ST. GEORGE — Almost a year after the Department of Veterans Affairs unveiled a program that was supposed to make life easier for U.S. veterans needing medical care, many veterans say the program has instead done the opposite for them.
The Veterans Choice Program stipulates that veterans who are enrolled in VA health care may get medical care through non-VA doctors, as long as they live 40 miles from a VA medical care facility or have to wait more than 30 days for care through the VA.
At first, this seemed like it would be a burden lifted from veterans who found themselves traveling or waiting for care, something that many veterans have experienced through the VA.
“I could have been dead”
Stevan Duke, an Army veteran who fought in the Vietnam war, shared his experience dealing with the George E. Wahlen Department of Veterans Affairs Medical Center in Salt Lake City, the one which most veterans in Southern Utah have to travel to for certain medical care.
After experiencing intermittent numbness in his left leg, arm and side of his face while he was in Preston, Idaho, he called in to the VA, which, he said, suggested he visit a doctor in Logan, Utah.
The doctor recommended him for heart tests in the VA hospital as soon as possible, but the VA told him their “soon as possible” would be in three months, he said, and they would not schedule him until he met with his primary care provider and a cardiologist in Salt Lake City.
Duke checked in to the ER in the VA hospital, told them he was having symptoms of a stroke, and after deciding he wasn’t having a stroke, the doctor had him wait for five and a half hours, he said, until they finally did some tests and found nothing.
Eventually, he went home and started feeling chest pains, Duke said, so he checked in to the emergency room at Dixie Regional Medical Center in St. George. There, doctors found his left aorta was 95 percent blocked, Duke said. They put a stent in his heart the very next morning.
The left aorta is often called the “widowmaker,” Duke said, because of how fatal it is when it becomes blocked.
“I could have been dead,” he said.
What concerns him, Duke said, is that he was so close to dying, but the VA tests had not been able to find anything wrong with him, except for carpal tunnel.
Physically, he is feeling much better, he said, but while the VA has promised to pay for his visit to the ER at Dixie Regional, he has yet to hear whether they will cover his visit to the ER in Salt Lake City.
The VA automatically approves covering the costs of visits to the ER for chest pains, Duke said, so he had no struggle with approval there, but that struggle is one that other veterans know all too well.
For many of these veterans, problems stem from waiting around for the Choice Program administrators to give permission for them to use a certain doctor, and that authorization has to be given for every procedure and visit.
The problem veterans experience is that the Choice Program takes so long to provide authorization so they sit around waiting, usually month after month, for someone to call back with the OK; and many times, veterans report, the program never calls back, and they are stuck dealing with the bureaucracy of the program.
“I give it a D”
Larry Harris, an Army veteran who also fought in Vietnam, has to have epidural shots in his back for pain twice a year.
He’s had them for several years now, but never struggled to get his medication until he went through the Choice program.
Hoping to find someone nearby who could take care of him rather than traveling over 300 miles to Salt Lake City, Harris called the Choice program; they took about three months to provide him with care, he said.
When he finally got an appointment, Choice had only scheduled him for a consultation, Harris said, while he was waiting in pain the entire time.
Eventually, Harris got his epidural shot, but only after months of hounding the VA.
“So that’s my experience with the Choice Program,” he said. “I give it like a D. I eventually got what I wanted, but I had to stay on top of it the whole time.”
Making a choice
Erwin Aguayo, a Navy veteran who served in Vietnam as well, shares a similar story. After suffering from rectal bleeding in September, his primary care provider referred him for a colonoscopy.
Aguayo has special authorization to use the VA Southern Nevada Healthcare System in Las Vegas, where it took him three months to get an appointment with an independent contractor working with the VA in Las Vegas. Once he finally got his appointment, he said, the doctor met with him for just a few minutes and scheduled him for an appointment a month later.
He then went to the VA hospital to give them notice of the appointment, but found that the people he needed to talk to had left by the time he got there. So, he had to stay in Vegas overnight.
The next day, Aguayo said, the VA hospital would not accept the card the independent contractor had given him, and he had to return to the contractor’s office to ask them to send the information to the VA hospital for processing.
A month later, his appointment had not been processed and no one know anything about it.
At home, and still bleeding, Aguayo finally decided to visit his wife’s doctor, who got him a colonoscopy the next day and also scheduled him for a CAT scan a week later. They found a tumor in his large intestine, he said.
In another week, he had surgery to remove 25 inches of his large intestine and 18 inches of his small intestine.
Before the surgery, he called Choice, but they decided they wouldn’t do anything about it, and referred him to a patient advocate.
“The patient advocate said, ‘well you did have a choice. You made a choice. You went to your own private doctor,’” Aguayo said. “I got really angry because it’s the same thing that I heard from Choice and the same thing I heard from the hospital. All I can conclude is somehow they teach each other how to turn us down.”
The advocate said they could not do anything for him because he had decided to go through his own provider, Aguayo said, rather than waiting around for the surgery he needed.
The care the vet gets
Ken Stewart, an Air Force veteran from the Vietnam War, also found himself having to pay for his own care after his primary care provider was out of town and the VA would not offer an alternative provider he could visit.
Suffering through a lot of pain, he called hoping for authorization to visit the ER. The Choice Program representative he spoke to suggested he go, Stewart said, but that the Choice Program might not pay for it.
After going to the ER, Stewart said, they prescribed him pain medication and physical therapy that the Choice Program would also not authorize without a recommendation from his primary care provider – who was still out of town. The program would still not allow an alternative recommendation for him, he said.
Stewart paid for a physical therapy visit out-of-pocket, but when his primary care provider returned, and they were able to get authorization for physical therapy visits through the VA, Stewart found that he would need to travel to Salt Lake City for physical therapy three times a week since the Choice Program wouldn’t pay for local visits.
He also needs triple bypass surgery, something that he will have to travel to the Salt Lake City VA hospital to get.
“It’s just very inconvenient and not much caring for the care the vet gets,” Stewart said.
Eleven years of waiting
Marlin Halford, a Navy veteran who served in Cuba following the Cuban Revolution, has been waiting 11 years for surgery.
Halford fell and tore the rotator cuff in his right shoulder in 2004. It took three months to get an MRI from the Salt Lake City VA hospital, and he was scheduled another three months later for a consultation to go over the results.
He was supposed to receive a call after that to schedule surgery, Halford said, but three years later, after multiple attempts to get a surgery scheduled, he was still living with an injured shoulder. At this point, Halford said, he found out they had no record of his MRI or of his consultation.
For years, neither he nor his primary care provider could get an answer from the VA, and he continued living with his worsening shoulder until the Choice Program began.
When he got his Choice Program card, Halford said, they immediately told him he was ineligible for the program because he lives within 40 miles of a VA clinic.
Distance, Duke said, is measured “as the crow flies,” disqualifying more veterans than the program would if the distance was based on the distance of road travel.
Halford finally got an MRI scheduled after getting Sen. Mike Lee’s office involved. When he then called to schedule a consultation, he found that the person he was speaking to had a copy of his MRI and his records from 11 years before – MRI and records that he had been told were lost.
He finally decided to get a consultation from a non-VA doctor, paying for it out-of-pocket, Halford said. Of course, after 11 years, the damage had only gotten worse, and now, he said, he not only needs to have his rotator cuff fixed, but part of his clavicle has to be removed; his entire shoulder needs extensive surgery.
“I can’t get surgery down here, I can’t get anything through the Choice card,” Halford said. “So I’m not happy with it. As far as I’m concerned, it’s a waste of paper.”
Southern Utah’s medical care
This is a wall veterans in Southern Utah have often hit, the distance issue, because the VA’s Community-Based Outpatient Clinic in St. George qualifies as a VA medical care center.
However, the CBOC is ill-equipped to handle most of these veterans’ health problems. The clinic does not even have an X-ray machine.
In fact, the CBOC cannot do much more than provide a physical, Halford said, forcing veterans who need any actual treatment to have to travel to see a VA doctor.
In a town hall meeting in January at the Southern Utah Veterans Home in Ivins, veterans found out that because the CBOC clinic is here, no one in St. George can qualify for Choice based on distance.
While St. George veterans don’t meet the distance qualifications for the Choice program, many are finding they can qualify because they have to wait longer than 30 days for care; but, going through the program almost always means yet another long wait.
“As far as I’m concerned, the choice is, you have no choice,” Duke said.
Harris and Aguayo disagreed. You have a choice: wait, drive or pay, they said.
“For me it was, ‘you’ve made a choice,'” Aguayo said. “‘Now pay for it.'”
Laying in bed, waiting
That was the case of Chuck Waddell, a Vietnam veteran currently living in Cedar City. He had back and knee injuries that were aggravated in late March and early April, sending him on the road to immobility.
Waddell was bedridden within a month or two of his back and knee injuries becoming aggravated and made multiple visits to the ER at Valley View Medical Center in Cedar City.
When he finally made a trip to the VA hospital in Salt Lake City, making a makeshift ambulance out of a rented van he could lay in on the trip, Waddell was told it would be a five-month wait to get the back surgery that would return some mobility to his life.
However, the most dehumanizing part of his story, Waddell said, is that they did not change his bed sheets or shorts during his stay at the VA hospital in Salt Lake. Instead, he said, he was left to sit in his own urine and feces. He said:
In the nine days I was there they never changed my linens on my bed, not one time did they change my bed when I was up there. I stunk so bad it wasn’t even funny.
Eventually, with the help of Sen. Mike Lee, Waddell was moved to the Southern Utah Veterans Home in Ivins where he qualified for the Choice program. From there, he tried to schedule the surgery that would get him back on the road to recovery and alleviate some pain. Working with the bureaucracy of the Choice Program, however, was a constant frustration for him.
He would make calls to Choice Program workers who would promise to schedule his surgery and return his calls, Waddell said, but he would never receive the calls.
Meanwhile, Waddell was in pain, bedridden, usually drugged from pain killers, he said, and that made it even harder for him to schedule his own surgeries.
A bureaucratic machine can’t feel
This lack of response is something Harris, who gives a D grade to the Choice program, said he also experienced. Veterans have to wait for authorization from the Choice Program before they can do anything if they want their care paid for, he said, and veterans are having to constantly call in and wait for that authorization.
“If you wait for them to call you back, they won’t,” he said. “You call them and they say ‘this will take about five or 10 days’; well, it never does, it always takes longer and if you don’t call them back, you don’t hear anything.”
The problem also stems from disorganization, Harris said. Choice is administered by independent insurance conglomerates, so when veterans call, they never talk to the same person twice.
“My experience, throughout this whole thing is, the left hand doesn’t know what the right hand is doing,” Harris said.
Having worked with Waddell, Christopher Scott, congressional and legislative affairs liaison for the VA, said the VA hasn’t abandoned Waddell or other veterans.
While he admits it takes some patience to work with the system, Scott said, they still work hard to give the patients attention, and Waddell is no exception.
“We have been in contact with this veteran,” Scott said. “I can tell you, I was on vacation and the veteran called me on my personal cell phone and I assisted the veteran and that’s very important. I’m not sure of how many veterans would get that nationally.”
It’s the patient’s responsibility, Scott said, to get in contact with the Choice program and submit proper paperwork. He said he has helped Waddell do this.
Bruce Solomon, a readjustment counselor at the St. George Vet Center in St. George, has seen many similar cases of veterans waiting for care. To the VA, he said, they are just one of millions more who are also in pain.
The problem, he said, is that the government, instead of spending money on doctors, is spending money on more bullets and more conflict, increasing the number of veterans who need care and increasing the load on an already over-burdened system.
“I look up and I see the population of veterans, which is millions and millions,” Solomon said; “you’ve got doctors in the VA system who’ve got 1,000 clients each. So the medical program is really taxed and really burdened.”
Solomon has seen plenty of veterans fall through the cracks, he said, because the VA runs as a corporation and, therefore, cannot feel for the veterans. The problem is explainable and understandable, he said, but that doesn’t mean it is excusable.
“It doesn’t hate these veterans,” Solomon said of the VA, “but it doesn’t feel sorry for them because it’s just a machine.”
St. George News Editor-in-Chief Joyce Kuzmanic contributed to this report.
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