How not to treat vets

The last couple of days have been rough on me and my friend Dave thanks again to the VA. This will be fairly long but I hope all will read this.

Dave has to take a medication or he will sleep walk and do stupid things while asleep to the extent that he could very easily hurt himself.  He has been on this medication for about 20 years. A few days ago he ran out of this medication while waiting for the medication to come in the mail. So he came over on Friday and had me check on-line that status of it. When I logged on to the VA site we found out that they had discontinued his medication.

So next we tried calling the VA pharmacy in order to get things straightened out so he could get his med.  Once we got through the announcement said he was the fifth in line while waiting on hold. After a few minutes the announcement then said because of the large volume of calls to leave a message and they would call him back. Of course he never got called back. But we then tried calling the tele care nurse as it was imperative that he get his meds. After explaining what was going on the nurse ( if they are really nurses ) said she would get things fixed and they would over-night the med for Saturday morning.

Well Saturday morning came and went and he didn't get his med. So he called the tele care nurse again. After again explaining what was going on he was informed the other nurse had just sent an e-mail to the pharmacy requesting them to get his doctors to renew the Rx on Monday. So mush for getting the med sent over night.

Next we headed up to the VA hospital as he could not take another night without the med. Saturday morning his dog woke him up at about 3AM and he was outside with a gun in his hand. Not a great situation. Once we got to the VA ER there were very few people there so we figured it wouldn't be long before he got to see a doctor. Of course that was not the case. We sat there for 3 hours and only saw them call back 1 person in that time. But finally he got to see a doctor.  After again explaining what was going on the doctor checked his records and told him there was no reason that the Rx should have been discontinued or why they had not sent out the Med. So he got a script for 10 days worth of the med and we headed to the in-patient pharmacy of the hospital.

After a little wait at the pharmacy they told him they could not fill the Rx and he had to return to the ER and talk to the doctor. By this time both of us were fuming mad. But we went back to the ER and he went inside to talk to the doctor again. After about 5 or 6 minutes I saw 2 cops going into the ER. I figured something was up and I was right. In the course of explaining to the doctor how with out themed he walks in his sleep and might end up shooting himself they took it as a threat of suicided and detained him. This was not what he was saying to them. It was about 1/2 hour after he had gone into the ER that a cop came up to me and asked if I was waiting for Dave. So the cop took me into the ER and this is when I found out what was going on and the cops were there to make sure that he didn't leave.  

After a little while one of the nurses told me to go back out in the waiting room while they got him settled into a room in the ER and she would come out and get me then. Well about 1 1/2 hours latter a woman came over to me and said she was a shrink and that they were going to keep Dave there for a few days. I had actually watched this woman talking with the receptionist in the ER for about 20 minutes before she came over to me. While I could not hear what was being said it sure seemed to be just a gab fest to me.

She took me back to see Dave then and the had him in a lock isolation room. As the shrink took me back to see Dave I acknowledged that he only does the sleep walking and weird stuff when he isn't on the med they have been keeping him from getting and also that the only time he doesn't take it is when the VA messes up and doesn't send it to him. This has not been the first time that they didn't send him the med. And she also acknowledge that this is a common side effect when you stop  taking this med. So she said they are keeping him and giving him the med that they have been refusing to give him.  So finally after 7 hours at the VA I was heading home, in agony from pain. I had thought about getting something for my pain before I left, but considering how things had been going at the VA I would probably also end up locked up in the hospital.

The the short version is:

We won't give you your med and since you are not taking your med we are locking you up. Sure sounds like a good legal case against the VA to me. Dave has told me he is going to check into this aspect as soon as they let him out. Also they refused to call his VA shrink to get things straightened out.

Dennis

[Sarahsmom46]

Two things came to mid while reading your post.  1, Bad things happen when we go to the ER on the weekend.  2. Dave is so fortunate to have a friend like you.  

The other things that came to mind about the VA and how both you and Dave were treated the past couple of days can not be put in writing.  My blood is boiling and I'm afraid I might write something I'd regret later.  

I hope Dave will be out of this unneccessary incarceration soon.  

Julie

[HVAC]

Oh my I am sorry for your friend,

  I have never dealt with the VA but I have been in similar situations with private health care providers I had to pay highly for the privilege. I would never have mentioned the gun, that pretty much is their right to hold him for better or worse. It is like you can't even joke about a bomb in an airport.

  If you had to deal with the Duke Health Care System you would have the same frustrations. The difference is it costs more and you sign your rights away to sue them before they will treat you. Only arbitration.

They almost killed me ten years ago when I got an E coli infection in my kidneys. It showed up on seven urine tests and they dismissed them all as flukes. The infection almost went into my brain.I also had a huge stone they would not remove. About ten Doctors screwed up in one way or another. It was clear malpractice and I suffered for four months due to multiple screw ups.

I still use Duke. Human Medicine is just too big. The problems are with any health care system.

I have a Doctor who is independent and does not take insurance. I pay him cash and he is worth every penny. I can even reach him when he is out of the country.

Alex

[caregiver222]

I am very familiar with the VA, and have to come to their defense. There are a lot of missing pieces to this story.

The Veteran's Administrations hospitals are very structured.  And they tend to shut down on weekends. On Saturdays and Sundays it is ghost-town city.

In addition a patient is given a slip that is to be mailed in for re-fills. Schedule one drugs do not have such a refill and require you to go back in. You cannot refill an expired schedule one prescription over the telepphone nor does the pharmacist have the authority to do so.

All VA hospitals have a sick call at 0800 HRS and to be reasonable, if the prescription was to expire the veteran must show up at 0800 on a weekday to see a physician. They always are referred.  Under VA protocol only psychiatrists are permitted to prescribe certain medications.

It appears there was a cris ochestrated by a failure to follow their simple, but admittedly bureaucratic rules.

Secondly, as I work ocasionally as an assistant to a psychiatrist they are very antsy when it comes to sharing any psychiatric information. I cannot conceive of a situation where a complete psychiatric evaluation would be conveyed to a relative or brother, even with a medical proxy signed.

Thirdly, recently, as a result of pressure from the DEA, they have begun a re-evaluation of prescriptions for all schedule one drugs. This includes valium. The standard for prescribing such medications within the VA has changed and this is not the fault of the VA.

The Veteran's Administration police are very courteous and deal with many stressful situations. The emergency rooms have ZERO, and I mean ZERO tolerance for lip from patients. They also have a protocol that involves mandatory psychiatric containment for observation whenever a physician of nurse is threatened. My experience with the VA emergency rooms is that they are as good as any in the United States. The physicians are hardworking and conscientious. I have been in several of them and always recieved top-notch care.

I am sorry for what happened to your friend, but much of this story is hearsay, and there are always  two sides to every story.

[Sailorsong]

I have to strongly disagree with your assessment of what happened in this case. I don't know where you got your information, but things do NOT work as you stated at the VA hospital in Nashville. they DO NOT have a sick call as you described here. What they have is a Same Day Clinic that operates out of the ER which operates until early afternoon. Both Dave and I have had plenty of issues with the Pharmacy at the hospital prior to this issue and we have both filed formal complaints against the pharmacy.

In this particular instance the problem started because they dropped the drug from the formalary and discontinued his medication. Prior to the change in formalary he had 3 refills left on the Rx. Dave had seen his shrink 2 weeks prior to this so evidentially not only didn't they inform Dave they also didn't notify his shrink or this would not have happened. It was only when we sent on-line to get a refill that we found out that the drug was discontinued. I know this for a fact because I order his refills for medication on my computer.

Dave also did not threaten any doctor or nurse so you are way off base on that. The only thing he said that when he is not on this medication he sleep walks and was afraid he might shoot himself if he didn't get the medication. I was present while Dave was talking to the shrink so what I stated in the prior post is what I heard, not HEARSAY. Quite often Dave will have me go with him to most of his appointments as he is hard of hearing and has a bad memory.

Also in getting refills at the Nashville VA you can not get a refill by going in. they only do refills by phone, mail, or over the Internet.

The problems were ALL caused by the VA in Nashville.

1) They discontinued his Rx without informing Dave or his shrink.
2) They sent the request for the drug through normal slow channels instead of an expiated route as required.
3) They sent the RX for approval from a committee when protocol says the approval is not needed for Dave's documented medical problems.
4) They refused to call Dave's doctor ( it was only 5:30 PM ).
5) They confined Dave even though they admitted that it was a misunderstanding of what he said. ( they are still keeping him confined as of today. )
6) At one point they tried to say he was never on this medication in a CYA move. I have the empty bottle for this medication in my possession.

Dennis

[essdipity]

I'm sorry about this lousy situation. I hope things straighten out for you and Dave soon.

ess

[KenDub]

It sure is silly for somebody hearing a story second-hand to assume what has happened... and then to tout Hearsay on top of it... My 2 cents

With that said, Dave, I am very sorry to hear about how the VA is treating your friend and I hope everything is resolved soon.

Kenny

[RedFlame]

Dennis,  That is about the most pitiful situations I have heard in a long time now.  How awful for both of you,  such an incredibly needless thing too.

I hope he is able to come home soon.

lois

[Quixotic1]

These situations need to make national press stories and be told to Congress.  I have become so disgusted with the malpractice and meanspiritedness of the VA via you and Bill that I could spit!

Quix

[Wind_and_Water]

Dennis, you provided a clear outline of events.  It's pretty darn clear what happened.  Thank you for informing the rest of us how poorly our beloved veterans are treated in Nashville.

[caregiver222]

At the VA you are assigned what is called a "primary care physician".

They see you every three months.

At the time of the visit you are given a list of your meds and a schedule for the next three months.

After seeing this physician you then go to meet with the pharmacist, who again reviews your meds, and insures you are a happy camper.

They do ocasionally discontinue medications, but that is a complex process, and the local VA is not responsible.

If there is difficulty involving an issue, in my experience the primary care physician returns a phone call within the hour to straighten things out. If the primary care physician is unavailable they have a "supernumerary" physician designed with authority to solve the problem.

If any veteran states he "might shoot himself" that is the ticket to involuntary psychiatric observation. Don't pass go. Don't collect two hundred dollars. He is entirely responsible for his own incarceration. In my jurisdiction such a statement would insure a minimum of ninety days in a secure psychiatric ward. The actions in confining him were appropriate and proper.

You they then go down to pick up a small supply of the meds, and at that time either deposit in a box the ticket to have them mailed to you, enter it on the internet, or mail it in. The VA at present has a mail-out refill policy.


If it appears that you have not recieved your meds within fourteen days you call them for a follow-up.

The approval and disapproval of various formulations is part and parcel of the bureaucratic process.

Having been both a patient and having worked in providing care at a VA facility, I can only state that there are many "missing pieces" to the story.

[Sparkysarah]

Just to add my support to others and that I am really sorry to hear of the terrible ordeal that you and your friend Dave experienced. From many miles away it sounds to me very very unsatisfactory.

Best wishes

Sarah

[Sailorsong]

This is an update. Dave was released from the hospital today at 3PM and again without the required medicine. They had him on the medicine for the first two nights only. Then they switched him to another medicine which has not controlled his sx before on the third night.

The staff shrink had resubmitted the request for this medicine to the committee ( non medical persons on it ). and it was again rejected even though he had specified that Dave had to be on this med. They responded that the only way Dave would be given this medicine was after a failed suicide attempt. Makes you wonder how many vets are going to die because of this. Is that what they are counting on?

I also found out when I picked up Dave that they didn't give him a cath until Sunday morning. I was with Dave when he told him he needed a cath due to his BPH Saturday evening. Even when he was taken to the Psych ward he told them he needed a cath but they refused him. So he spent the night in agony.

Dave is very happy to be home now and is planning on finding a lawyer to sue the VA for what has been going on.

Dennis

[Sailorsong]

I am a vet too so I know what the procedures are but since you laid them out I will respond to each item.

"At the VA you are assigned what is called a "primary care physician". "
While this is true at least in my case they have been "Physician Assistants" that are just about worthless. cases in point:
1.  Had torn cartilage in my knee and had to complain about the pain at 4 different visits before he referred me to Orthopedic surgeon.
2. Complained about bladder control problem..did not enter into my records and just told me to talk to my Non-VA Neuro about it.
3.  Had fluid on my elbow - response was we don't do that here.

"They see you every three months. ". Not true at all. It is up to the PCP as to how often they see you. Prior to last PCP visit it had been 6 months.

"At the time of the visit you are given a list of your meds and a schedule for the next three months. " I have never been given a list or any kind of paperwork on any of my visits.

"After seeing this physician you then go to meet with the pharmacist, who again reviews your meds, and insures you are a happy camper. " Partially true. You do see a pharmacist and they make sure you understand the medications that have been prescribed. But after that it is anybodies guess if you will get what you are suppose to get at the pickup window. They last time I went I was suppose to get 3 Rx filled. but they only filled 2 of them. The one they didn't fill was for one of my BP meds which I was completely out of. They had decided to mail that one between the time I saw the pharmacist and picked up my meds. As a result I had to go a week without it.

"If there is difficulty involving an issue, in my experience the primary care physician returns a phone call within the hour to straighten things out. If the primary care physician is unavailable they have a "supernumerary" physician designed with authority to solve the problem." I have never been called back within an hour. You are lucky if they call you back within 2 days if they call you back at all. And when I do get called back it has never been by a doctor.

"If any veteran states he "might shoot himself" that is the ticket to involuntary psychiatric observation." This is also not true. If it was I would have been locked up at least twice in the last years for making such statements to my doctors at the VA.

"Having been both a patient and having worked in providing care at a VA facility, I can only state that there are many "missing pieces" to the story."

So you were there during all of this? That is the only way you would know if there are parts missing or not. I was there through all of this and there are NO parts missing.

Dennis

[supermum_ms]

Hey Dennis,

I think what has happened to you and your friend Dave is appauling, no excuse will make this right! My respect for you and all those that have put their life of the line can never be matched, your medical treatment (in a perfect world) should be the best of the best, if for nothing else but it being the least that you ALL deserve. It just isn't good enough!

One thing i think this discussion has highlighted, is what 'should' happen (procedure) and what unfortunately 'does' happen (reality), it would be misguided to assume correct procedure is always followed, when faced with a personal account of failed medical care.

The tragedy is not so much Dave's loss of liberty (though that is horrific) but that none of what Dave (and you) had to go through was necessary, it could of all been avoided if 'procedure' was followed and Dave's Dr knew his 'necessary' medication was being pulled. If the lines of communication were working, if any of the mistakes had not been made any where along the chain, Dave would not of been put in a position of helplessness in the mass of beurocratic bungling!

I have to think that Dave is not the only one who is going through this, or will go through this when their medication runs out, these others, i feel need warning of the possibility. Is there a vetrans affares organisation or the like that could help warn the others, i'm thinking preventative medical intervention in a more timely manner, so that the others do not go through what Dave went through, is there some help to get the word out?!

Cheers...........JJ

[Karen99]

Yes indeed.  What should happen and what actually takes place is often two entirely different scenarios.

It is INEXCUSABLE to take away a medication from ANY patient who needs that medication  to be safe.  If that patient gives "lip service" because it is dangerous to be without that medication, they find themselves locked up in a psychiatric unit?  INEXCUSABLE!!  

I don't know what medication was taken away from him, but I would bet my last dollar it is one that is not to be discontinued abruptly.  This causes the patient needless suffering and possible harm to the patient.

I would imagine most VA hospitals are much like the large conglomerate HMO's.  When dealing with them, you might as well just beat your head against the wall (whoops- would that get me locked up?  Giving lip service and all......)  

Is it proper protocol and procedure to allow a person to retain urine for 24 hours?

  

[Ufrustrated2]

>>At the VA you are assigned what is called a "primary care physician".

true

>>They see you every three months.

not necessarily true, that time frame is dependent on "factors"


>>At the time of the visit you are given a list of your meds and a schedule for the next three months.

true on the meds, sometimes true with the appt list


>>After seeing this physician you then go to meet with the pharmacist, who again reviews your meds, and insures you are a happy camper.

almost never have i been "met" with a pharmacist after seeing any physician at any VA, nada


>>They do ocasionally discontinue medications, but that is a complex process, and the local VA is not responsible.

true. happened recently for like "provogil" or something like that. one of the ones for MS type fatigue.


>>If there is difficulty involving an issue, in my experience the primary care physician returns a phone call within the hour to straighten things out. If the primary care physician is unavailable they have a "supernumerary" physician designed with authority to solve the problem.

PCP returning a call? not in my universe. Neuro used to, but, i guess some authority told him not to anymore. a "supernumerary" physician? nope not for me. i've called for refills and if my neuro is out the nurses there won't get another "supernumerary" to help. they'll say call your PCP! and then you have to leave a message.

My MS med wasn't refilled once due to the "Rx committee" issue. i called that in 8 days prior to running out. i now will call 2.5-3 weeks before running out.


>>If any veteran states he "might shoot himself" that is the ticket to involuntary psychiatric observation. Don't pass go. Don't collect two hundred dollars. He is entirely responsible for his own incarceration. In my jurisdiction such a statement would insure a minimum of ninety days in a secure psychiatric ward. The actions in confining him were appropriate and proper.

yep, gotta watch those words. mention it out in the ocean and you'll find yourself confined or helo'd off to a base.


>>You they then go down to pick up a small supply of the meds, and at that time either deposit in a box the ticket to have them mailed to you, enter it on the internet, or mail it in. The VA at present has a mail-out refill policy.

not sure what you mean by "mail-out refill policy." all my meds get mailed out and they prefer it that way here. too many people in line otherwise.


>>If it appears that you have not recieved your meds within fourteen days you call them for a follow-up.

they say 7-10 biz days here on the phone recording i think. but i take meds for memory so don't quote me. ;-)


>>The approval and disapproval of various formulations is part and parcel of the bureaucratic process.

found that out the hard way. BUT, if the med is a highly necessary med, and it is due for the "bureaucratic process" to see if refills are medically met they really could alert the doctor so they/staff/mail can alert the patient.

[Wind_and_Water]

If this is how our VETERANS are treated -- that is, those who deserve the very best treatment in the entire country because they put their very lives on the line to protect the rest of us -- then I dread how the rest of us will be treated when there are no options left other than the "public" option.

[HVAC]

I was at our State's legislature with the MS Society and other advocacy groups. Our MS chapter has a strong veteran's advocacy division which deals with the VA among other things. It is vets with MS helping other vets. The National MS Society may have help for Veterans as well.

I think you could contact your Congressman for starters they have someone who deals with veterans so does your Senator.

A letter to the editor would be good. If you and Dave are having problems so are others so you may not only help yourselves but others.

I met a group today at the legislature in our state called "disability rights"  and all they do is help those with disabilities with legal matters free of charge. Perhaps your state has something similar.

I am finding more and more resources in our state through my volunteer work at the legislature.

I personally hate bureaucracy and have learned to work around it. In my experience with with the modern medical system bureaucracy trumps common sense.

Alex

[Ufrustrated2]

>>I think you could contact your Congressman for starters they have someone who deals with veterans so does your Senator.

not to be too blunt, but this is a joke. ask thousands of vets who have written for years to these folks only to get back a boiler plate template note that the VA itself doesn't care much about. ask me, i've even written the WH twice. this does nothing. but it will get a paper trail going for your records.

>>A letter to the editor would be good.

editor? what editor? i wrote the local newspaper, national mags, national news orgs. no one but the local newspaper wrote back. he gave me a name of some guy at the local VA. that guy in turn gave me the local VA claims office. you see where that roundabout is going? you think i needed to write a local newspaper to get an address to a VA claims office? WTF? i learned my lesson. no one really cares but yourself. it is up to the individual to fight their battles. get used to it, prepare, and go fight. no one else will be there to help.

>>Perhaps your state has something similar.
maybe. but other states have better programs for treating such people.

i know you mean well Alex i really do. but the VA is a goliath who's time has come to be broken up. take the pressure off the doctors regarding playing two roles, that of disability adjudicator and being good doctors. let the disability claims peoples be truly qualified at medical issues to make determinations also.

if you haven't experienced the bad side of the VA then you really don't know and i wouldn't want you to know.

hey don't take my word or experience for it. at your leisure go to the sites below and make up your own mind about the VA and fed run medical services:

http://www.vawatchdog.org/

http://www.hadit.com/forums/

note: i have also met some of the most gifted, sympathetic, brainiac doctors and nurses at some VAs. it depends on the location and who manages them. and these are not the norm in my 24 years experience in various states.

[HVAC]

Touche!

Alex