Hospital officials: VA patient care not an issue for majority

3 years 10 months 4 weeks ago Thursday, August 21 2014 Aug 21, 2014 Thursday, August 21, 2014 4:22:00 PM CDT August 21, 2014 in News
By: Tyler Castner, KOMU 8 Reporter

COLUMBIA - One local veteran and his wife are raising concerns they have with the quality of patient care they have been receiving at the Harry S. Truman Memorial Veterans' Hospital in Columbia. Retired U.S. Marine Sgt. Robert Brightwell and his wife are writing to the legislature and governor to raise awareness of what they said is "horrible" patient care at the VA hospital. Brightwell said his care at the VA hospital has recently been on the decline since he began treatment there in 2009.

"I think they make it sound really good at the beginning but once you actually get there you see that it goes downhill after a while because you can go out and go to a smaller clinic and get better care," Brightwell said.

Brightwell said he was happy with the care he received at first was great, but things began changing when his primary physician at the VA clinic in Jefferson City left for another job opportunity. For a little over a year, Brightwell said he had to move his appointments to the VA hospital in Columbia. Since the move, the Brightwells said their frustrations have been building and it was their most recent visit to the VA hospital that finally convinced them to reach out for help.

"We went to my husband's appointment at the VA and we were told that the lump on his hand it's either a cyst or some kind of disease that makes your hand contract," Brightwell's wife, Jessica, said.

The Brightwells said the first doctor they spoke to opted for surgery to remove the possible cyst, but sought an opinion from one of her colleagues.

"He [the second doctor] said they weren't going to do surgery, because they wanted to see if it makes his hand contract first, which is not ok," Jessica said, "They are telling us that something has to happen to my husband's hand so they can try to fix it even though the problem could be easily fixed. What if they cannot fix the issue after it arises? Do we tell our children daddy cannot hold you or get dressed by himself because of a mistake that could have been prevented?"

For the Brightwells, this wasn't the first time they've been upset with their care. One of the jaw-dropping moments for Robert Brightwell came in March, when he said he saw a student doctor instead of the doctor he was expecting.

"I was expecting to see him [another doctor] when I went up there and when the doctor walks in, she sits down and starts talking and everything is good. All of a sudden she looks at me and she goes, ‘are you smart enough to work your insulin pump?' Just, I was in shock. I was like, 'really?' I thought to myself, 'I can't believe she just said that' and I said 'yes, I've been doing this for almost 5 years.' From day one I knew how to do this."

L. Stephen Gaither is the public affairs officer for the VA hospital. He said he couldn't speak to the specific incident in question, but in general it is about communication to resolve these types of concerns.

"If that really did take place and that was an inappropriate interaction with the patient, did that get communicated to someone who could educate the student?" Gaither said. "Because that's the key. This is a learning environment for the students. They don't know unless they're told that's appropriate, that's not appropriate. People have to speak up. They have to share the information; they have to be willing to allow us to address a perceived problem."

Gaither said having student doctors in the hospital is not detrimental.

"Quality of care measures historically have been higher at affiliated teaching hospitals than non-teaching hospitals in American society," Gaither said. "There are people who are not comfortable with that kind of environment and there are people who accept it and understand it but with all of the metrics that measure quality, affiliated medical centers tend to do a better job."

There was another instance weeks before the Brightwells met to discuss Robert Brightwell's cyst when they drove up from their home in Jefferson City for several appointments at the hospital, but when they arrived at 8:30, they said Robert Brightwell's lab work wasn't entered in the system. They couldn't go to the other appointments without the results of the lab tests and had to go home without seeing anyone.

"He had to be at work and his blood sugar was already low because he had to fast," Jessica Brightwell said. "Normally in the morning his blood sugar is always low, so it was like, ‘Really? We can't really wait. We drove up here for nothing."

Robert Brightwell said having to travel to Columbia for his appoints is a tiring process.

"Living in Jeff City, that's a 30-45 minute drive up there, 30-45 minute drive back," Brightwell said. "It's a long day, doing that."

Brightwell spent nearly eight years in the Marine Corps before being medically discharged in 2008 when he found out he had Type 1 diabetes. While in the Marines, Brightwell served two tours in Iraq and two years in Okinawa in the Marine Expeditionary Division.

Robert Brightwell said the VA system as a whole wasn't bad and he actually enjoyed the care he received at his outpatient clinic in Jefferson City, where he had his first primary physician. He said the most concerning issues he had were at the main VA hospital in Columbia.
"It seems like going to a big hospital like the VA, it's like you're just a number. You were just the next person in line and they've got to get so many people and they book so many people," Robert Brightwell said, "It seems like they care a little more at the smaller clinics they do at the big hospital. I think it's 30, 40, 50 times better."

Gaither, who has been at his job for 37 years, said the feeling of being "just another number" is a minority opinion.

"We here in Columbia we have primary care teams for veterans. We have ‘Red,' ‘White,' ‘Blue,' and ‘Silver' clinics. The patient panel size for those providers is the same panel size that we have at our community-based outpatient clinics. The size of the panel, the size of the clinics is the same," Gaither said. "There may be a perception because of all the other activity - it's a bigger place and somehow you're going to be lost in the system. The majority of veterans we see don't feel that way and they share that opinion when we ask or they participate in customer satisfaction. So that tends to be a minority opinion and hopefully we can address that when someone has that perception of our organization."

Robert Brightwell said he is just like many other veterans who share his distaste the hospital.

"It takes long enough to get medical help with a lot of us because I know a lot of vets, they don't like going to the hospital. A lot of military personnel I know don't like going because that's just the way we are," Robert Brightwell said. "I don't like going to hospital, my wife makes me go to the hospital and it's one of those when we do go to the hospital, it is usually serious enough in our minds and to be told that it's not, we don't like to hear that."

Robert and Jessica Brightwell have been married for 17 months and live in Jefferson City with their 3-year-old son, Logan. Jessica began accompanying Robert to his VA appointments in Sept. 2012.

"When we first went, I liked the doctors, I was impressed and it seems like the more interns or rotation doctors they get, the worse the care gets," Jessica Brightwell said, "Honestly if you're getting a doctor on rotation, my thing is, they're not really going to care as the same doctor you see all the time. They don't care because they're never gonna see you again."

Jessica Brightwell said she doesn't see her husband's care as an isolated incident and has spoken to and seen other veterans she believes aren't getting the attention they deserve.

"There was a gentleman there [at the VA] and he had a brace on his leg but the brace was cutting into his leg because it didn't fit his leg right. So was that the VA's fault, that it didn't fit him properly? Or did he go outside somewhere?" Jessica Brightwell said. "It seems like we've seen more and more older gentlemen who just really look horrible like they're not getting the proper care and it isn't right."

However, Gaither said he believes unhappiness and unsatisfactory patient care are not as widespread as Jessica Brightwell said.

"That flies in the face of all the feedback. We did not only the satisfaction surveys, but we have individual sessions with veterans to give us that feedback," Gaither said. "Over and over and over again we get kudos for our customer service, how we treat the patients that we take care of, the helpfulness that the staff exhibits over and over again so that kind of a message is really diametrically opposed to the measurements that we see."

Robert Brightwell said he's concerned for the older generation of veterans if they are receiving the same care as him.

"I am 32 years old. I see these World War II, Vietnam veterans in there that they're walking around and they can't be getting the same treatment that I've gotten," Robert Brightwell said. "You're looking at guys that are 50 years old, 60, 70 years old that they went back home to some little town that doesn't have a hospital. They've got to drive two and three hours to get to the hospital, yet their lab work doesn't get entered in the system. Well there's a three-hour drive up here then to sit there and be like, 'okay so what do I do?'"

Robert Brightwell is particularly unhappy with the "wait-and-see" attitude his doctors are taking with his hand and doesn't want to see the same for other veterans.

"You're talking about a 70-year-old man or woman who is having to watch something for six months more. That could be something as small as well but it's just a benign cyst on their hand or on their neck or whatever," Robert Brightwell said.

The Department of Veterans Affairs has been under national scrutiny in recent years for the quality of patient care. In late 2013, CNN began reporting on wait times and delays for veterans seeking healthcare. In April 2014, CNN aired an interview with Dr. Sam Foote, a retired 24-year veteran of the Phoenix VA system, during which Foote said his system keeps two separate lists on patient waiting times - one with accurate times and another with fake times to be reported to the government. Foote alleged some veterans had to wait months to receive treatment and in some cases, the delay resulted in their death.

In May 2014, Sen. Claire McCaskill, D-MO, released the second report on results of the Veterans' Customer Satisfaction Program. During this program, McCaskill solicited feedback from veterans across Missouri about the quality of their care through the VA healthcare system. Hospital officials said this report shows that the Brightwell's dissatisfaction with the VA patient care puts them in the minority.

In a letter to the director of the Columbia VA medical center, McCaskill said, "I am encouraged by the strong satisfaction ratings of VA facilities in the Columbia region. These results confirm my belief that we are maintaining a high rate of veterans' confidence in the Columbia region VA Medical Center."

In McCaskill's study, more than 81 percent of the 251 veterans who responded received medical care at the Columbia VA hospital. Of those, more than 50 percent were veterans of the Vietnam War.

Almost 90 percent of veterans in the survey said they were treated with appropriate respect while at the hospital and an equally high percentage reported the VA staff communicated with them clearly and explained what was going on.

Almost 80 percent of respondents said their overall experience at the VA hospital was above average or excellent. More than 90 percent said they would recommend the Columbia VA hospital to other veterans.

Although the Columbia VA hospital received the highest marks in the Missouri VA system, Gaither said there are some veterans who are dissatisfied.

"Because of the volume of the health care that's delivered, for the most part, veterans that we treat are very satisfied with the quality of care and customer service they receive. That doesn't mean that everybody is," Gaither said. "And so we do hear from folks that aren't always happy and we try to make sure they understand that we can try to resolve questions or concerns and lots of times we're successful. There are other times where someone just isn't happy with what happened and if they have a legitimate beef about it there are ways to address that concern."

Gaither said the hospital has treated more than 37,000 patients this year and that number is growing. Last year, veterans visited the outpatient clinics more than 400,000 times. While the hospital strives to meet the needs of all of it's patients, Gaither said he is realistic about what can be achieved.

"We try to make everybody happy but we are not perfect and there's no such organization in the world," Gaither said. "Now hopefully we don't repeat something that has caused some adverse effect on the patient but that's our approach. Continued performance improvement helps us do a better job of that."

Gaither said that veterans who are concerned with their care have several options for getting their issues resolved, but should be sure to talk to the right people.

"If you go to the state representatives all they can do is be a concerned citizen asking on behalf of one of their constituents. There's no direct relationship between the state government and the federal organization," Gaither said. "If a veteran finds himself in need they really need to go to the federal elected official.

Gaither said he attributes some of the unhappiness a patient may feel over their care to a more widespread cultural problem.

"We often times find ourselves with healthcare being not as assertive as we need to be. I think that's true. It's a stereotype but I think that's true in our society," Gaither said. "People have to know that part of their responsibility as a patient and often as a family member who speaks for the patient because the patient may not be in a position to do that. We have an obligation to do that for ourselves. And I believe that we have the necessary mechanisms in place to address those kinds of issues for the patients that we serve."

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