Saturday, March 24, 2018

Me v. Department of Veterans Affairs

I did not want to write this article, but I have no choice. 

I deeply appreciate the Department of Veterans Affairs. I received life-saving treatment at the Lake Nona VARO in Orlando, and I take medications daily from the VA which prolong my life. 

I see a PTSD specialist weekly courtesy of the VA, I never see a bill, they pay it, and this is an incredible gift as I live in Bangkok. 

I do have to pay out of my own pocket to see a local cardiologist, and I pay to see a pain specialist every month. I can theoretically file for reimbursements for these expenses, but the reimbursement procedures with the Foreign Medical Program are bureaucratic and difficult. 

The Trump administration attempted to extend policies which enable veterans to seek treatment at private facilities, but the status of this legislation at the Congress is unclear this week. 

This is important legislation, as the VA still cannot cope with the deluge of veterans seeking treatment, despite expenditures in the billions of dollars. It does not really matter for me, as treatment at facilities overseas is not covered. 

Veterans are supremely expensive. I often say that if you do not wish to pay for the medical care of veterans at the VA, then stop having wars. 

An ideal solution for me would be to extend this legislation to cover my medical bills overseas, and this would actually be beneficial for the VA and the taxpayer, as medical care in Bangkok is cheaper and comparable in quality to what it would cost in America. 

But that would be a miracle, and while I have witnessed miracles in my life, I am not accustomed to seeing them where legislation is concerned. I never even win the lottery. This is just my karma, and I am resigned to it. 

- My Latest Battle With the VA -

I am battling with my beloved VA this week as I attempt to renew my medical prescriptions. You would think that this is a routine thing, but my blood pressure always spikes when I interact with the VA, as it is a bureaucracy and it can be intransigent and unaccommodating. 

I freely admit that I am a 100% disabled American veteran, my injuries and maladies are service connected, and I was adjudicated permanently and totally disabled in 2012. I bear honorable wounds. 

This week, I had to fight the VA to renew my medications. Firstly, my primary care doctor refused to renew a medication that I have taken for years, Quetiapine Fumarate, a medication that I take in horse doses for sleep management and mood stabilization. I have taken this medication for years, and it took time for psychiatrists to adjust the dosage to achieve its palliative effects. 

- The Mental Health Clinic Undermines My Mental Health -

My primary care doctor, a nice doctor named Dr. Shaikh, said that I needed to get a Mental Health clinic psychiatrist to renew this prescription. So I sent a Secure Message to my Mental Health clinic doctor, Dr. Alessi. I received no reply. 

So I tried again, sending to a different doctor. Again, I received no reply. Finally, I reached back to Dr. Shaikh and I asked her to shake trees over at the Mental Health clinic to get somebody to respond to me. 

Side note: it took the VA multiple tries to update my address and my phone number. I apologize, but veterans sometimes move and sometimes we have to change our phone numbers. 

As I spend much of my time in Bangkok and I only occasionally return to the US, my American address is used principally for banking purposes under the Patriot Act and for voter registration. I also use this address with the VA, though I did ensure that they have my address in the Kingdom of Thailand. 

Despite this, the VA persisted in sending correspondence to an old, obsolete address. I know this because the recipient was perturbed and informed me. I realize that these are bureaucratic issues that are common to all bureaucracies, they are inherent to them, and I am nobody special. 

I also use an American phone number, which unfortunately I was never able to get ATT to activate so that it would ring in my pocket in Thailand. It does instantaneously relay SMSs and voice mail, so I declared victory and I moved on. We cannot always get everything that we want. 

Finally, a nice doctor at the Mental Health clinic called me and he left me a voicemail. I returned his call, it took some fiddling in the clinic to figure out who called me, but the very competent clinic clerk surmounted this challenge. I then spoke with a new doctor. He never heard of me. My old doctor is gone. 

- My New Psychiatrist is Unacceptably Nosy -

This new doctor was so disturbed that I live in Bangkok, and cannot immediately rush over so that he can look at my face, that I finally had to tell him that it was no business of his what I am doing in Bangkok and it is not his prerogative to tell me where I should live. When I told my PTSD therapist about this he agreed with me, which astonished me, but I got that going for me. 

This nice doctor, whom I must commend, because he maintained his emotional equilibrium with a grumpy veteran wrestling to keep a PTSD rage in check, finally agreed to renew my Quetiapine prescription. I had to promise him that I will rush over to the Mental Health clinic to see him the next time that I return to America. And I will. 

He was very disturbed that I have no immediate plans to return to America. I did not have the patience to explain to him that life is much more affordable for a veteran dependent upon a VA disability pension in Bangkok. For example, a $20 haircut in America costs me $3 here. A $10 liter of fresh coconut milk, when it is findable in America, costs me $1 here. I could go on, endlessly. 

This nice doctor explained that he needed to see me in order to prescribe medications for me, and I cannot disagree with him. Nobody knows what happened to my last doctor. She vanished into thin air. And apparently, she left no records about my existence, which is very strange, as I distinctly remember her pecking at her keyboard as we talked. 

- VA Clinicians Struggle With Antiquated IT Systems -

This may be a reflection on the antiquated IT systems that VA clinicians must use. They are endlessly being updated, backups constantly overwrite newer data, the VA pays billions of dollars for these systems and they never seem to work as contracted. 

For example, the feature that promises to track my Pharmacy deliveries still does not work, though it mocks me, promising me a helpful feature on the VA myHealtheVet website. The option appeared on the VA website a couple of years ago. It never works. I always get, "No Data Available." 

Things like this happen with the VA, incessantly. This nice doctor also explained that I am taking a large dose of Quetiapine, and that this requires ongoing psychiatric monitoring and occasional blood serum sampling. I am pleased to get any blood work that the VA desires and send it to him. He did not say anything when I said so. 

- This is What Happens When You Get Old -

I explained that I am under a doctor's care here in Bangkok. Several of them, in fact. I see a cardiologist monthly, primarily to monitor my INR Warfarin values. The VA assures me that this is the primary drug keeping me alive, as I am doomed to suffer a stroke due to atrial afibrillation at an unknowable future date. 

My cardiologist also orders blood work every month for various other things. I should pay more attention to this, but honestly, it exhausts me. I also see my PTSD specialist, and I have, for more than a decade, every week. He helps me keep the wheels on, and he is the primary reason why I am still happily married to Wife Number 3 for the past 11 years. 

Finally, I see a local pain specialist, and she prescribes my crucial opiates to manage chronic pain, an unending adversary in my life. She transitioned me off of the VA's preferred narcotic, Oxycodone, and I am delighted, as I hated that medication. It barely worked, and I had to take ever increasing doses to achieve pain relief. 

I now take an older regimen of Methadone twice a day, my dosage is low and stable, and it enables me to manage pain surprisingly well. She also prescribes codeine for me, but I rarely take it, only when I really need it. That happened once so far this month. So I am pleased with my opiate situation. 

- Victory? Only Partial -

So anyway, my new Mental Health clinic psychiatrist agreed to renew my Quetiapine script, but I am sure that I will face another battle with him or some other psychiatrist in coming months when I need to renew my medications again. This is what veterans deal with, when we deal with the VA. I am lucky that I take medications for high blood pressure. Because my blood pressure was spiking. 

I also explained to this nice psychiatrist that I have been taking the same dosage of Quetiapine for many years now, and it has been quite some time since I was required to get blood serum testing, and I have never been required to see a psychiatrist to get a renewal. I suspect that this was historically a reflection of the number of veterans that the average psychiatrist sees at the VA. 

I have been taking Quetiapine for many years. Maybe a decade now. I understand that systems and policies change, as does physician compliance with them, but I do not appreciate it when I have to argue with a clinician to get a simple prescription renewed. 

- No, This Story Is Not Over -

I was finally ready to call the Pharmacy and coordinate a delivery of medications to an American address. I send my medications to an American address because I have an old friend, we went through the Q Course together, who travels back and forth between California and the Kingdom frequently. He brings my medications in for me. 

I must use this workaround because sending my medications to the US Embassy Annex at JUSMAGTHAI was hopeless. I did not retire after 20 years of service, so they did not want to give me a mailbox. 

Apparently, a 100% permanently and totally disabled veteran with service-connected injuries does not rate. Then, the Embassy mail service placed numerous restrictions on us, prohibiting everything but VA medications. 

When VA medications arrived, they rejected the shipment and returned them back to the VA. Talk about spiking blood pressure. So I do not deal with the AMEMB Bangkok anymore, because under Obama, they seemed to only hire people who were hostile to veterans. 

I would love to see nothing more than Secretary of State Pompeo reading the American Embassy in Bangkok the riot act to straighten them out, but I am sure that he has other priorities on his agenda. 

If somebody reading this would like to yell at the Embassy personnel to make them give me a mailbox and accept my VA medications without hassle, that would be miraculous. I do not hope for miracles. 

So my friend brings me my medications. We are talking about cardiac, diabetic, blood pressure, cholesterol medications and massive doses of vitamins, which my neurologist assures me will help my brain function better. Since I began taking them several months ago, I think that he is right. We shall see. Read on. 

- A Six Month Supply is a Bridge Too Far -

I coordinate for a six month supply of medications at a time, as this gives me sufficient medication to compensate for the VA's inevitable errors in delivery. I can coordinate my next shipment one month out, so when the VA screws up, and they always screw up, I still have a couple of weeks to fix the error. 

This time around, the Pharmacy clerk flat refused to process a six month resupply. In the past, and I am talking about several years now, Pharmacy clerks used a work around to ship me a six month supply. They processed one order on one day, and then they repeated the order the next day. 

This resulted in two shipments, but they were on consecutive days, and it worked for many years. I had minimal trouble with this process. At some point with the Orlando VA Pharmacy, however, this workaround was apparently forbidden to the clerks, and they are no longer permitted to do it. 

I get the impression that there is high personnel churn at the Orlando Pharmacy. Instead of talking to the usual kind folks who were experienced and remembered my case, I keep getting new, grouchy clerks who are struggling with their IT system. 

Pharmacy clerks in the VA Orlando Pharmacy are now directed to coordinate only a 90-day supply of medications. No exceptions. 

- Fun With the VA Phone System -

This time, the clerk flat refused. I will not argue with clerks, so I asked her to transfer me to a pharmacist. The first time that I tried this, a pharmacist picked up and she said "hello? Hello?" And then she said, "just a moment," and then she transferred me to the Urgent Care clinic. 

This sort of thing is continual when dealing with the VA. If they do not "accidentally" hang up on you, they transfer you to the wrong clinic. I would love to use the VA website to coordinate these deliveries, but it cannot be trusted, and I have learned the hard way to call and speak with a human and to always get the name of the clerk. 

I told myself, "serenity now." Then I called back. The second time around, the clerk was combative with me and he raised his voice when I asked him to transfer me to a pharmacist. 

He claimed that it was impossible, he physically could not transfer me to a pharmacist. I said, "ok then, let us play it this way. Transfer me to your supervisor." He could not say no to that. 

He was not happy, but I was not calling to make him happy. I was calling to get my medications delivered. I hope that the VA recorded that call "for training purposes" as they claim. I wish that I had made a note of his name.

This time, the transfer actually worked. A very nice lady named Mary picked up, and she explained that, however it worked in the past with the Orlando Pharmacy, that they could no longer transfer me to speak to a pharmacist. 

What Mary did do, and again, I am amazed that this actually happened, she agreed to take my name and my number and to ask a pharmacist to call me, upon which I would immediately return their call. 

And this actually happened. I called back and spoke to a very nice pharmacist named Janice. She would only process a 90-day refill for me. She said that she could not process a six month refill. And that is where things rest today. 

- I Hope That My Blood Pressure Medications are Working Now -

I am angry, of course. My desire for a 6 month refill is dictated by VA's inevitable errors. I have learned through agonizing experience with this agency to always, and I mean always, leave myself sufficient time to compensate for their inevitable screwups. 

It may seem like a minor thing, this refusal to process a six month resupply, but I assure you, as a veteran living at the far end of a tenuous medical delivery system, with multiple potential points of failure, it is not minor. 

There is no way that I can afford to purchase the medications that the VA prescribes for me. It would cost me more than a thousand dollars a month. Me and Momma and Her Majesty barely get by on my disability pension. 

A gratuitous photo of my silly cat, Her Majesty. I discussed this opus with her and she helped me feel better about it. Cats live in the now. I do not know how she experiences time. But when she sits on my chest and I pet her, and we discuss the events of our day, she helps me feel better. 

- Now I Begin Bitching -

So then I started calling people, namely Ms. Debra Ward, a Patient Advocate at the Orlando VA. I have dealt with Ms. Ward in the past, and she is a superlative patient advocate. She took very good care of me previously. But she was not answering her phone, which is understandable, as the Patient Advocates office is chronically understaffed and none of them can answer their phones. 

All their calls go to voicemail, and in her case, she says that she may need up to three business days to get back to callers. I believe it. I am familiar with Ms. Ward's work load, and it can legitimately take her 3 days to get to a call. 

I did not mean to leave her so many voicemail messages, but her system only gave me a short amount of time in which to leave a message. So I left her like three or four of them. I apologize, Ms. Ward. I really needed to speak to you. 

VA employees cannot return my calls to an overseas exchange in Bangkok. If I lived locally in the Orlando area, they can and often do return phone calls. But they cannot call overseas. It is my decision to live here, I accept that. But I also insist that it is not up to the VA where I decide to live nor why. 

Then I had the brilliant idea to send Ms. Ward a Secure Message through the VA website. So I did so. I imagine it may still take her three days to get back to me using that medium, as well. I still have not heard back from her. Today is day three. 

- Enter the White House VA Hotline -

Stewing by this time, I called the White House VA Hotline. I did not know who established this phone number, nor who runs it, but there is indeed a phone number that veterans can call to get assistance with VA problems in a timely fashion. 

I see now that this is a VA service established by the Trump administration.  The phone numbers that the VA website posts are not the phone number that I call. I was given my phone number through the veteran bamboo telegraph. I call +1 855.948.2311. 

I got lucky and I spoke to a switched on clerk, another Mary, who transferred me to somebody that she said was with VHA. That individual, named Carlton, who was apparently in Kansas, was very helpful. 

Unfortunately, Carlton could not give me a phone number so that I could call him back. All calls get routed to a random system, so it is impossible apparently to call back to speak to the same person. Carlton claimed that he had no direct line. 

The next time that I called the White House VA Hotline, I got another switched on clerk, a gentleman named Will, and he walked me through the process of filing a complaint and he issued me a case number. I instantly received an email confirmation of my case. 

And that is where things rest at this time. 

- Thank God for Patient Advocates -

I am trying to give the Patient Advocate Ms. Ward in Orlando time to tussle with my issues. She is very good, and she humanizes an otherwise inhumane system and she makes it flex in ways that keep the Orlando VA functioning. 

I do not know of any VA facility that does not utterly depend upon Patient Advocates. I pity those veterans whom, for whatever reason, are not competent to call and work with a Patient Advocate. 

I cannot fix this world, no matter how much I would like to try. I regret writing this article, but this is what writers do. We get angry and then we write. 

- My Unknown Benefactor -

The last time that I wrote an article like this, somebody, I still do not know whom, got on the horn with the VA in Orlando and told them to fix my issues. And they did. 

Somebody waved a magic wand to take care of me. 

I have no idea who is reading my words, nor who is picking up the phone and calling the Orlando VA on my behalf, but I hope that that anonymous angel will read this article and do it again. 

It is unrealistic to hope that I will not reexperience these same or even worse obstacles the next time that I need to renew my prescriptions,  because we are taking about the VA. 

The VA is what veterans have to deal with, and because we are veterans, and because the VA costs America billions of dollars, we have no choice but to be grateful for whatever we get. 

And I am grateful for the VA. I made a deal with the American government when I was young, and I never expected to live this long: I agreed to go to war on behalf of America under the supposition that the VA would be there for me when I got old, assuming that I did not die. 

For whatever reason, I did not die. To my vast surprise, I am still here. And so is the VA. So as far as I am concerned, America kept its word with me. I have health care, and it is keeping me alive at this very moment, and I am profoundly grateful for it. 

I know that my wife appreciates it, as well. She is not ready for me to die. I am working to prepare her for it. Because we all know that that day is fast approaching. 

But it sure would be nice if the VA was not such an utter nightmare. I would love it if I did not have to accommodate the VA's inevitable mistakes. I would love it if I did not have to fix inevitable errors, or adapt to irrational policy changes. 

And it would be glorious if the VA in Orlando would resume, as they did for so many years, renewing my medications without hassle and for a six month supply. 

I do not know who read my words before and got on the phone to whatever administrator in Orlando, but I desperately hope that that person, whomever he or she is, will do it again. 

Because this veteran, yet again, needs help from a mysterious, unnamed guardian angel from on high. 

Are you out there? 


Post a Comment

<< Home