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Thursday, July 27, 2017

Veteran’s care hindered by lack of access at VA hospital

July 27, 2017  By Nora Doyle-Burr of the Valley News

The White River Junction VA Medical Center. Veterans Affairs file photo

WHITE RIVER JUNCTION — While Vietnam veteran Ed Miville waited for a neurology appointment at the White River Junction Veterans Affairs Medical Center this spring, the symptoms of his Parkinson’s disease worsened.
Miville, a 70-year-old retired bank examiner who lives in Claremont, New Hampshire, had an appointment scheduled to see a VA neurologist in May. But in early April — because Miville’s medications no longer were controlling his symptoms — he called seeking to schedule an appointment sooner.
“No effort was put forth to move up my scheduled appointment,” he said in a letter published in an area newspaper.
Miville, a former ultramarathoner who says his Parkinson’s is a result of exposure to Agent Orange in Vietnam, said he felt he could still hold out for the May visit. But that appointment was canceled and rescheduled for late June.
In the meantime, his symptoms became more difficult to manage.
“I was unable to sleep, had great difficulty initiating movement, suffered multiple freezing episodes, falls, and unreliable balance,” he wrote.
Then the June appointment was canceled and rescheduled for Aug. 2.
Miville could not wait, so he again contacted the VA seeking to see a neurologist.
“After several back and forth messages, I was told they appreciated my frustration, but couldn’t help me other than to say they could make a referral to the Boston VA or try to get approval from the VA to see a fee-based neurologist (outside the VA),” he wrote. “Both of these suggestions would take some unknown length of time, of course.”
Then, one night in late June, Miville awoke feeling severe anxiety and an urge to get up and move. Instead, he froze and could not walk or stand on his own.
Days after the June episode, Miville scheduled an appointment with a neurologist at Dartmouth-Hitchcock Medical Center.
“I just kept getting put off, so finally I was ticked off,” Miville said in a phone interview Tuesday.
Miville sought coverage through the VA’s Veterans Choice Program. It was put in place through the Veterans Access, Choice and Accountability Act that President Barack Obama signed into law in 2014 in an effort to expand veterans’ access to community care.
But Miville learned the program could not immediately refer him to another provider, and the cost for being seen right away would be his responsibility.
Though he will have to foot the bill through his private Blue Cross Blue Shield coverage, Miville saw the DHMC neurologist June 30. The doctor was able to adjust Miville’s medication, and he is feeling much better.
Miville said he is concerned that his experience reflects a broader scheduling issue at the White River Junction VA.
“It’d be nice to get it cleared up for everyone,” he said, “because I can’t be the only one.”
A former White River Junction VA employee, Mary Ingalls, saw the letter from Miville about his scheduling difficulties that was published Monday in the Eagle Times, and she penned a response.
Ingalls, who left her position as a medical support assistant in late 2015 after more than 19 years at the VA, said Miville’s experience sounds familiar and he is unlikely to be alone.
“I believe what he’s saying because I have seen it,” she said in a phone interview Tuesday.
While she was working at the White River Junction VA, there often were more veterans seeking the care of a neurologist than there were appointments available, she said.
If Miville’s appointments were canceled, Ingalls said, it’s likely that anyone else who was scheduled to be seen that day also would have had their appointments canceled.
“It wouldn’t have just been him on a clinic list,” she said.
Katherine Tang, a spokeswoman for the White River Junction VA, said the wait time for a neurology appointment is currently greater than 30 days, which is the threshold that allows veterans to qualify for the choice program.
“Our goal is to provide the access for the veteran,” she said.
She did not know more specifically how long the wait time is for a neurology appointment at the VA, but she said the medical center’s chief of staff is working with Dartmouth-Hitchcock officials to re-establish a residency program in neurology at the VA.
Regarding the time to schedule an appointment through the Choice Program, Tang said it takes Health Net, the contractor providing the scheduling service, five to 10 days to schedule an appointment.
Beyond that, Tang said she didn’t know how long it might take for a veteran to be seen by a community provider through the Choice Program.
Miville said his neurologist Dr. Seth Kolkin left the White River Junction VA in January. It was Kolkin’s departure that left Miville without consistent care, he said.
“Had Dr. Kolkin still been there, we could have arranged something over the phone,” Miville said. “I had no one who knew me.”
VA officials offered Miville no explanation for canceling the May and June appointments, he said. He suspects that veterans’ need for treatment for conditions such as post-traumatic stress disorder and Parkinson’s are outstripping the VA’s capacity, he said.
Maybe “they’re just swamped with needs for neurologists,” he said.
U.S. Rep. Annie Kuster, D-N.H., who sits on the House Committee on Veterans’ Affairs, pointed to the Choice Program as a way of expanding veterans’ access to care.
“We know that veterans in New Hampshire and across the country have faced challenges in accessing the care they need,” Kuster said in an emailed statement Wednesday. “This is completely unacceptable, which is why we’ve worked to expand options for veterans through the Choice Program.”
But Kuster, in her statement, acknowledged deficiencies with the program.
“Unfortunately, the Choice Program hasn’t been able to deliver for all veterans and needs substantial improvements to honor our promise to the men and women who have served in uniform,” she said.
Other than this difficulty with neurology, Miville said he has been satisfied with the care — including in the areas of podiatry, primary care and ophthalmology — he receives at the White River Junction VA Medical Center.
“My guess would be is they’re understaffed,” Miville said. “I would imagine it’s adversely affected by this problem in Manchester they’re having.”
Alfred Montoya Jr., the director of the White River Junction VA, has taken on leadership of the VA Medical Center in Manchester, New Hampshire, after whistleblower complaints about patient care and sanitation there, revealed in a story published in the Boston Sunday Globe earlier this month.
After the publication of the Globe’s story, the Manchester VA Director Danielle Ocker — a former top official in White River Junction — and her chief of staff, James Schlosser, were asked to step aside while federal officials investigate the allegations.
While Ingalls said part of the scheduling problem in White River Junction likely lies with the VA being short-staffed, there are things veterans can do to help each other, such as calling in advance if they have to cancel an appointment so schedulers have time to call another veteran to take the spot.

“They’re blaming the VA for a lot of these scheduling issues, (but) a no-show takes a spot from a veteran who could be seen,” Ingalls said.

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