Tuesday, June 19, 2012

With Some VA Doctors, Veterans Don't Seem To Matter

The service, congeniality, and helpfulness of workers within the Veterans' Administration, particularly the health care division, varies greatly from location to location and, sometimes, office to office. The personnel in Tucson, for example, have always been outgoing and personable to those I know who frequent their services. The same goes with many of the smaller outpatient clinics scattered throughout the country.

Various laws  and policies have been  passed in efforts to bring better care to our veterans. Some of these involved bogging the system down with more administrators while leaving actual healthcare providers and case managers undermanned. These are the effects of numerous laws passed in 2010 that increased the manning without actually increasing the level of service. Those within the system who are actually dedicated to their jobs seem to go out of their way to help as best they can. Sometimes the system itself actually works against the published intents of these laws. For example, one military retiree I know is still waiting on a disability rating a year later. This rating was supposed to be complete within 60 days of his retirement date. All appointments were made, all paperwork filed, and yet the weekly letter stating "we are still reviewing your case" arrives. This is because of the increased bureaucracy and not because of the lack of qualified healthcare personnel.

The lack of qualified healthcare personnel just causes long waits for appointments. Some appointments need to be made two to three months in advance. Even with such advanced scheduling, it seems the doctors, technicians, and nurses still run at least an hour behind on most days. Of course, if the veteran's appointment is later in the day, he stands a chance at having the appointment cancelled because they ran out of time, causing another 2-3 month delay before being seen.

With a mandated increase in Traumatic Brain Injury (TBI) screenings, this makes the process even more clogged up. The doctors get frustrated, understandable. However, they should not take this out on the veterans. The veterans are even more frustrated already due to the backlog. In addition, coupled with the mandate for increased TBI screenings, there are rumors that the VA is changing their own policies in regards to any new PTS screenings that are requested. Despite current murmurs in the psychology and neurology fields, rumors are that the VA is going to backpedal and restrict new filings, making more of them claims of preexisting anxiety disorders rather than PTS. The current studies and these rumored policies are at odds. The doctors suffer with the back-and-forth changes in policy. However, it is the veterans who suffer the consequences.

But if a veteran requests to be seen, the veteran deserves to be seen. If service related, the injury should be treated. That is the law. The Veterans already paid for these services by serving in the military. The injuries and afflictions mark the sacrifices they made in defending our great republic and our US Constitution. The least we can do is take care of the medical conditions that resulted from those sacrifices.

When the doctors themselves decide to be the weeding-out factors in who they will provide care for and who they will not, the issue gets worse. The doctors cannot make up their own policies on whims, deciding whom they will provide care for and whom they will see.

One doctor who appears to be doing such things is Dr. Susan Kim, a neurologist at the Mather Field VA complex near Sacramento, CA. Dr. Kim seems to have had quite a number of veterans complain about her to the Patients Advocate at the complex. She is rude to the patients. She cancels appointments on a whim even with the patient sitting the the waiting room. If quality care is the desired end result the laws and VA policies strive for, Dr. Kim appears to be a wad of America's Original Dubble Bubble that is gumming up the works.

In a recent conversation with a former Veterans' case worker, I was told a shocking tale. This case worker has advanced degrees in Psychology, is one of the most tolerant people I know, and has a history of going out of her way to take care of veterans and anybody else she can help. She is also an ordained clergy member within her faith, tending to those in need outside of her "day job".

She is also a disabled vet. She has a list of service connected injuries due to events while she served our country. This is from her experiences with Dr. Kim:

Her first visit with Dr. Kim indicated potential trouble. During that visit, she was not seen until 90 minutes after her appointment time. She lives two-hours away from the nearest clinic, so a trip for an appointment is already an all-day event. Waiting 90 minutes past the appointed time makes matters worse. By the time she was seen, the nurses were packing up to leave and the maintenance staff were shutting off the lights.

The veteran had an experience in the past where she was given an appointment and waited. The person with whom she was supposed to meet left, and she waited until she was ushered out, forgotten and abandoned. Incidents such as these ping on certain anxieties for her.

While she combated against the panic attack, the doctor finally called her into the office. The doctor had to restart her computer to access the veteran's chart. Dr. Kim had evidently failed to even screen the medical files (chart) to prepare for the appointment. Dr. Kim then decided to address the veteran's panic attack in a rude and condescending manner, telling the veteran to get a pregnancy test because her hormones must be all out of sorts. Dr. Kim refused to even reference the veteran's chart to see the diagnosed service-related anxiety issues.

The veteran's overall experience was one of little care given, rude treatment, and being dismissed as though she were a child complaining of a minor boo-boo.

The veteran had to be seen a second time for a more thorough screening. As usual, this appointment was scheduled more than 2 months in advance. Due to the behavior received during the first visit, the veteran attempted to contact the clinic multiple times in order to request a nurse to escort her during the visit. She wanted a witness to the sort of treatment she received the previous time. No calls were returned. No emails were responded to. The replies were silence.

So, on the day of the appointment, the veteran directly requested an escort. She also requested permission to record the appointment on a digital recorder. The response given was that she could not have an escort because it wasn't coordinated for in advance. In addition, Dr. Kim flat out refused to be recorded. She has a right to refuse, under law. However, if the patient is fine with the recording, what does the doctor have to hide if she is doing her job properly?

This was after another 90 minute wait past when the appointment was scheduled.

In addition, Dr. Kim decided to cancel the appointment on the spot. She even stated that the veteran would not receive the legally mandated travel reimbursement for the two-hour (one way) trip.

The veteran got upset, demanding to be seen. Canceling the appointment then denying reimbursement for the wasted day crossed a line. The wheel-chair bound veteran asked for a case worker or patients advocate or some other authority to come and rectify the situation. Then she was told that she would not be reimbursed for the wasted four-hour drive. The veteran, understandably, lost her composure. I have known this veteran for years. This is a person who seldom curses frustrated and belittled to the point of cursing like a sailor. Patience didn't work. Understanding didn't work. Attempting to reach an adequate solution through mature, adult means didn't work. So, the veteran raised her voice in a justifiable manner intended to draw attention. In effect, the dismissed veteran caused a necessary scene in an attempt to escalate awareness of the situation and receive the treatment she earned. Even that met with apathy and indigence. Finally fed up, she and her husband decided to leave.

More than likely, this woman, pushed beyond her limits, was regarded as just another "crazy vet" by the staff, particularly Dr. Kim. Either Dr. Kim or one of her staff called the police in an effort to have this dangerous (wheelchair bound) woman forcible removed before she harmed some innocent bystander. This should answer questions about why some veterans lose their composure. They aren't "crazy". They are fed up. 

Upon exiting the building and heading towards the parking lot, seven police officers arrived. Three of them rushed to block the door to the clinic. The remainder remained in the parking lot while one came forward to assess the situation. Upon hearing the veteran's story (and seeing her in a wheelchair), the officer went into the neurology clinic in an attempt to find some peaceful solution that would take care of the veteran. He met with little progress. The police office did arrange an appointment later this week (another four-hour round-trip trek) with Dr. Kim's boss. 

The police accompanied the veteran to the travel reimbursement office, and the veteran still received compensation for the trip. She then went to the Patients' Advocate, whom she had worked with in taking care of numerous veterans in the past, and filed a complaint. The PA was shocked at the police response over this particular veteran but immediately ascertained that it was the result of Dr. Kim's inappropriate and rude "bedside manner".

Here you catch a glimpse at socialized medicine. The doctors will be underpaid. They will be rude. They will be able to get away with canceling appointments on a whim with little to no recourse. Patients will be subjected to mounds of red-tape in order to file a valid complaint that will fall upon deaf ears (or be filed in a shredder bin). It will take a police officer going out of his way to attempt to do the right thing to even grant a glimmer of promise that a patient will be seen in a timely and professional manner. That, of course, assumes the police officer doesn't just arrest the patient.

Of course, this would not happen if the VA system were to contract out to private physicians. If they did so, the screenings and care could be done more locally (avoiding that four-hour round-trip drive). Also, if the private doctor failed to adequately and professionally do the job, the patient (veteran) could just select another. With a filed complaint (or two) the contract agreement with the poorly performing physician could be cancelled, in effect, fired.