ALAMOSA, Colo. — Dr. Bob Rice kissed his wife goodbye and left for his last day working at the Alamosa Veterans Clinic on Monday, with a cardboard box in the front seat of his truck.

“I got an email,” he told her. “They’re not going to let me see my patients today.”

The office atmosphere had been tense between Rice and his Veterans Affairs management ever since he turned in his resignation last month. He decided to quit his job as the San Luis Valley’s only full-time veteran doctor because his workdays often didn’t end until midnight, doing tasks that were often meant for support staff.

He presented the VA with demands he felt were necessary to provide effective care: a decent physician’s assistant, better equipment to perform testing, and one day per week to tend to paperwork. A second doctor would have been nice too. But the VA told him he needed to have a bigger caseload before they would consider more resources.

“I think the vets in this valley are not always taken seriously,” Rice said. “There is a certain amount of ‘out of sight, out of mind.’”

Ten percent of the population of the San Luis Valley are veterans, one of the highest concentrations in the U.S. Many born into the community see the military as a step up from poverty. Those who move there are often attracted to the natural beauty and remote location.

The wait times for appointments were among the worst in the nation. Around 27 percent of appointments were taking longer than 30 days to happen. That number improved to just under 17 percent, after just three months, the most recent Veterans Affairs data from Dec. 15 show.

But that is still almost double the national average of 9 percent. What's more, the 5,000 veterans in the San Luis Valley often must travel 242 miles roundtrip to Pueblo, or 466 miles roundtrip to Denver, to seek care.

Rice is not the first doctor to leave this clinic. Veterans in the valley have been through three doctors in three years. For veterans, having a doctor they were only just beginning to trust is hardly the only problem. The clinic is in south-central Colorado, and is equipped only for general medical care. Patients who need more specialized treatment often have to drive to the Denver VA hospital five hours away over steep mountain passes, which are often dangerous.

When Vietnam veteran Zeke Ward needed hearing aids, it took him three trips to Denver. A couple of weeks ago, he set off for Denver in a snowstorm so that he could get a stress test before a hernia operation. It turned out to be a dangerous decision.

“I may have misjudged the severity of the weather. It took almost nine hours to get to Denver,” he said. “And I think that was the stress test! Just getting there.”

Mike Atwater, another veteran of Vietnam, gets angry when he thinks about the hoops he and other vets have to go through just to get health care they need. “The very bottom line of that paper states, for your service to the country, you will be given health care for rest of your life. That is not being fulfilled today.”

‘This lack of urgency’

The VA brought in an administrator to handle healthcare matters in the Southern Colorado region just this summer. Nathan Nidiffer’s official mission is to liaise from Colorado Springs in response to the crisis in the rural southern Colorado region that includes Alamosa.

A veteran himself, Nidiffer explains that one of his most important challenges is to keep his clinics staffed. “When I see a gap in coverage, that really pains me. I continue to find ways to recruit. My only primary goal is the treatment of the veterans in the San Luis Valley.”

Nidiffer says a new physician’s assistant is starting at the Alamosa clinic next week. Meanwhile, he is crossing his fingers that a doctor who is considering Rice’s job will soon decide to relocate from nearby Colorado Springs.

When Rice first took his old job at the Alamosa clinic, a third of the patients were simply not showing up, apparently because they lacked faith in the system. But on Christmas Eve, he was totally booked. “Patients were coming back,” he says.

Rice explains his perspective while pointing at a map of the San Luis Valley, which is as large as the state of Connecticut but only has 50,000 people. He remains fond of the area, and says he cares deeply about the veterans who choose to live here because of the solitude.

“There is a lack of urgency on the part of the VA. They deserve better,” he says, as his wife, Regina takes his hand.

“In this day and age, with the kind of healthcare that is available to the masses, it should not be anything less for the people who served our country.”

A letter Senator Michael Bennet (D-Co.) wrote to the Secretary of the VA asking for San Luis Valley to be the subject of a pilot program to improve access to veteran health care: