Where is the Patient Advocate? – A Story in 3-Emails

Three secure messages, sent through the My Health eVet secure messaging system, all related to a need for VA Hospital services, and all reflecting something in common, the VA’s refusal to act.

First Email: Good Morning,

I have but one question, I would appreciate a timely and thorough response, within 24-hours. “Where is the advocacy from the patient advocates?”

Last Wednesday I needed to discuss the problems I am having with pharmacy refills, but was bounced off VA property because I can NOT Physically. Wear. A. mask! This is for patient safety concerns. Why am I being discriminated against and refused care at the VA Hospital and the patient advocates office is doing nothing to help improve this situation?

I was promised a letter from the VA Hospital Director over the incidents from June and July, still no response from the director or advocacy from the patient advocates. Why?

I need to be able to access the VA Hospitals services and cannot do so when the VA Police are enforcing a mask policy that puts my life in jeopardy! Without an adequate workaround to the mask policy, I suffer from refills that are delayed, and without the drive thru pharmacy, now have no recourse to develop a solution!

Why? Where are the Patient Advocates in standing up against the bureaucracy and demanding solutions for patient problems? Where are the Patient Advocates regarding the incidents from June and July, using hard evidence to improve VA Hospital performance?

Enough is enough! Where do I find a patient advocate?

Thank you!
Dr. Dave Salisbury

Second Email: Hello,

Is there a reason the drive-thru pharmacy is no longer?  I must get refills and the refill process through the mail is taking 3-5 times longer than normal; thus, reordering when you have a 10-day supply remaining is not good advice as I keep running out before the delivery is made.   Only because of the drive-thru pharmacy have I been able to stay ahead of medication emergencies with the refill process being broken.

Why? How do I get refills; when, because I cannot physically wear a mask, I cannot be seen in the VA ER or walk into the VA Pharmacy for refills?

I am thoroughly and completely out of two medications, they have both been reordered and I have no word on when they will arrive. The last refill on a diabetic medication took longer than normal (7-10 business days) to be received and I wonder when I should schedule reordering that medication with the added slowdowns and longer delivery times.

How do I gain refills when I have zero access to the VA Hospital and the refill process has failed to delivery on time?

Thank You!
Dave Salisbury

Third Email: Dr.

I do not know what is happening with pharmacy, but something must give! I reordered my refills with plenty of time since March 2020 through the Phoenix, VAMC, and I keep running out before the meds arrive!

Due to the continued increased symptoms, usage of medication increased, but the refill process has slowed, and without the drive-thru pharmacy I am stuck without access to pharmacy.  Especially, since I can never get a straight answer when trying to use the phone.

As of this morning, I had to wake up, and take the remaining dosage and two Advil for the crushing, horrible light sensitivity, facial pain, twitch bordering, headache! How do I get this refilled with the drive thru pharmacy out of operation, and the VA Hospital off limits because I cannot physically wear a mask?

I have, as if this writing 0330 27 October 2020, been out of one medication for two days, having taken the last pill on Sunday (25 October 2020)! One of the reasons why I had 90-day supplies, instead of the VA (policy?) 30-day supply in Albuquerque was because of this exact reason, I kept running out before the deliveries were made. I must be able to trust the VA Pharmacy Refill process, and the pharmacy refill process is untrustworthy, and currently in disarray.

I showed up at the hospital last week (21 October 2020) trying to have this conversation with pharmacy and was first kicked out of the hospital, then escorted off property because I cannot safely wear a mask and asked why.  I also asked for a copy of the mask policy, and had a supervisor turn himself into a pretzel trying to explain why he cannot produce a policy upon request. What do I do?

Thank you!
Dave Salisbury

Before leaving Albuquerque, NM., I had the privilege of being able to discuss certain topics with local hospital representatives.  I had the ability to talk to directors, medical department heads, patient advocates, and so many more dedicated healthcare professionals who work in in non-VA or government run hospitals.  Every one of them stated categorically that if their hospital was run like the VA Hospital system, they would have been fired, and more than likely legally charged with malpractice, shut down, and sued.

Let that sink in for a moment.  The VA Hospital purports to be doing a service for veterans, but the biggest problem in veterans receiving care is too often the VA Hospital system, and if a non-VA Hospital was run in a similar manner, criminal, legal, and other repercussions would sink that hospital system forcing the government to take over to “rectify the situation.”  Yet, this atrocious behavior is tolerated where the veteran’s hospital system is concerned; I can only ask why?

“The VA Hospital purports to be doing a service for veterans, but the biggest problem in veterans receiving care is too often the VA Hospital system!”

Why is it that every time a solution begins to show the promise of working, the VA bureaucracy stifles the momentum, destroys the people involved, and the veterans keep suffering?  A recent VA Advertisement on LinkedIn talked about how the VA is available with a ready hand to help, it was very well marketed, the advertisement was full of great phrases, sound bite captions, and solemnity; except too often the marketing hype does not reflect reality. Yet, the veteran, the spouse, and the dependents suffer!

Want reality in a VA Hospital, if you and your symptoms do not meet a predetermined checklist of boxes, you are considered the problem and the VA Hospital cannot/will not help you.  The VA Physician cannot issue a diagnosis, nor can the records of patient interactions have sway with the Veterans Benefits Administration for a claim determination.  America sends troops all over the world, places them in literally thousands of crazy environments, but the Department of Veterans Administration still demands cookbook medicine, checklists, and cookie-cutter one-size-fits-most medical practices.

Want reality in a VA Hospital, ask a bureaucrat behind a desk why the patient is being inconvenienced, and watch how fast that veteran is labeled as “The Problem,” and the veteran gets surrounded by the VA Police who then threaten, attempt to intimidate, and arrest/fine that veteran.  Average current time is less than 2-minutes!

Want reality in a VA Hospital, look at the lack of cleanliness, everywhere, and monitor how long spills, blood on walls, black “gunk” stuck in corners, etc. stays around.  I have personally witnessed blood spots lasting on doors and walls for months before being removed, even after complaining about the mess multiple times.  One incident, on an ER treatment room door, there was a roughly 2″ blood spot, dried, sticking to the back of the door, was there for 18-months before finally being removed. Yet, the VA Hospital system will always cheer, about cleanliness, friendliness, and helpfulness of VA Staffing.

Want reality in a VA Hospital, depending upon the tier upon service conclusion originally assigned to, you will experience a significantly different VA Hospital experience.  Even if the Veterans Benefits Administration changes your disability rating, you do not change treatment tiers, and receive reduced medical care accordingly.

Need hospital records, run the leviathan and draconian process of filing a Freedom of Information Act (FOIA) request, and wait.  Need to understand policies and procedures, there is a FOIA for that as well, but do not expect anything written down; because, the VA operates upon the philosophy that if it is written down, then you can be punished for not complying.  Not having operational procedures, patient care processes, standards of behavior, etc. written down provides a ready-made excuse for when the VA Office of Inspector General (VA-OIG) calls investigating.  In over 10-years of reading and commenting upon VA-OIG reports, this remains the number one excuse for failures to comply, dead veterans, and incompetence masquerading around as leadership.

Where is the media, the watchdog of society?  Where are the elected officials whose job it is to monitor the actions of the bureaucrats to ensure these problems do not begin, let alone thrive?  Where is the patient advocate’s whose job is to stand between the bureaucracy, and the patient, to aid the patient in completing tasks that the patient cannot do for themselves?  Where are the patient advocates who are supposed to be making suggestions for improvement based upon the data they collect from complaints and failures of hospital bureaucracy?  Where are the patient advocates in improving operational policies to protect the health and safety of patients, before that patient ever arrives at the hospital facility?

The VA has removed my access to the VA-OIG reports, it has been two-months since I saw a VA-OIG report in my email box.  This is standard practice for the VA, when problems arise, shoot the messenger instead of working to find and fix the problems, and this too is a reality at the VA!

© Copyright 2020 – 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 pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/

Patient Health and Safety Concerns – Phoenix, VA Medical Center

Alyshia Smith
Medical Center Director
Carl T. Hayden VA Hospital
650 E Indian School Rd
Phoenix, AZ 85012

08 July 2020

Dr. M. Dave Salisbury Ph.D.
10002 N 7th St
APT 1125
Phoenix, AX 85020

Subject: Healthcare policies that endanger patients.

Dear Ms. Smith,

I have been a patient of the Carl T. Hayden VA Hospital since 1998 when my family first moved to Phoenix.  I was a witness to the award-winning days, and have been a witness to the dead veterans, paper waiting lists, and incredible fall of the Phoenix VA Medical Center.  I want to help fix this VA Medical Center and moved back to Phoenix specifically for this purpose.  As an organizational psychologist, I have made a careful study of the VA, as a patient, as a previous employee, and as a concerned citizen.  I blog about VA issues because “I-Care” about the VA.

One of the first lessons taught me in new hire orientation training, concerned the Emergency Room and the Emergency Medical Treatment and Labor Act (EMTALA; 1986), a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay.  EMTALA was being abused in the hospital I worked at and I reported this issue.  EMTALA is being abused at the Phoenix, VA Medical Center.  Twice I have followed my primary care providers’ instructions to report to the VA ER for treatment, and twice I have been refused service.

30 June 2020, I was refused service at the VA ER because I cannot wear a mask due to breathing issues.  I was informed upon entering that I could hold the mask in front of my face and this is an acceptable workaround.  Upon entering the ER to be checked in, the office staff refused the information provided at the entrance, and said: “If the mask is not worn, we are refusing service.”  I have had shortness of breath, not lung-related, for many years now and cannot wear a mask.  This information is noted in my VA Medical records.  I have been through several rounds of breathing tests which confirm my lungs work great, but I remain short of breath, and when I wear any mask my problems breathing include lightheadedness, dizziness, nausea, and eventually my vision grays and I pass out.  The original problem was diagnosed at the Salt Lake City VA Medical Center (2010/2011).

08 July 2020, I walked into the VA through the South Entrance.  Not wearing a mask and those performing the COVID check did not offer a mask, offer a face shield, or say anything.  I walked to the ER, the admitting person did not mention my need for a mask, nor did they ask why I was not wearing a mask, I was checked in to be seen in the ER.  I was triaged and the triage nurse did not say anything about a mask.  I sat in the ER for 3-hours and none of the medical staff, hospital staff, employees, or Federal Officers walking past ever mentioned the need for a mask.  I walked to the Patriot Store feeling sick because of diabetes and needing food.  On my way, an employee whines about me not wearing a mask, and I ignore this person as my medical information is private and I should not have to explain to every nosy-nelly about why I am not wearing a mask.  I go to complete my purchases and suddenly the VA Police, who were called by the unknown VA Employee, are there insisting I need to wear a mask.  I explained, for the first of at least 40-times that I cannot physically wear a mask to protect my health and safety.

I realize the VA Police are executioners of policies that they have no say in forming and I refused to be anything less than professional as we walked back to the ER.  By the time I arrive back in the ER, my police escort has grown from 2 to 7 or 8, led by one plainclothes person claiming to be a Lieutenant and the other was a uniformed Lieutenant.  My intransigence at wearing a mask was not disorderly conduct, but a patient safety issue. I have a hard time breathing and when I must speak, this exacerbates my breathing condition.  I was accused of yelling, and before I could explain, I am being threatened with being arrested, cited, and thrown out of the VA ER.  By this time, I am in trouble physically and neurologically, between diabetes and my need for food, and the neurological condition I suffer through, my stress levels are making a bad situation worse.

A person identifying themselves as a doctor handed me a face shield and my wearing of the face shield did not stop the harassment from the VA Police over not wearing a mask.  During my conversations with Timothy Mikulski from the Patient Advocates Office after the last time, I was refused care illegally at the VA ER, I was told wearing a face shield is acceptable.  Thus, when I put the face shield on, I was expecting to be left alone.  Instead, I was demanded to either wear a mask or be arrested.  My third threat in less than 5-minutes for not wearing a mask, even though I now had the face shield properly worn for the same 5-minutes.

Eventually, I am arrested, I experience a seizure where I fell to the floor and injured my knee, then was hit repeatedly in the spine while being “patted down,” which continued to collapse my legs and increase my pain.  I was handcuffed to a bench in a holding cell where I bruised my right wrist because my seizures include my arms jerking and with one arm handcuffed to an immovable bench, I could not control my body and the handcuff was not allowing my involuntary movements increasing patient harm.  I have a bruise and scratches from the handcuff on my right wrist.

Here is the problem, the policy for wearing a mask does not have exclusions for those of us who cannot wear a mask.  Thus, wearing a mask creates more health problems, the potential for injury, and issues for the medical staff who are already overworked.  If a face shield is acceptable as a replacement for a mask, why was my wearing the face shield insufficient to closing the police issue?  If a face shield is not acceptable as a replacement for the mask, why is the patient advocates claiming this is acceptable?  If wearing a mask is so important, why was no one bothered by my not wearing a mask until the nosy employee called the Federal Police?

I sat in the bench seat beside the bookshelf in the ER.  Multiple officers, staff, and more walked past and no one was bothered, no one said anything, no one made any fuss over my not wearing a mask for three full hours while I was waiting in the ER.  Even when I interacted with the employee’s passing nobody made any comments.  This is a failure of policy, or it is the unfair harassment of a single person by overzealous police officers.

Let us talk about access to medical records.  The Federal Officers harassing me, sent one of their own to view my medical record for a statement from my PCP regarding my inability to wear a mask for health reasons.  I told the officers what they would find, “Records pertaining to my being diagnosed with shortness of breath and difficulty breathing.”  They claimed that since those records were from my time in Albuquerque, I was “blowing rainbows up their butts.”  Hence, even if my medical records had reported a message from my PCP, I would still have been in the wrong.

From my time as an employee, Medical Support Assistant, VA ER, Albuquerque, I know that the police do not have a reason to be surfing my medical records.  Yet, in the holding cell, I heard them discussing my medical records, my mental health diagnosis and cracking wise about details in my medical folder.  How did they get my medical records?  Why did they have possession of my medical records?  What is the purpose of the police having access to my personal medical files?

I freely admit, by the time the VA Police handcuffed me, my “cherub-like demeanor” had melted away.  When I am in extensive pain, I cannot think clearly, speak coherently, and my ability to suffer fools and liars is non-existent.  But this entire affair was brought about by a policy that does not make sense, a nosy employee who does not need to know my medical history and two overzealous lieutenants who need their ego’s clipped!

Another issue, why is my full SSN, DOB, and Full Name printed on the triage wrist bands?  Why are all VA ER patient’s data displayed in human-readable data on the wristbands?  This is a HIPPA and PII security issue that was supposed to have been corrected back in 2014.  Human readable data being bandied about places patients at greater risk for having their identity stolen.  This is especially true on an item regularly thrown away.  As someone who has followed the VA problems with protecting veterans, protecting data, and adhering to rules and regulations, I find this lapse highly questionable.

The following is requested:

  1. Remove the arrest and cancel the citations.
  2. Correct the policy.
  3. Train so the policy is properly applied, fairly communicated, and a standard is set. Removing individual adaptation and personal interpretation.
  4. Correct the PII on the wrist bands and other printed patient documents to protect the identity of the veterans. This is a simple fix of programming and your IT department should be able to complete this task easily.

Thank you for your prompt response in this regard.

Sincerely,

Dr. M. Dave Salisbury Ph.D./MBA

© Copyright 2020 – 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 pictures.

All rights reserved.  For copies, reprints, or sharing, please contact through LinkedIn:

https://www.linkedin.com/in/davesalisbury/