Wednesday, December 14, 2016
[Shasta County] Veterans still struggle to get health care
Blog note: this article references a grand jury report on the subject.
One morning in April, 68-year-old Richard Chaviers could not catch his breath. His sister knew he slept restlessly overnight and he was hospitalized a few days before, so she was worried. She called 911. An ambulance took him from his Shingletown home to a waiting helicopter that flew him to a hospital in Redding.
It was the Vietnam veteran’s second trip to a hospital in less than three weeks. In early April, Chaviers experienced similar troubles breathing, but when the ambulance pulled into the parking lot of Shasta Regional Medical Center, his heart gave out.
“That’s the type of thing someone does in a firefight. You hold out, and keep fighting, and you have to give it your all before you get to safety,” Chaviers said. “I felt the ambulance get to the hospital and I must have just let go.”
Like many veterans Chaviers receives his regular health care through the U.S. Veterans Affairs Department. He goes to the clinic on Hartnell Avenue in Redding, about 35 miles from his Shingletown home.
He and others who go to the Redding Veterans Outpatient Clinic are better off than some of their big-city counterparts, who can wait months for appointments. By contrast, the Redding VA has an average wait time of around four days to see a primary care doctor and 10 days to see a specialist. It boasts five doctors, two nurse practitioners, two pharmacists and five registered nurses, among other support staff and volunteers.
“The Redding clinic offers so much for such a remote location and the staff go out of their way for the population,” said Tara Ricks, spokeswoman for the VA Northern California Health Care System.
Chaviers and other veterans have plenty of hassles with the VA. But the worst of the agency's well-documented failures have occurred elsewhere. Although veterans here must travel to Sacramento or San Francisco if they need a VA hospital, those facilities both had three out of five stars at the end of last year, in a secret internal rating system obtained by USA TODAY and published last week.
The VA determines the ratings for 146 of its medical centers each quarter and bases them on dozens of factors, including death and infection rates, instances of avoidable complications and wait times.
Even so, some local veterans find they must turn to the Veterans Choice Program to see physicians sooner. The program allows veterans to see doctors and specialists outside of the VA, which can be helpful in metropolitan areas. But in a rural area like Shasta County, the selection of doctors through the Choice program is slim, and veterans find themselves competing with the general public also seeking appointments among a limited pool of doctors. Veterans who have major medical needs must travel to Sacramento or San Francisco for care.
Chaviers knows about trying to get in to see specialists. After his hospitalization, he spent time in a rehabilitation facility to regain his strength. Staff advised him to follow up with a pulmonologist — a lung specialist — after he was discharged. The pulmonologist would teach him how to properly breathe as he copes with end-stage lung disease. He had already met with one during his stay at the rehabilitation facility, where his condition improved.
He said he made an appointment with the VA clinic to see a doctor who could recommend him to a pulmonologist. They scheduled him for one four weeks out – but a couple of weeks before the appointment, he learned his doctor was leaving the VA. His appointment was rescheduled for a later date.
Taking shrapnel and a bullet
Before he was old enough to buy a beer, Chaviers traveled to a foreign country to fight in a war. He enlisted in the U.S. Navy at 17 and was stationed in Vietnam and later in the Parrot’s Peak in Cambodia as a gunner’s mate in a river patrol boat. He sat in a small niche in the boat surrounded by ammunition and survived taking shrapnel from a rocket and a few minutes later a bullet to his chest. He received a Purple Heart. He was also exposed to Agent Orange, the chemical agent used to thin out the jungles in Vietnam that eventually washed away into the rivers.
“We washed ourselves in that water and the crud would build up on our backs," he said. "We didn’t know then what we were wading through.”
Now, he speaks with a heavy rasp, his breathing labored. He is winded after crossing his living room. According to medical records, Chaviers smoked until the day he was brought to the hospital in April.
Chaviers’ sister, Gayle Boren, is his full-time caregiver. She struggles to get his medical bills paid. After several weeks of speaking to the VA claims department, Boren was told her brother’s bills were paid. She even received a letter from a Congressman’s office notifying her his staff worked with the claims department to settle her brother’s bills. But the final notices from the doctor’s offices kept coming several months after the hospital stay.
“It’s difficult to weave and bob your way through the VA medical system,” Boren said.
Boren’s great fear is that her brother will die while waiting for paperwork to be filed or an appointment to see a doctor.
‘You have to advocate for yourself’
In 2015 more than half of the 14,800 appointment visits at the Redding VA clinic were by Vietnam War-era veterans.The next highest group of visits was Persian Gulf War-era veterans with 2,300 visits.
Veteran Denise Quantz, 48, of Anderson said staff members at the clinic are responsive to her concerns, including when she was seeing a mental health therapist who had different political views than her.
“He was a helpful guy, but once he began to share his liberal views I couldn’t ignore that. I’m conservative and I wanted a doctor who would have those views,” said Quantz. The mental health staff listened and assigned a conservative doctor.
Quantz served in the U.S. Navy and was stationed in Gulfport, Mississippi, during the Gulf War. For most of her life Quantz has had anxiety. She was taking medication provided by the VA and pain pills for fibromyalgia that included neck and back pain. She also lost her leg through a bone infection about a decade ago.
Quantz said veterans need to be assertive when dealing with the VA.
“You have to advocate for yourself, strongly. I have to make sure I ask for things all the time. It’s almost a full-time job.”
Benefits process flawed
Veterans say it's also not simple to get benefit claims resolved.
Benefit applications are facilitated by the Veterans Service Office in Redding. Staff members determine which conditions or injuries were received during wartime and they build a case for those benefit claims. They search through the veteran’s history to establish a timeline and verify all the information of service.
The VSO was the subject of a Shasta County Grand Jury report in July, which said a lack of trained employees was responsible for a backlog of applications and a slow response for veterans. Veterans Service Officer Tommy Keys said the grand jury based its report on outdated information, and that currently there are no backlogs with benefits and several staffers will be trained on how to file benefit claims on behalf of veterans.
Richard Chaviers, a Vietnam Veteran, walks out of the Redding Veterans Affairs Outpatient Clinic on July 18th. (Photo: Andreas Fuhrmann, The Record Searchlight-USA TODAY NETWORK)
“We’ve always been in touch with the county to let them know how we’re doing and what we strive to do on behalf of all the veterans,” said Keys.
But the VSO’s filing only guarantees the benefit claim is passed along to the Veterans Administration, which processes all claims. It doesn’t mean the VA will respond immediately.
Boren said her brother filed a benefit claim in July and in August was told the paperwork was not filed by the Redding VSO. Chaviers’ rent was due and other bills were piling up, along with the doctors’ bills. “I called and they apologized and said it wouldn’t happen again,” Chaviers said.
In May Boren reached out to Rep. Doug LaMalfa, R-Richvale, for help getting a response from the VA.
LaMalfa’s office cannot speak about the specifics of Chaviers’ filing, but the Congressman has made a habit of discussing wait times veterans endure. One anecdote he shares is hand-delivering a veteran’s benefit claim to an office in Washington, D.C.
Mark Spannagel, LaMalfa’s chief of staff, said if the VA is unable to see a veteran, LaMalfa’s office will push for local providers to see them. About 80 percent of the casework his office takes on is veteran related. It’s worked on more than 1,500 veterans’ cases.
It’s September and Chaviers shuffles through an envelope with his medical records and test results. He holds up a paper that details his heart condition and shakes his head, then lets out a chuckle.
“I wrote ‘unknown’ on it, because I don’t know what it means. I can’t get anyone to tell me what these tests showed,” said Chaviers.
His sister said her brother did more than was asked of him by serving three tours in Vietnam.
“The VA said they have advocates within the system who will help Richard,” Boren said. “But at this point I’m his advocate and without me, well, I feel sorry for anyone who has to do this alone and going through some type of ordeal in their life.”
December 10, 2016
By Nathan Solis