Attention: Some information has been removed to maintain privacy or merely to protect the names of those involved.
08 July 2022
Director VISN 17
Department of Veterans Affairs
2301 E Lamar Blvd.
Subject: Customer/Patient Complaint – The Failing Customer/Patient Experience in EL Paso, TX
It has been my misfortune to have been a patient in the VAOPC El Paso for a year. In that time, my primary care provider changed three times without my consent or knowledge. With the current PCP, I have had consults waiting for over a year, and in the latest example of disastrous service, my ability to communicate with the PCP has been closed for “abuse of secure messaging.” Please allow me to elaborate with some specific examples and questions:
- I suffer from involuntary movements; these movements affect my voice. The pain in my neck dictates the severity and the frequency of involuntary movements, verbal stuttering, and loss of voice entirely. The pain in my neck also dictates the volume of tinnitus in my ears and my ability to tolerate light. The PCP, Neurologist, and every other PACT team provider have witnessed these issues. These are facts and are recorded in the EHR.
- On 06 July 2022, an ER Doctor at Three Crosses Regional Hospital, Las Cruces, referred to these involuntary movements as dystonic tremors. 09 May 2022, Fort Bliss, Community Consult, called these same involuntary movements Tourette’s. Why is this pertinent; from 2010, when intermittent bouts of wild mood swings and involuntary movements became 24/7/365 and present, none of the VA providers would venture an opinion about what these movements were or how to treat them. Bringing me to my first question, aren’t all those who attain a capstone degree supposed to be lifelong learners? If so, why are providers not held to a standard of continual learning and access to research libraries? For my alma mater, I have access to medical libraries and spend an inordinate amount of time researching the test results and imaging reports to ensure I am an informed customer when I enter a doctor’s appointment. Why is my provider not held to the same standard of professional courtesy?
- Regarding available learning opportunities and research resources, my neurologist related that research is discouraged, access denied, and funds never available to provide access to a research library. Funding, I see the Community Care amounts the VA Pays out, and because I have external insurance, I know what my insurance company pays the VA. There is a significant disparity between what a provider is paid and what the VA receives from third-party insurance providers. Why are funds not available to access research libraries for the providers? Why can my PCP relate to my face that she cannot answer questions and can only prescribe drugs and send me to someone else to answer questions? Even when I provide peer-reviewed research, the question is simply, “Does this research apply to me?” and I cannot obtain an answer. Does this sound to you like an engaged and professional learner?
- Speaking only of treatment from 15 May 2021 to the present, at the EL Paso VA-OPC. The PCP has shown nothing but passive-aggressiveness, raw hostility, and a refusal to act or listen from day 1! Until 22 March 2022, I was willing to give the benefit of the doubt to the PCP, I filed a complaint with the Patient Advocate, and a claim/problem was lodged. A senior medical person called me, and I was to expect action. The result, I got lied to by the provider, no follow-up from those responsible, and the Patient Advocate could not find the claim/complaint.
- Why was the Patient Advocate’s complaint closed without contacting me, the patient? Are you aware of the OIG inspection into this fallacious and diabolical process found at other VISNs, VAMCs, and clinics? If so, why is this occurring at the El Paso VAOPC? If you are unaware of this problem from the OIG or that this is ongoing at the El Paso VAOPC, I have to wonder.
- When reporting my ER visit to my provider to ask a series of questions, I discovered that access to Secure Messaging from myhealh.va.gov had been removed. I called my PCP and left a message asking for a call with the call center, no answer. I called the Patient Advocate and waited on hold for 30-minutes on 07 July 2022 and 30-minutes on 08 July 2022. Then an additional 15-minutes on 08 July 2022 to finally reach a person, who constantly interrupted me, and eventually transferred me to a party I had already spoken to. Tell me, is this acceptable phone etiquette and the highest level of customer experience a patient can expect in VISN 17? Better still, what is the expectation for the customer experience?
- 07 July 2022, the PCP’s nurse, called me and began to harangue me. Then she claimed she was not haranguing and had been “trying” to contact me. Tell me, if you have a cell phone number on file, and the EL Paso VAOPC is regularly calling that number to conduct business, would you call a spouse’s number and leave a voicemail if you are trying to reach someone? Wouldn’t you use secure messaging to conduct business if you know that patient struggles with verbalizing? When I finished work (01 July 2022), I work from home; my spouse brought me her phone, complaining of a missed call and voicemail and asking me why anyone would be calling her phone to reach me, especially on a Friday before a long holiday weekend. I call this behavior designed incompetence. By calling my spouse, the nurse can claim, “I tried to reach the patient and left a voicemail.” In reality, the nurse intentionally called a non-primary contact number for the patient and put the onus on the patient for the nurse’s inability to do her job promptly and efficiently. Tell me, is this acceptable behavior in VISN 17 because this is the level of incompetence I have struggled with from day 1, and I would like to know what to expect moving forward.
Sidenote: the nurse, when she finally reached me, calling my cell phone number on 07 July 2022, blamed me for not getting ahold of me. Not happy, not impressed, but this is the level of designed incompetence it has been my displeasure to expect from this PACT team, leading me to ask, “What is the path forward?” The PCP blatantly and profusely refuses to answer this question. The senior doctor claiming responsibility has declined to answer this question by changing the topic. The nurse cannot answer this question. The patient advocate refuses to attempt to answer this question.
- During the call on 07 July 2022, the nurse related that my secure messaging “privileges” had been suspended for 90-days due to “abuse of secure messaging.” Really, I have a known vocal problem, from spinal injuries to my neck, and secure messaging is the only reliable means of communicating with the clinic. How is “secure messaging” a privilege? How else can a patient who struggles vocally communicate with the clinic? I am reminded on EVERY SINGLE SECURE MESSAGE that there is a 72-hour response to be expected. I have proven my ability and willingness to wait; how long should I wait? Since my PCP and the majority of specialty clinics at the El Paso VAOPC never respond, let alone within 72 hours, what is a patient supposed to do? We cannot call the clinic. We cannot get messages to the clinic verbally without going through the call center, which adds a new level of human error to the red tape of communicating with a provider. Hence I ask, what is a patient to do to communicate with the clinic? Of course, the follow-up question remains, when should a patient expect a response? 72-calendar hours (3-days), 72 business hours (9 business days which is the better part of two work weeks), or something else entirely?
- In my inbox, I have messages that have never been responded to by the patient advocates, the neurological clinic, and the PCP, to name a few. Speaking of expectations, in November 2021, my PCP and I discussed a nerve conductivity test for my hands. As of 07 July 2022, I am still reminding the nurse to ask the doctor when I can expect a nerve conductivity test. This is not the most egregious or the only example of the lack of response to patient experienced, but this example remains a sign of what I have been dealing with. What is the standard expectation for turnover a provider at the VA should complete a consult within? On the topic of expectations, after a medical appointment, how long does a provider have to enter clinical notes into the EHR and sign them? A regular feature on the OIG reports is that unsigned EHR notes are a root cause of a veteran’s death or permanent injury. At VISN 17, what is the written and published guideline for a provider to enter and sign notes after a clinical visit? I have sat with providers who use Dragon speech-to-type software to capture the clinical notes and handle the consults while I sat in their offices. Why is this not standard operating procedure?
- Finally, dystonic tremors and Tourette’s are movement disorders where driving is either closely monitored by the state or refused. Several times, the PCP has needed to hold a video appointment and has actively chosen not to use VA-approved and secure tools to conduct these appointments or has blown off these appointments using the weakest and most paper-thin excuses. Are VISN 17 providers allowed to choose the technology for video appointments, or are they mandated to use VA-approved technology? Several times, the PCP has called me, using speaker phone, to conduct a phone appointment. I have asked about the security problems in having the provider’s side of the call on speaker phone, and the PCP dodges, ducks, and evades answering these questions. HIPAA is a really interesting law, and the technology employed to pass HIPAA-protected information is regulated and reported annually in OIG reports, where the VA is always negligent in honoring HIPAA law. I have some serious concerns about the behavior of the PCP, who continues to refuse to answer direct questions about why and the privacy and security of my HIPAA information. On 08 July 2022, what did the PCP order a face-to-face appointment that requires me to drive into El Paso? What should I expect from this careless PCP moving forward? Why wasn’t I assigned a PCP in Las Cruces?
I am an I/O Psychologist, I study the VA as a hobby, so I can more fully write about the OIG reports and summate them on my blog. This letter and any future communications will be posted there to maintain transparency in communications following the pattern established long ago. As a published leadership development, adult education, and customer service professional with considerable experience, I can help identify the root causes and help design solutions for the El Paso VAOPC and VISN 17, or I can continue to be a customer/patient who documents and asks tough questions. Either way, I am not some low-level functionary to sweep under the rug.
The immediate solution I desire is to reinstate my secure messaging abilities ASAP. Then, since the El Paso VAOPC was able to change my provider quickly three times in succession last year, it is past time for the PCP to be removed from my PACT Team and investigated for dereliction of duties. I offer my services to improve VISN 17, repair the damage, and ensure this insanity never transpires again.
I await your timely response!
Dave Salisbury Ph.D./MBA
Dual Service Veteran
Industrial and Organizational Psychologist
CC: Department of Veterans Affairs – Office of Inspector General
© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images. Quoted materials remain the property of the original author.