Brian Cressy was minutes away from open-heart surgery at Catholic Medical Center last December, his chest shaved and painted orange with surgical disinfectant, when a social worker delivered the news.
Cressy, a 58-year-old Vietnam-era veteran from East Kingston, would have to be transferred to a Boston VA hospital for his surgery, she said. The Department of Veterans Affairs wouldn't pay for the operation to be done at CMC.
Cressy had just survived a serious heart attack and was afraid he was going to die.
"I don't want to die," he told the social worker. "I want to have this surgery done now."
He refused the transfer, and the cardiac surgeon went ahead with what turned out to be successful bypass surgery.
Now Cressy, who works as a licensed alcohol and drug abuse counselor, faces medical bills totalling tens of thousands of dollars after the VA declined to pay his claim. While the federal agency will pay for emergency care at a non-VA facility, its policy clearly states that if a patient can be safely transferred to a VA hospital once he's stabilized, he has to move.
"If you refuse to be transferred, VA will not pay for any further care," reads a "non-VA emergency care fact sheet," sent in response to a reporter's inquiry about the policy.
But under a bill that passed the Senate last week, veterans like Cressy wouldn't face such choices in the future, thanks to bipartisan advocacy on behalf of New Hampshire veterans by the state's two U.S. senators.
Democrat Jeanne Shaheen and Republican Kelly Ayotte worked together to insert into a VA reform bill a provision that would expand care options for veterans who live in states without a full-service VA hospital, such as New Hampshire.
The Senate voted, 93-2, on Wednesday to pass the bill, sponsored by Sens. Bernie Sanders, an independent from Vermont, and John McCain, R-Ariz., and it's likely to go to a conference committee, since the House has passed its own similar measure.
The Shaheen-Ayotte provision would allow veterans in states without full-service VA hospitals to seek care from private providers if they live more than 20 miles from the nearest VA.
Had that been in place last fall, Cressy's care at CMC would have been covered.
Ayotte said in a written statement that Cressy's situation "highlights the real hardships New Hampshire veterans are facing when it comes to accessing care." And she said, "The provision that Senator Shaheen and I worked to include in the VA reform bill will give our state's veterans the choice to receive care from a private provider instead of waiting in line or driving hours for VA care."
Elizabeth Kenigsberg, press secretary for Shaheen, said what happened to Cressy is "just one painful case of the problems New Hampshire veterans face" and that the senators are trying to address.
Veterans here "have faced serious inequities within the VA system, such as enduring long drives to neighboring states for care," Kenigsberg said, and the proposed change would finally give them "the opportunity to seek care closer to home and get the timely and accessible care they deserve."
So how did Cressy end up in this predicament?
To start with, he doesn't have health insurance and usually gets his medical care through the VA. But after he suffered a heart attack on the day after Thanksgiving, he wound up in the emergency room at Exeter Hospital. Tests showed that four major blood vessels were 80 to 90 percent blocked, he said.
Exeter doctors told Cressy he had to have emergency open-heart surgery, and gave him a choice between CMC and Portsmouth Hospital. He chose CMC and was taken there by ambulance that Saturday. No one suggested the Boston VA, he said.
It was only on Monday morning, a half-hour before his scheduled surgery, that he was told the VA would not pay for his surgery there and he'd have to go to Boston, Cressy said.
It's not clear why he wasn't transferred to the Boston VA after he was stabilized at Exeter's emergency department that Friday night.
Because of patient confidentiality, representatives of the three hospitals involved - Exeter, CMC and the Manchester VA - said they can't talk about the specifics of the case.
Debra Krinsky, acting public affairs officer for Manchester VA, said she couldn't discuss Cressy's case, even if he gave permission, since he plans to appeal.
But she provided information about the appeal process, which gives veterans one year to file a Notice of Disagreement with their local VA office and the Board of Veterans' Appeals in Washington, D.C., and to request a hearing.
Mark Whitney, vice president of community relations at Exeter Hospital, also said he can't speak about Cressy's private medical records.
But in a typical emergency situation, he said, Exeter doctors would do interventional cardiac catheterization. And if surgery was required, it's typical to transfer patients either to CMC or Portsmouth, he said.
Whitney said his hospital coordinates with the VA on care for their patients, and under the VA's policy on emergency care, "We do under certain circumstances get reimbursed for certain patients."
He urged Cressy to contact Exeter Hospital with any questions about how his case was handled there.
Michelle Marshall, director of marketing at Catholic Medical Center, also said CMC "works collaboratively" with the VA in caring for veterans. "If we are aware that a patient is a veteran, we work with that veteran and the VA system to make sure they receive prompt and appropriate care," she said. "The VA is a source of medical support for otherwise uninsured veterans. This sometimes means transferring a veteran to a VA medical center for their acute medical care."
However, Marshall said the hospital would never turn away a patient because of a lack of insurance. "We have the highest percentage of charity care in the state," she said.
"If he was really in dire straits and he chose not to go to the Boston VA himself, we can't turn him away because we treat anyone who needs care regardless of their ability to pay."
Cressy said since his surgery, he has gotten good care at the Manchester VA Medical Center, where both his primary-care doctor and his cardiologist are. And the VA paid for his emergency care at Exeter Hospital and authorized 16 weeks of rehabilitation at Parkland Hospital in Derry.
He went back to work a month after surgery, and he's feeling much better, notwithstanding some good-natured grumbling about his new diet of "fins and feathers" (fish and chicken).
After the VA denied his claim, Cressy didn't file an appeal right away. "I thought I was fighting against a giant," he said.
But now he plans to do so. "I'm going to shake the dust off and get back on my horse, I guess, and do what I have to do."
And while it won't affect his own case, he welcomed the news that Congress may enact more options for New Hampshire veterans. "What I find is hope," he said.
There's no shortage of excellent hospitals right here in New Hampshire, Cressy said. "Boston is an octopus of medical care, but it's also big and confusing. We feel comfortable in our region," he said.
He was touched that New Hampshire's two senators worked together to get it done. It's something his late mother, former state Rep. Ellen Cressy, would have applauded, he said.
"She was the type that it didn't matter that you had a D or an R after your name," he said. "She didn't vote along party lines. She voted for the people."