Dr. Richard Trotta is well aware of the issues surrounding veterans' health care. Trotta is the chief medical officer of the Wilmington Health Care Center, the Veterans Affairs clinic on the grounds of Wilmington International Airport. He's heard the horror stories about veterans dying while waiting for appointments at other VA centers. He's experienced the ongoing problems with water quality at his own facility.
"We earned some of our black eyes," he says.
He acknowledges the need to do a better job caring for the men and women who served their country in the military.
"We could do what we do a lot better," he says. "That's just ? it's the bottom line. We've got to get better, quicker, faster at doing what we're doing."
Trotta also understands the inherent difficulties of working within a system plagued by bureaucracy and sometimes stymied by partisan politics.
"It is what it is, it's the VA, it's government-run medicine," he says. "We live with the laws that are made, and we have to go by them."
But as Trotta sits in his office at the Wilmington clinic, surrounded by military memorabilia, he also speaks with pride about the compassionate and professional care his staff provides for the Cape Fear region's veterans.
"I'll put these guys up against anybody in town," he says. "The bottom line is yes, I'm proud of this facility and the people who work here. We provide excellent medical care to a very large group of very deserving veterans. I still personally get very frustrated because this thing could be better, we could be better. And I fight every day to try and get there. I know there are things I can do better, but I'm very proud of where we've come."
The Wilmington facility is a 100,000-square-foot "superclinic" with an onsite pharmacy -- about the size of a super Walmart, says Fred Roche, administrator for the center that offers primary care and a host of other services, including mental health, women's health, dermatology, urology, podiatry, dental, eye and audiology clinics, and more.
It does not have surgical services, an emergency department or an urgent-care clinic. But for most healthcare needs, veterans on the coast can receive care locally rather than having to travel to the closest full-service VA medical center in Fayetteville.
"That's why we were put here," Roche says. "We're not going to be able to provide everything that everybody needs, but a good portion of what they need they can get here. The attempt was made to minimize the amount of time they were spending on the road going to Fayetteville."
The need for the center arose because of the growth in the veteran population in the region. Roche says New Hanover County has about 19,500 veterans. Brunswick County has a little more than 14,000, Pender County has 6,400, and Onslow County has almost 28,000.
"We saw 18,500 veterans last year," Roche says. "With about two more weeks in this fiscal year, we've seen almost 19,000. Our growth percentage is about 15 percent over the last two years."
Before the new center opened in March 2013 -- a soft opening followed by an official grand opening the following month -- Wilmington-area veterans using VA healthcare services had to travel for most treatment. There was a small, 10,000-square-foot clinic on Medical Center Drive, but it only offered primary care and some mental health services.
"We had a waiting room that was probably as big as that waiting room that's right outside of my office, and they were packed in there like sardines," Trotta says. "There was no parking in front of that building. Now if you're a veteran in southeast North Carolina, you get supported by this. What's going on over here in the past few years is just incredible. We went from just primary care and mental health to this."
Trotta is a veteran himself. He joined the Army "because they paid for medical school," he says. In return, they asked for a seven-year commitment. He stayed for 28. He's also an Afghanistan vet, serving there for 14 months as theater surgeon.
He moved to Wilmington in 2008 after retiring from the Army and went to work for Wilmington Health as an infectious disease specialist.
"After two years at Wilmington Health, the VA recruiter actually came to me and said would I consider going over there because they were going to build a bigger facility," he says. "So I knew this was coming, but I worked over at the other building for a while."
After taking the job, Trotta began doing some recruiting himself, bringing in cardiologist Bill Holt, urologist Greg Drake, and family medicine specialists Belinda McPherson and Thomas E. Marcinowski Jr. The number of Patient Aligned Care Teams -- which include a primary care provider, other caregivers, nurses and administrative support -- grew from four to 10.
"We got some local talent in here, which is really good to see," Trotta says. "I've got more than double the number of primary care teams. I got a cardiologist, dermatology, endocrinology, infectious disease, urology, a full lab, full radiology, a full pharmacy. The more good care I can give a veteran right here in Wilmington, rather than them getting in a car and having to go to Fayetteville, that's success to me. And we've had a lot of success over the past five or six years."
The compensation for VA doctors is getting more competitive with the civilian world, Trotta says, but most who make the switch take a pay cut. In theory, any gap is made up in quality-of-life benefits like regular hours -- the center is open 8 a.m. to 4:30 p.m., Monday-Friday, and doctors are never on call. But it doesn't quite work out that way.
"If you come here on Saturday morning when this place is closed, you'll see several cars in the parking lot," Trotta says. "Those are typically my docs coming in to catch up on their paperwork or do something over here. So, Bill Holt's in here reading echocardiograms every weekend. That's the type of folk we want to put here. Practice good medicine, and have a little heart for veterans."
Harriet Browning, the chief nurse, personifies the latter quality.
"There is a certain honor in providing care to the veterans," she says. "I am not a veteran, but I am married to a veteran. I view my working for the VA as my service to the country, to serve those who served."
Browning oversees telehealth services for all of the Fayetteville VA system, which includes Wilmington and a small outpatient clinic in Supply in Brunswick County. Through remote access, patients can receive care from clinical technicians in Jacksonville or a doctor in Richmond, Virginia.
"The physician who's in Richmond will see the patient who's in Brunswick County," Browning says. "We can look at the eyes and ears and the throat and use a tongue blade, and it's really kind of neat because it's displayed on the screen. On one of the screens the veteran can actually see what the provider is seeing on the other side, as well as see the provider's face. The ones that have done it, they're like, 'That is so cool, can I do that again?' It really increases the access for our veterans."
That's the bottom line at the health center: access to quality care for those who have served their country.
"Give me a vet that walks in that door with any problem at all, any day of the week, and it's going to get at least attended to," Trotta says. "I'm very proud of where we've come. And for the guys that come in here and sit in that chair and talk to me about complaints, because I know them, I say, 'Just remember Medical Center Drive. Remember when you used to talk to me over there? OK, now really take a look and tell me what you got now.' Almost 100 percent of the time they look at me and go, 'You know what, you're right.' It's a lot better now."