Hospital wouldn't treat dying vet - VA says its call to 911 right action

spokesmanreview.com ^ | October 7, 2006 | Jody Lawrence-Turner

[Tammy8]

Did you see this post by america-rules? It explains what the issue is with that facility: this is excerpt...

This VA is 1.5 miles from my house and it shut down the ER back in June. There are no ER staff and they don't handle advanced life support.

It's basically a clinic now and if you have an emergency you don't go there. They sent all the vets registered there a letter telling us this about six months ago.

[TheRedSoxWinThePennant]

As someone who did some residency time in a V.A. emergency department let me say this. For all those in favor of government run health care let them spend a day in a V.A. Hospital. The staff and physicians are all great people but it is a bureaucratic clusterf##k

[1rudeboy]

I've heard of this happening before. It's some sort of a lawyer (liability) thing. Don't remember how.

[Vn_survivor_67-68]

Did you see "crash cart" and "outside"?

The guy was quite possibly near the end of his life w/both asthma and emphysema, I understand that.

Had he been able to actually enter the building, they'd have had a crash cart at his side in no time......(hint: "code blue in the lobby") and a wheelchair is the security guys job, not the buddies. How long was spent by the guard trying to get them to go away?

I dunno how long it was before the 911 call was actually made, at which point the alleged four-minute clock started.

I've been the recipient of VA health"care" myself. This little horror story is not one bit unusual. The truth as I see it is that if you actually get to a Dr in timely fashion, chances are you'll be OK.

Time and time again I've seen and experienced the "care" of the mostly-obese non-medical/administrative staff as THE MAJOR OBSTRUCTION.

[monkeyshine]

the VAMC focuses on providing primary and secondary care, with emphasis on preventive health and chronic disease management."

Precisely. Though I disagree entirely, this is how they view their job. Give checkups and pills as needed, but if a patient looks like he's about to die, then let him die. It's cheaper that way. They could have hooked him up to all kinds of doodads and thingamajigs, but that would be expensive. And besides, he was old. (/sarcasm).

Our vets should receive the highest standards of care, period. What happened here is nonsense, resulting from bureaucratic and political folly. The VA hospitals should be top notch and run around the clock. Veterans risked their lives for the decisions made by our government. Many died in the course of acting on those decisions. Those who lived through it deserve nothing less than the utmost respect of our citizenry, our politicians and our bureaucracies.

[Samwise]

"Calling the fire department was quicker than getting equipment and bringing it back out or finding someone who could offer the medical assistance," said hospital director Joe Manley.

I guess they don't watch ER.

[lunarbicep]

I've heard of this happening before. It's some sort of a lawyer (liability) thing. Don't remember how.

you're correct and it's screwy and I don't understand it either. I worked at a hospital for years and our ER doors were 200 feet from an intersection. 25 years ago when there was a wreck out there, you grabbed a stretcher, ran out and brought the people in. Now you call 911, an ambulance mounts up, drives 2 miles, loads the people and brings them the 200 feet to the ER (ECC now) doors.

[Tammy8]

VA hospitals/clinics are not free to all veterans. I'm a Vietnam Era veteran and I pay to go to the VA facilities. (I think it's based on your income/assets?)

It's even more complicated than that; they prioritize the Veterans into groups depending on their disability and how they got it. All Veterans are supposed to get treatment but they do not have resources to treat them all so the lower priority Veterans (according to their system) have a hard time getting treated or if they do they have to pay. It also goes by percentages somehow and if you are a certain priority and below then it goes by income. I don't know how it all works for sure.

I know my husband is rated priority 1 by them, he is rated 100% disabled by the VA and he was wounded in combat. He was also medically retired from the Army. He is eligible for all VA care even for things that are not directly related to his combat wounds. In his case it is not related to income- we could be millionaires and he would still be eligible. We know a retired US Army Ranger that has a disability for bad knees from jumps- he is only rated as a priority 4 (I think) anyway he is only eligible for all care for his knees- for other issues it is income related. He makes quite a bit of money as he now has a second career in the Gov't. so for things other than his knees he has to pay. To make it more complicated I think there are also Veterans that have NO service connected disability but are eligible for all services free because they are indigent. You would probably have to be a lawyer to understand how it all works.

It also changes every once in a while so I feel lucky if I can keep up with hubby's deal- much less understanding the whole system.

[codercpc]

I worked at a clinic that was directly attached to the hospital. Protocol dictates that if someone goes down in the parking lot (this included the Hospital parking lot), 911 MUST be called. The reason behind this was exactly as others here have indicated, ambulances have portable equipment, and are often much quicker responses than trying to get a "full code" outside. The hospital equipment is not meant for outdoor use. That didn't mean that a Dr. if immediately available couldn't assist, it just means that 911 is the appropriate venue.

[Zeroisanumber]

A sad case, but the medical staff handled it properly. Urgent Care centers aren't set-up for intibation (which is what this patient needed) and the quickest way to get him the help that he needed was to do just what the hospital staff did: Dial 911.

[Tammy8]

You are right, the mistake was made by taking him there. I don't think he and his wife realized he was that sick, and when he collapsed the man driving him probably had no idea they could not treat him there.

[Tammy8]

In a June 28 Spokesman-Review article, the mid-afternoon closing time was justified by a spokeswoman who said "very, very few patients come in after the hours of 4:30 p.m." and denied the facility was ever equipped for trauma patients.

According to the other poster this facility downgraded to basically a Drs office and pharmacy recently. The hospital spokesman said in this article that they were never equipped for trauma, so I guess he meant they couldn't have helped this man before the downgrade.

I don't want to argue with you at all, I agree with you that it is a sorry deal, I just don't know that this facility is to blame- I think the whole system is. Not only the VA, but did you read the posts where those that work in civilian hospitals say they cannot treat people in the parking lot because of liability? It is insane.

I feel terrible for this man, and his family. I feel terrible knowing this could happen to any of us- not only at a VA facility but even at civilian facilities. I am angry that it works like this.

[Vn_survivor_67-68]

here's a little "catch 22" story from the Spokane VAMC, published April this year:

Here's a little story, and it's not only true, but just occurred within the past month. A priority group one (100 percent service-connected disabled veteran) veteran who served in Vietnam has a major back problem. In truth, he has a ruptured disc and it's pinching a nerve, causing this individual severe pain. We'll just call him 'Jack', for this article.

Jack contacts the Spokane VAMC and informs them that the Hydrocodone he is on isn't helping with the pain. The VA tells Jack to come on down and we'll get you in to see a doctor so he can issue you better pain relievers. Jack has a friend drive him some two-and-a-half hours to get to the VA. He walks up to the Green Team desk and states his name and last four of his Social Security number. "I was told to come in and that the Green Team would get me in to see a doctor right away, so I can get pain relief." The lady sitting at the Green Team desk at the front counter says, "I'm sorry, but you'll have to wait until your next appointment to see a doctor. There's none available that can assist you today. Try going through the Emergency Room here, and perhaps they can have you see someone."

So Jack goes to the Emergency Room at the VA. He's told there is a five hour wait. (Bear in mind that Jack is in priority group one and, according to the VA's own handouts, is to be taken care of ahead of anyone in a lower priority group).

Jack explains to the ER lady that his ride will leave in one to two hours, and therefore he needs to see someone within that time frame. ER lady advises Jack that he'll probably have to come back when his next appointment is scheduled. Jack advises her that he doesn't currently have a next appointment scheduled. His team doctor has to read the CT scan to determine if surgery is needed, and the Green Team told him that his team doctor wasn't available.

Back and forth, up and down the halls of the Spokane VAMC, Jack moves himself via crutches. He goes to the Veterans’ Advocate; she advises him there is nothing she can do to assist him. All Afghanistan and Iraqi veterans are being treated ahead of all other veterans. Jack's had it. He writes down the name of the Veterans’ Advocate and then returns to the Green Team. He writes down the names of each and every person on the Green Team he has spoken with, asking each person for the correct spelling of their name.

Suddenly, one of the Green Team staff asks Jack why he wants their names. Jack replies, "Because I'm going to write up what happened here today to me, and send it on to Senator Craig's office. You tell me to come to the Green Team and I'll be seen and given relief for my pain, I'm driven two-and-a-half hours and then turned away because, "No one can see you today, you'll have to wait for your next appointment."

Guess what. Jack is asked to wait in the waiting room for a few minutes so the Green Team can see what it can do (A veteran says "Congressional," and the VA Hospital jumps into action). Fifteen minutes later, Jack is called into the Green Team and is seen by none other than his regular team doctor (you know, the one that wasn't available). He is prescribed stronger pain medications, until his doctor has an opportunity to review the CT scan. The doctor will then contact Jack as to what the next step will be to solve his back problem.

Hours wasted, additional pain caused to the veteran, and only after a 'threat' of investigation does the VA respond the way it should have responded when this veteran originally arrived at the Spokane VAMC. HELLO, does anyone else see a problem here?

http://www.riverjournal.com/cgi-script/csNews/csNews.cgi?database=Archive.db&command=viewone&id=429&op=

[Tammy8]

I see a big problem there, I know VA care is not the same every where and not as good as it should be anywhere. The VA here is fairly decent considering, but they nearly killed my hubby by switching medicines around and then not monitering him the way they should have. They got his blood pressure higher than it ever had been and then some of the meds they gave him weren't supposed to be given together and his liver and kidney function was not normal. He went to WBAMC for an ortho visit because they have a pretty good ortho team there- anyway they caught all this other when they took his BP and freaked out. Hubby hasn't been back to the VA since, he had been going to them for many years.

I don't know what the answers are though- there are lots of problems with civilian facilities too. My biggest gripe with the VA is when something happens like this last deal you posted. That is just wrong no matter how you look at it. They lied to the man more than once and it seems they were trying to get out of treating him at all. The fact that he was a 1 makes it worse- but really they should treat any Veteran that is in severe pain.

[Vn_survivor_67-68]

I've worked in active-duty hospitals, and been a pt in VA facilities.

I can't kick too much about the priority/category thing.....most people don't even understand it, but I think its as fair as is possible.

Overall, I think the VA Healthcare system should be shut down, and then (subject to priority categories) all enrolees should be given rights to attend active-duty hospitals and/or issued a Medicare card.

But of course they'll never do this, because the VA facilities are nothing more than the gov't funded extension of the Med Schools adjacent to the major VAMC's......it has also been my perception that these major VAMC's in fact revolve around the needs of intern/resident/fellow programs and their needs. I've been acutely aware of this as over-treatment/testing or undertreatment, according to the needs of the current crop of mentors. This is after recent (during last 5 years) first-hand and observational experiences at Chicago Lakeside and Hines; Detroit, Ann Arbor, and Indianapolis (Indy is the best of this lot, and lightyears above the others).

[Tammy8]

I don't really have a problem with the priority system either, it's just hard to explain to people. I don't totally understand it, but what I do know seems as fair as it can be if they don't have funds to treat all Veterans the same.

Most people think all Veterans get all medical treatment free at all VA facilities. They also think all VA facilities are fully capable of treating all things. We know that is not true- but what most taxpayers think Veterans are getting is not reality. They are constantly making changes too- closing and downgrading facilities left and right and changing rules too.

You are probably right that the VA needs to be shut down and Veterans care should be paid for at other facilities. You are also right that it won't happen. As I said hubby doesn't go to VA any more, he goes to WBAMC for everything now. Problem is not all Veterans can go to Military facilities and many can't afford to go anywhere but VA.

[Polybius]

While I appreciate all of the comments and insights, I still have 1 major problem that this story brings up. ...... Other then making a call to 911 where did anyone from this VA facility offer any type of assistance? ....... ..... "The most skilled people we had went out to the patient, but you have to have the professional equipment to do the work," and with the ambulance showing up quickly, the VA nurse and physician did not tend to Fuller.

The Fire Department EMT's showed up in 4 minutes. That is a blazing fast response time.

Four minutes is far less time than it has taken me to read and type out a response to this post.

The likely scenario is that, after the "Urget Care Clinic was closed ("Urgent Care" is just a hype term for "Walk in Clinic for Minor Problems" just as "Sanitation Engineer" is a hype term for "Janitor") it took a couple of minutes for the security guard to hunt down a nurse and doctor to say that "something" (who knows what) was wrong with a man in the parking lot. One minute later, the doctor and nurse are in the middle of the parking lot and think, "This man needs to be intubated. We need to get an ET tube. Go get one!" One minute after that, the Fire Department EMT's show up with, literally, a truck-load of medical equipment and the man is intubated, loaded into the ambulance and taken away with the sirens blaring.

So, with the EMT's showing up so quickly, the VA doctor and nurse literally had no time to do anything before the man was intubated and rushed off to the nearest ER.