A VA VIDEO CONNECT APPOINTMENT GONE UPSIDE DOWN: WTF, AGAIN!

THIS IS THE “QUALITY” OF CARE

WE GET AT THE NORTHPORT, NY VAMC

[ This is the actual report in PT. file ]

This is DUBOSQUE, HUTCHINSON JR, a 71 gentleman with a past medical history of former smoker quiet smoking in 2004 with PMH HTN, HLD, hypothyroidism, PTSD, depression, spinal stenosis s/p fusion (9/15), essential tremor, PUD, COPD on home O2, OSA not complaint with nasal CPAP and chronic respiratory failure who was called via VVC for discussion regarding his lung transplant evaluation.

Participants of the VVC meeting included myself and pulmonary attending, Dr. Chernyavskiy.

Pt comment: I just love me some I---. These notes from our little video chat point out that I--- just doesn’t give a flying fuck about Veterans.

Patient reports that he has undergone extensive evaluation with John Hopkins' lung transplant team over the past year and has recently been listed on the lung transplant list on January 7, 2021. We explained to him that the VA would not pay for his lung transplant at Johns-Hopkins' as the VA lung transplant protocol is to go through VA eligible lung transplant centers, i.e., at Wisconsin.

We explained to patient repeatedly that the lung transplant process at the VA hospital goes through either the University of Wisconsin or Seattle VA.

Pt comment: Right up front, they state that they will deny me access to Johns-Hopkins for lung transplantation through the Mission Act. Further down, they start back-peddling like the little weasels they are. If I get just a whiff of COVID, I’m dead, and I---knows that.

Patient would forward all the information and investigations performed at Johns-Hopkins to Northport VA and we will forward this information to the University of Wisconsin. Patient and his wife agreed to the above and would be sending us a package of his results and hospital records from Johns-Hopkins.

Pt comment: No way in Hell this is ever going to happen!

 Nature of patient call is to request VA to pay for pulmonary transplantation at Johns-Hopkins Medical Center, where patient went more than 1 year ago and underwent extensive evaluation, testing, and as I understood he is placed on the transplant waiting list over there. Pt went to Johns-Hopkins on his own; he stated that he doesn't trust care at the VA and he didn't want to wait until he dies at the VA.

Pt comment: I had to do my own research on this, as VA and I--- conveniently never mentioned anything about a lung transplant…ever! Not in these notes is I---’s statement that he knows nothing about Johns- Hopkins. It is only #3 in the Country for transplants, including lungs.

 

Patient has advanced COPD/emphysema from smoking complicated with significant fibrotic changes. At some point I spoke to the patient regarding his request to have in the bronchial lung volume reduction procedure. I strongly advised him again this procedure as it appears that he can be harmed rather than helped from this procedure; pt was advised that VA will cover this expense if he finds someone to offer this procedure and he would accept the risk. Patient on triple therapy and Daliresp and he is on oxygen replacement therapy.

Pt comment: I initiated the discussion on Bronchial Bypass, after doing my own research. VA and I--- never mentioned any options at all…ever.

But, stated right here, is an admission that VA will pay for a procedure that would kill you!

 

Patient can be considered potential candidate for lung transplant given that his cardiac pathology and other comorbidities will not interfere with success of intervention. Patient stated that he wasn't at VA for more than 1 year because he is afraid of catching COVID 19 infection.

Pt comment: Based on historical experience with this VAMC, there is no way I’m stepping foot in the place.

 

I explained to the patient that pulmonary transplantation can be offered at the VA medical system and for the EAST Coast the hub is Univ of Wisconsin. Should the patient express interest, we can initiate that process; in layman terms I explained that this is a standard process applicable to all veterans who are receiving medical care at Veteran’s Affairs Medical Center.

Pt comment: No way in Hell am I traveling to Wisconsin with my condition and COVID raging in the midwest. No way in Hell am I moving to Wisconsin for three months to complete the process. After that, there are periodic visits involved which VA would task I--- with in Northport, NY.

 

Patient became extremely angry and started using nonstandard expressions in the conversation; I strongly advised him to calm himself and use an appropriate language in order to continue our dialog. I reiterated to the patient and his wife that no one can deny and assessment/evaluation for pulmonary transplant for the patient of his type.

Pt comment: You bet I became enraged and nasty. And, yes, he and VA are realistically denying my request to use the Mission Act before anyone has even looked at my files!

 

I do not understand why they will undergo impression that VA in pulmonary section deny this assessment. Patient and his wife that told by Johns Hopkins Hospital that transferred is a local geographically procedure, but it is their opinion and the it is not standard practice for any kind of transplants which can perform at VA, kidney, lung, liver, etc. even though patient was adamantly not interested to go to Wisconsin for the evaluation.

Pt comment: It was not recorded that I--- did deny access to the Mission Act.

 

The following is never going to happen: even though we agreed to do it.

He and his wife agree for us to start formal process. They will send all available information obtained from Johns-Hopkins Hospital, which will be included in the package to be sent to Wisconsin. Patient medications were renewed. Patient didn't have any other questions. 25-30 minutes total encounter.

Contacted Senator Chuck Schumer’s office re. denial for Mission Act.

 

/Es/ I-- -----------y  Pulmonary Attending--

Date/Time:   14 Jan 2021 @ 1340

Signed: 01/15/2021 16:15 

 

Johns-Hopkins, 2/24/2021 – The aftermath. A new, 20 y/o lung