Friday, July 11, 2014

VA Scandal: Temple Texas VA may have sentenced vet to death


Temple Texas VA medical center and Austin, Texas VA pharmacy failures leave Howard Smith fighting for his life

Olin E. Teague Veterans' Medical Center in Temple, TX | PHOTO CREDIT: Dept. Vet. Affairs (public domain)
Olin E. Teague Veterans’ Medical Center in Temple, TX | PHOTO CREDIT: Dept. Vet. Affairs (public domain)

AUSTIN, Texas, June 25, 2014 — Vietnam veteran Howard Smith is in the process of putting his affairs in order. His health is rapidly deteriorating and he feels the Department of Veterans Affairs failed him. The recent revelations of the ongoing VA scandal leave him less optimistic about his future. “I just don’t know who to trust out there, anymore,” said the U.S. Marine Corps veteran in an interview.
My first entry to the VA Health Care system was in 1988 or 89 and my Outpatient Clinic was in Marlin, Texas as the Austin facility wasn’t built as yet. I started going to the Austin VA after my divorce of 2002, my first visit was in early 2004 on a triage walk-in basis. I had Bi-Laterl DVT, they admitted me to Brackenridge Hospital due to the severity.
Howard has been a regular patient at the VA, since. He has been on several medications and pain management programs. It has been rare for him to cancel or miss an appointment. In fact, the only one he recalled was one appointment in 2006 or 2007. His car broke down on the way to the appointment. He called to let them know he was running late. They rescheduled him.  This left him surprised when a clerk remarked that he “missed and rescheduled a lot of appointments”.

As the ongoing investigation into the VA’s “secret waiting lists” revealed, Howard is a victim of one of the “gaming” strategies VA workers employ to “cook the books” so they appear as though no patient waits more than 14 days for an appointment. The strategy the Temple, Texas facility used on Howard is the “kick the can” policy. When appointments are overbooked, a VA worker will reschedule veterans on one of the “secret waiting lists” for an appointment two weeks later, repeating the process until an opening on their unofficial calendar approaches. Several times, Howard was in his car or already at the Olin E. Teague Veterans’ Medical Center in Temple, Texas when he received a phone call “confirming” his cancellation and providing the rescheduled appointment information. “It was the VA rescheduling me. I didn’t cancel these appointments. They did. But the records showed I had called and cancelled.”

Making matters worse, Smith has an aggressive infection affecting his kidneys and lungs. The infection required strong antibiotics when first detected. Since diagnosed, the problem has gotten worse. However, the VA “kicked the can” on his last two consecutive appointments. For somebody with a routine concern, 30-45 days may be nothing more than discomfort. For Howard, though, it could be a death sentence.  Howard has been begging for an appointment since before May 9, 2014, when they started rescheduling his appointments without his consent.

This is the fourth such incidence Howard experienced since November 2013. “They do that. They reschedule my appointment a couple of times, then I’m finally seen. Next they tell me I cancelled a lot of appointments. I didn’t cancel any.”

Howard related more on his history with the VA. After news stories of past VA healthcare system issues in 2003-4, VA care greatly improved, according to Smith. He had few issues or problems receiving treatment or seeing a care provider between 2004 and 2013. In 2013, however, things changed dramatically.

“In September 2013, I took the first vacation in years. While I was gone, my apartment caught fire. The fire and water damage from the fire department destroyed many of my copies of my records”, said Howard. For the past several months, he has fought for the VA to provide copies of just his last two years’ medical records.

Howard’s ordeal reveals other systemic problems with the VA system beyond the scheduling “gaming” and the willful destruction of records discovered several months ago. The VA’s pharmacy, prescription and drug delivery system also requires reform and better oversight. Smith said:
It’s more than just falsifying information, losing records, and waiting lists.
Starting before that fire in 2013, in late 2012, Howard started noticing discrepancies between what he was prescribed and what he received. The first time, the invoice stated he received a full refill of 240 doses of a class II narcotic. Suspicious, he counted the pills. A small prescription bottle containing 40 pills was missing. Howard contacted the VA pharmacy system and reported the problem. Surveillance cameras in the Waco, Texas VA pharmacy discovered that a postal clerk pilfered the pills. But the pharmacy refused to replace those Howard didn’t receive, despite acknowledging they were stolen by a VA employee, without consent of his primary care provider.
This lady told me to talk with the Austin Outpatient Pharmacy Mgr to replace the shorted medications, in which that was done. I went to the old Austin VA Clinic and talked with the VA Patient Advocate, Mr. Tandy Kinard, at that visit Mr. Kinard stated any narcotics missing for whatever reason had to be approved by my primary care doctor, Dr. Tin Tin Wai. When all of this came to a head in early November 2013 and I talked with Dr. Wai, she was not aware of any of the shortages of my Hydrocodone.
As Howard relates, the issue continued:
About three months later after the 40 ct, my, (supposedly) 240 Hydrocodone came in, Certified Return Receipt Requested and it was a 100 ct. bottle short this time. Again I go out to the Austin VA and meet with the Patient Advocate, Mr. Kinard and he called Mr. Matt Garret into his office and I explained the problem of the missing narcotics. Again it was replaced, at the time frame that it would of been needed. The very next month, the very same situation, 1 – 100 ct sealed bottle of Hydrocodone was missing again. My Garrett came into Mr. Kinard’s office and while I was there he called, I assume either the Temple or Waco pharmacy and told them to put all 240 in one large bottle, seal it and double bag it.

Well, for the next two months I received the correct amount of my Hydrocodone, (not in one bottle as Mr. Garrett had requested) but on the next two months straight after getting the correct amount, again a 100 ct bottle, sealed from the pharmaceutical company was shorted. Again I go out to the Austin VA and meet with Mr. Kinard, he notifies MR. Garret. On that visit Mr. Garret ask me to bring in the mailer bag the meds came in in which I did. And once again when it was the time of the month for me to need the other 100 it was replaced by Mr. Garrett, but… without my primary care doctor, Dr. Wai knowing about the shortages, strange.
During my March 2014 visit with Dr. Wai, she called Mr. Matt Garrett into her office for my visit. After the visit was over and me speaking to Mr. Garret about all the shortages he stated, “I only remember replacing 140 Hydrocodone for you”. I told him no, it was a total of 440 missing. On my next meeting with Mr. Garret this time he stated, “I only remember replacing 240 Hydrocodone for you”. After a visit with my Neurologist Dr. Little, (one of the good ones), on May 14th 2014 he increased my Hydrocodone back up to the correct amount of 240 Hydrocodone a month, an amount I have been on since I believe about 2008, somewhere along there.

As when the VA finally, after 4 1/2 months of withholding any pain meds or muscle relaxant, the Hydrocodone was only reinstated at half dosage. Again after talking with Mr. Garrett this time he stated, “Any Hydrocodone I replaced for you came from your refill amount on file”. No mention this time of a total amount replaced, strange. Again I simply don’t know who to trust within the VA and that’s a shame.
Then troubles worsened. “I checked my prescriptions and they told me they expired”, said Howard. He didn’t receive all of his pills during the time. He received no official notification of expiration or a consultation for a refill.

Screen capture of EMR | IMAGE CREDIT: Howard Smith
Screen capture of EMR | IMAGE CREDIT: Howard Smith

Howard made an appointment. The VA turned him away, telling him that he needed lab tests done before they could reissue the prescription. Over three days, Howard had five different batteries of blood tests performed. Next they turned him away again, refusing to refill his prescription because none of the tests were a urinalysis. No urinalysis had been ordered before that, only the blood tests. Howard had the urinalysis. It came back with a positive for THC. One of Howard’s neighbors had offered him some tea that was described as a holistic and herbal pain remedy. It turned out the tea contained a cannabis-like substance. Policy requires a 30-90 day waiting time before a retest in cases of a positive result.

Screen Capture of EMR | IMAGE CREDIT: Howard Smith
Screen Capture of EMR | IMAGE CREDIT: Howard Smith

Now, Howard’s fate rests in the balance, again due to prompt reception on prescription medication. Howard was supposed to receive antibiotics to treat an ongoing, aggressive infection that has now become life-threatening.
The withholding of the antibiotics either from incompetence or whatever from one of my doctors nurses, nurse Rebecca Friday was totally uncalled for. As I did call and speak with her, (7 to 9 days after the 05-23-14 lab test) and advised her of not receiving the antibiotic yet, never heard back from anyone Most likely as I have never met the nurse, she simply seen the tested positive for cannabis and assumed by my age, here is another one of those 60′s or 70′s stoners. Not true, not even close.
After 30 days, the VA admitted a clerical error on behalf of a nurse. She failed to enter the prescription into the automated system. One of the excuses given was that false positive urinalysis. His last two appointments were rescheduled. The antibiotics arrived, possibly too late.
I was withheld much needed antibiotics for 30 straight days and it has caused me much problems especially with my breathing. Last Sunday [June 22 2014], I awoke about 4:30 AM and I didn’t think I was going to make it. I simply could not breathe. There was blood on my pillow. My temperature, though not extremely high, it was 101.8. And upon doing my lab test on 06-23-14 the kidney infection was still showing on my lab test. I waited around the VA for 4 hours waiting to pick up my meds, both my Hydrocodone and the antibiotic, but had to leave due to another appointment. As I was in the VA parking lot getting ready to load my scooter, Dr. Wai’s other nurse, Nurse Stan, (good nurse, compassionate) came out and caught me before I left. He stated he was sorry for the wait, (I truly believe he was) he said to me, “your meds are ready at the pharmacy window.  But that’s not the problem Howard. You have a massive kidney and bladder infection.” He later called, “The day you called and I missed your call”, he stated, “Dr. Wai wanted to do a CT Scan on your abdomen to try and see what is going on.” I see her next Wednesday, July 2nd.
Howard stated his reasons for coming to the press were not selfish. He has attempted every avenue available including state and federal political officials and letters to senior VA officials. Filing official forms and letters to VA executives resulted only in notification of receipt with caveats that processing is delayed due to backlogs. Howard feels it is now too late for him to receive the care he needs. He seeks public awareness so other veterans don’t needlessly suffer the fate that bureaucratic incompetence and systemic failures done unto him.