Fort Collins VA Clinic Experience

Fort Collins (CO) VA Outpatient Clinic

Today I related to the American Legion Crisis Action meeting here in Fort Collins my most recent
appointment experience. Previously, I'd been disappointed only with the long delay arranging an initial primary care appointment (I'm 100% service connected) after we moved to Colorado. I didn't think much about it and subsequent experiences, both with health care and appointments, were perfect; nice folks, superb care, attractive facility, short waiting time...everything great. Good reason to move to Fort Collins!

But a real problem hit in June. I'd been in the Palo Alto (CA) VA War Injury & Illness Study Center for several days of extensive tests, with more problems identified. I was discharged with instructions to seek an appointment with my primary care within two weeks. Doing so, I left a message with the Fort Collins VA Clinic recorder - no live person free to answer the phone, I guess. Gave the details of the request and waited.

Eight days later, not having heard anything, I called again, only to have to leave a message on their machine again. The next day I was called (June 26) and we discussed my request to see my primary care.

I related my recent VA hospitalization in California, mentioned I'd also just had shoulder surgery three days earlier, repeated my issues with heart disease, cancer, spinal cord injury, diabetes, 100% service connected and other stuff. The scheduler explained that I saw my primary care twice a year and so the next appointment should be in September.

Just in case he didn't understand or I'd not been clear, I repeated everything, especially the Palo

Alto VA orders to see my local VA primary care in two weeks (which would be late June into early July.) Just in case I didn't understand, the scheduler then repeated that my next appointment should be in September.

"Okay," I said. I certainly didn't want to "bump" anyone needing care more urgently, and the next available appointment offered me was again, September. I told the clerk that because I felt I needed care more promptly than that, I'd seek it through non-VA means. I repeated I didn't want to bump anybody from ahead of me at the VA. We finished our call.

Three months. A long time for a vet already rated "catastrophically disabled" and 100% service connected by the VA to wait for an appointment to see his primary care provider. An especially long time given the VA Palo Alto discharge instructions to see the primary care provider within a couple weeks. An especially long time given the twice-repeated summary of the reasons behind the appointment request, and also because the primary care had referred me to Palo Alto's War Injury and Illness Study Center and follow-up with him was necessary.

Admittedly, I was passive, unassertive, letting the appointment clerk make his decisions without my pushing, but carefully waiting to see what the outcome would be. How quickly would I be seen or how long would my appointment be put off? I was already alarmed because my first call to their appointments recorder had been eight days earlier. Eight days passed and I heard nothing until I called a second time, and then a day passed before we connected. Nine days, with the first request left on their answering machine apparently lost and never acted on.

Today, relating my situation to the team of VA specialists helping the American Legion conduct their Veterans Crisis meeting, the VA gentleman from Cheyenne typed my info into his laptop (on line with the VA) and offered me three choices for appointments next week. No big deal – when did I want to come in? What time of day was most convenient?

Wonderful! But I don't understand why I was tossed a 90-day delay with my earlier request, but today, before relating my situation in detail but simply saying I wanted to have an appointment,  was offered numerous possibilities anytime next week.

I do know the ninety day delay was bad enough that it could have left some vet dead. No non-vet would ever tolerate such a delay elsewhere in the medical community. Discussing it with VA managers today was unburdening but nobody took notes, nobody said it was something that wouldn't happen again, nobody said it was something to fix, everybody was polite.

I was told to mention it to my primary care when I see him next week. That's all.

I see no reason situations like this won't repeat, especially with confused, depressed, stoic or passive veterans who quietly accept whatever's offered in terms of appointments, scope of care, ancillary services, things which can be quite important to life and limb! The patient's role is to ask for help from the VA and explain the need.

In its ninety-day response, VA proved dangerously inadequate in my most recent experience. At least in this instance and in this place, VA's process depended on a patient to push past an appointment clerk for proper telephone triage appropriate for the urgency to be acted upon. VA cannot count on patients to push the system, and doesn't take well to them doing it, either.

Recovery from VA Malpractice - Sue the Government??

Recovering from a VA misdiagnosis, failure to treat or malpractice is quite complicated. The federal government is sovereign, meaning usually immune from the threat of lawsuits. In the interest of justice, the government allows damages to citizens to be evaluated under the Federal Tort Claims Act (FTCA).

FTCA allows a citizen to claim compensation from the US government when damage is caused by the negligence of an employee or agency (such as VA hospital malpractice) of the US government, including the Veterans Administration. VA medical malpractice law falls within negligence law, which is applicable to all lawsuits by attorneys against medical professionals, from VA hospitals to doctors and dentists to podiatrists and chiropractors. 

Increasingly, more medical negligence claims have been directed toward VA medical malpractice claims. According to the VA itself, the "environment of care" needs to be improved at most of its facilities.

Recovering damages under the FTCA is complicated and often can require help from experts experienced in the requirements for filing medical negligence lawsuits. For instance, before you sue, an administrative claim (an §1151, filed on Standard Form 95) has to be made against the VA for the full amount of damages you have suffered, and that is difficult and risky to determine. Once you have filed your administrative claim, you won't be able to ask for more damages—ever again--unless you have evidence that proves additional damages are warranted and you didn't have knowledge of them prior to filing your claim. One shot, and you'd better be on-target!

Either a veterans service representative from one of the larger veterans organizations (DAV, VFW, American Legion) or a VA-experienced attorney can help determine how much in damages you are entitled to receive and will make sure you don't "short change" yourself during this, the VA's investigation stage. The VA's regional lawyers have the authority to settle claims with awards up to $100,000, and the VA's General Counsel can make awards up to $200,000 when appropriate. The VA often has about 1000 malpractice lawsuits a year and annually loses about $125,000,000 in awards. About twice as many administrative awards are made than lawsuit awards, and only about a quarter of all claims (administrative as well as lawsuits) are awarded any damages. The VA often has as many as 4,000 administrative claims presented with awards per year totaling around $75,000,000 with about one in four claims succeeding with some amount of an award.

After your administrative claim is filed with the FTCA, the VA is entitled to six months for investigation and review of your claim. The VA can then do the following:

• Accept the claim and pay it out in full
• Settle the claim for less
• Reject the claim outright.

If your claim is rejected, your next step is to file a lawsuit in federal court. If the VA does nothing within six months, this means that your claim has been rejected. You can sue in federal court under the FTCA, which allows you to file a lawsuit within 2 years of discovering your injury and what caused it. But keep in mind that this timeframe includes the 6-month time period needed to file and complete your administrative claim. It is imperative that you meet these legal deadlines; if not you may lose your claim forever...thus the suggestion to be guided by experts in this field and not fly solo on your first flight!

My advice? Talk it over with your primary care provider and the specialist involved. Mistakes happen and if they don't cost you life or limb, often all we want to hear is an explanation and an apology, and an idea that such things will be prevented in the future. One of the monster problems within the VA, as I've found, is that you can't simply call the doc and discuss the problem...it seems when you ask to talk about the concern, you're referred to Patient Affairs. There, a general explanation might be offered but usually you're encouraged to write to the medical center's chief of staff and detail your issues. Once that letter arrives the VA generally refers the issue to an expert outside that particular facility for examination and response. Wow...what a procedure and what a public discussion of something you only wanted to discuss with your doc to complain and hear his/her response and perhaps even explanation as to why you might be mistaken! Actually...that would be good news, of course.

Often the VA at this point will suggest a settlement if it seems to be clearly malpractice, misdiagnosis or failure to treat. Experts advise that the amount of this initial offer can be six to eight times less than their offer against a lawyer-prepared administrative claim, but sometimes all we seek is a modest $1.00 and apology. Your call, but there is no reason to sit on your backside if you believe harm has been done you at the VA...they offer a pathway to recovery via the FTCA.