors had to start over with veterans because their former counselors hadn’t kept records from their visits, she said. Juza declined to say whether former counselors were disciplined, but said at least one was transferred to a different Vet Center.

“There were a lot of veterans that we as a team had to say, ‘I’m really sorry, unfortunately, the counselor who saw you before is gone,’” she recalled. “‘They’re not here anymore and this was never completed, so if you don’t mind, maybe we could start again.’”

The American Counseling Association’s code of ethics directs counselors to keep notes of all their sessions with clients.

Missing records from a previous counselor could trigger a lack of trust in the new one, Kaplan said.

“If somebody said that to me, my feeling was, ‘That other counselor didn’t care about me. They didn’t care about me at all. … Why should I open up to you and give you a chance to earn my trust?’” he said.

Standiford agreed.

“That vet will need to start at the beginning to get that person up to speed, which — speaking as a combat vet with PTSD — that is not a fun thing to do,” he said. “It takes a long time to build that rapport.”

‘Bureaucracy at its worst’

Hunter led the Vet Center during Standiford’s time there in addition to working as a counselor.

A handful of veterans described having personal issues with Hunter’s counseling style.

Roger Riolo, a 73-year-old Vietnam veteran who lives in Bend, is a longtime member of a counseling group for veterans with PTSD. When Hunter started leading the group, Riolo said some veterans stopped going because of they weren’t comfortable with him.

“We had bad experiences with Gary,” he said.

Riolo, a former Air Force captain, recalls one veteran who appeared to be struggling with severe PTSD and never spoke at meetings. Finally, after several months, the man began to talk about his experience.

“Gary shut him down in group immediately and said, ‘We don’t talk about that stuff here,’” Riolo said. “We never saw that guy again.”

That incident upset many in the room, said Rex Tompkins, a 69-year-old Vietnam War veteran who lives in Bend.

“Everybody in the group just looked at each other and went, ‘That was messed up,’” he said.

Troy Wise, a 69-year-old Army veteran who served two tours in the Vietnam War, said after that, he and others were fed up with Hunter.

“The group made it clear that if Gary showed up, we were leaving,” he said.

Wise also received couple’s counseling with Hunter and said the counselor would have trouble referring to previous sessions. It seemed to him Hunter hadn’t kept good notes from previous sessions.

“That didn’t work for me at all,” said Wise, who is now divorced. “Like most of the vets there, I have no respect for Gary. He’s just putting in time.”

Before he left the Vet Center, which employed five people, Standiford said he and two colleagues signed a letter of no confidence calling for Hunter’s resignation. When nothing came of it, Standiford said he quit. VA spokesman Dave Bayard declined to comment on Standiford’s departure.

Riolo describes the situation as a “travesty.”

“It was bureaucracy at its worst,” he said. “When three employees stand up and say we have no confidence — thank God they did — but none of those three work there anymore, and Gary Hunter still does.”

‘A considerable number of complaints’

Problems started shortly after the Center Oregon Vet Center began seeing patients from a temporary location in 2010. That year, it failed its first clinical inspection.

The VA provided The Bulletin copies of inspection reports dating back to 2011 in response to a Freedom of Information Act request. Although the 2010 report was not provided, the 2013 report deemed the facility unsatisfactory “for the third year in a row.”

The VA’s regional office strives to perform clinical inspections of Vet Centers annually, Bayard wrote in an email. Clinical inspections are a subjective analysis of the quality of service provided and focus heavily on patient charts.

The inspections repeat the same issues year after year. Each are signed by Steve Reeves, the manager of the Fairfield, California, office that oversees Vet Centers in Oregon and a number of other states. Reeves did not respond to multiple requests seeking comment.

In 2011, the clinical inspection report found nearly half of the Vet Center’s cases lacked proof of eligibility, although about half of those had been transferred in from a different VA clinic. Eighty percent of closed cases were missing summaries the VA requires when patients stop coming.

The report’s concluding remarks were damning.

“There have been a considerable number of complaints from various members of the Veteran and Veteran services community since this center was opened,” the report stated. “These complaints have continued and have required interventions by the regional office.”

‘No longer functioning as a team’

By 2015, the Vet Center seemed to have reached a breaking point. That year’s inspection report cited “multiple staffing challenges and disagreements to the point where it is no longer functioning as a team” and said its reputation had suffered greatly due to the “inconsistent services” provided.

That year, several patient files were missing treatment plans or the plans were late. Treatment plans outline the issues a patient wants to resolve.

Dozens of patient files were missing their military release or discharge documents, which serve as proof of eligibility. Seventy percent of patients whose cases were closed had not been sent a follow-up letter or email, which is required.

Kaplan said the American Counseling Association considers failing to follow up with clients who fail to make appointments abandonment.

“We have a responsibility to try to reach out to them and say, ‘Hey, is everything OK? Would you want to make another appointment?’” he said.

Hunter stepped down as the Center’s leader in 2015.

Problems persisted into the following year, when an inspection found 42 intakes were past due. Intakes are performed when clients begin counseling and assess issues, behaviors, thought patterns and contributing factors such as drug use, medical conditions or relationships.

“Without that kind of thorough assessment, you’re just sort of flying by the seat of your pants,” Kaplan said.

Progress notes — about what happened during counseling sessions — hadn’t been completed in 326 cases, according to the 2016 report.

“Let’s say you went for a checkup and the physician did not write a single thing down,” Kaplan said. “How would you feel?”

Disagreements between staff

Emails between Vet Center staff members in recent years provided by Standiford illustrate a precarious work environment.

Both Standiford and Wells Kempter, then a counselor at the Vet Center, expressed concerns to superiors about financial ties the Vet Center and its outreach specialist, Greg Ford, had with outside groups. It’s unclear whether ethical or legal violations existed. Kempter, who is currently listed as a counselor on the Portland Vet Center’s website, could not be reached for comment.

Ford, who declined to comment for this article, now serves in a newly created position at the Vet Center focused on suicide prevention and crisis response, Juza said.

Counselors Kempter and Hemmer both complained in 2014 emails to Hunter — which they included Standiford on — about new clients being placed on their caseload without their knowledge.

“Arbitrarily assigning people, w/o informing me of this action, at worst, sets me up for failure as a member of this team and at best creates a lot more work for me that may not be completed in a timely manner, since I hadn’t been consulted or informed,” Hemmer wrote.

The tension between staff members was obvious to Tompkins when he visited the Vet Center for both individual and group counseling. The negativity — among both employees and fellow veterans — prompted him to stop going. He’s currently being treated for lung cancer.

“I just couldn’t deal with it anymore,” he said. “I have to keep my attitude high. I have to keep positive.”

‘Just what this place needs’

Veterans interviewed for this article say they lobbied hard for a new director to replace Hunter. They wanted Juza, a Blue River native who served two tours in the Iraq War, to lead the facility.

“She seems like just what this place needs,” Wise said.

Juza, a licensed independent clinical social worker, welcomed the change. She worked at the Portland Vet Center before coming to Bend.

“I’m not really a city girl,” Juza said. Plus, Central Oregon is closer to family.

On top of her administrative duties, Juza also performs counseling. She has a bachelor’s degree in psychology and a master’s degree in social work. Juza is the facility’s only female counselor and its designated military sexual trauma counselor.

Wise said he found one-on-one counseling with Juza comforting after his divorce.

“She helped a great deal with taking the worst-case scenario and making a plan for it,” he said.

Juza has added a women’s group and a class for military spouses and family members. The Center now sends counselors to La Pine, Prineville and Madras. A counselor also sees veterans at the Deschutes County jail every two weeks.

There are weekly staff meetings, and Juza said she performs extensive reviews of patient charts once a month.

Until Juza arrived, 71-year-old Vietnam veteran Craig Jorgensen said the Center was “pretty chaotic and not very helpful.” Recently, he said things are turning around.

“There’s things that are happening that never happened before,” Jorgensen said.

Despite failing its 2016 clinical inspection, the report noted it expected significant improvements the following year.

Juza said she wants veterans to know that the Vet Center is “re-energized.”

“We are basically a brand-new facility from what it was in the past,” she said, “and we would really love the opportunity to earn a chance to get to know them.”

— Reporter: 541-383-0304,

tbannow@bendbulletin.com

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