As President-elect Donald Trump makes his department secretary appointments, potential candidates have to wend their way through the gantlet of the press in the lobby of Trump Tower in New York and head upstairs for a meeting with Trump. Anyone thinking of being VA Secretary — as Alaska Public Radio reported last month that former Gov. Sarah Palin was doing — might want to face a tougher audience: a roomful of disgruntled military veterans.

On Nov. 29 at the Homer Elks Lodge as part of “listening sessions” held in Alaska communities, for two hours Dr. Timothy Ballard, a retired Air Force colonel and director of the Alaska VA Healthcare System, Anchorage, took comments and tried to answer questions from about 30 lower Kenai Peninsula veterans and their families. He also met in brief sessions one-on-one with veterans after the meeting.

“I appreciate you coming here and listening to our concerns. We’re very passionate in Homer. The outreach is terrible,” said veteran Michelle Mellchert at the meeting.

“That is exactly why I’m here,” Ballard said.

Each quarter, Ballard and other staff visit five VA Community Based Outreach Clinics, or CBOCs, meeting with clinic staff and holding listening sessions, said Samuel Hudson, VA public affairs officer. Homer is considered a CBOC through a clinic held through South Peninsula Hospital.

“He wants to hear first hand and see it first hand,” Hudson said of Ballard’s visits. “He wanted to hear it raw from the veterans.”

Raw is what he got. Mellchert complained that some doctors doing VA outreach clinics in Homer don’t understand the needs of women veterans. Homer needs more choices, she said.

“I will never go to a doctor who says, ‘I don’t know what to do with a crying female,’” she said.

Ballard said he understood that, but with limited staff and budgets, and Alaska’s huge geographic area, the VA can’t have a clinic in every town. Homer has a doctor doing VA clinics because a provider saw the need and was willing to visit, Dr. Ballard said.

“There are only so many places the VA Health Services can be,” he said.

Ballard pointed out that’s also why the VA has the Choice program, a way for veterans to get care in their own communities through non-VA health providers. That raises other issues, though. How does the VA coordinate care between VA doctors and other providers?

“Who steps up to do the coordination?” one woman asked. “Who understands the complexities of the system?”

“I would like to see all these pieces put together, yes,” Ballard said. “It is not a leadership problem. It is a bureaucracy problem.”

That also raised other question asked: How are medical records from local providers shared with the VA? Ballard said in the past clerks would scan records. With 1,000 referrals a week and 20 pages of information per referral, that could be a challenge. The VA now shares records electronically through a health information exchange. A doctor in Anchorage can log on and see records from around the state.

“This revolutionary,” Ballard said. “We’re way ahead of most health systems, particularly rural.”

Health Information Exchanges are a provision of the Affordable Care Act, and South Peninsula Hospital recently joined the statewide Health Information Exchange and can share patient data through it.

When veterans do go to doctors outside the VA, sometimes it can take a while to get approval for referrals. Those can sometimes take too long, said veteran Bob Hickman.

“You’re absolutely right,” Ballard said.

Authorizations can usually be done over the phone, but if a written referral is sent to staff, it goes into a queue and can get delayed. It’s better to call.

One problem with the VA system is that veterans have to sign up with regional VA clinics. That doesn’t help Alaska veterans wintering in the Lower 48 or who might be traveling. Veteran Terry Cotton mentioned how he and his wife Rebecca, also a veteran, had been traveling in Florida and she got a back injury. They went to the nearest hospital, but because she didn’t get preapproval, the VA disallowed that claim.

“Why? We’re all vets,” Cotton said. “If I’m all over America, I don’t count at all.

Ballard noted the bureaucratic reason for that.

“Our budget is based on who is enrolled in our facility,” he said. “I would love to be the hand of God to change a bunch of rules and regulations and fix the system. … It’s policy, procedures and laws. Part of the solution is reaching out to your legislative representatives and saying there are rules that aren’t working and need to be addressed.”

Perhaps the biggest problem veterans complained about was communication. One woman told of trying to make a call to the VA and being put on hold for an hour and 15 minutes and then getting disconnected.

“When I call the VA, generally what I get is ‘We’re busy. Call back,’” said veteran and American Legion Service Officer Craig Forrest.

Veteran Alan Turkington said it took a call to Sen. Lisa Murkowski’s office to get a call back from the VA.

“I’ve got ‘phone calls, waits, disconnected phone calls, and calling and not leaving a message,’” Ballard said, noting the complaints.

“For all those who have called and been disconnected, I apologize,” said Hudson, the VA public affairs officer.

Hudson said the Alaska VA is working on a one-stop shop to handle veteran issues. There will be an office of advocates in Anchorage to meet with veterans, someone “to talk to about the problems and actually get them fixed,” he said. The VA is interviewing applicants for those positions now and hopes to have that office set up within a couple of months. Veterans also will have an Alaska phone number and email to contact. Information on that service will be announced on the Alaska VA website at www.alaska.va.gov. Veterans also can email Hudson at samuel.hudson@va.gov to get on a mailing list.

Ballard said he plans to visit Homer and other communities frequently.

“When I took my job, I understood part of my job was to go to the CBOCs,” he said. “Clearly, there is an interest to have me come out to Homer on a regular basis. The point of all this is I’m sincere in hearing your concerns.”

Despite the complaints, Forrest said things have gotten better at the VA over the past five or six years. He’s been in the VA system since 1969.

“I go to the VA in Anchorage and I actually see smiles. Ten years ago you wouldn’t see smiles. Twenty years ago you wouldn’t see anybody.”

Michael Armstrong can be reached at michael.armstrong@homernews.com.