One Man’s Odyssey Across Thin Red Tape of Veteran’s Care

CHARLOTTE, N.C. _ Emery “Lee” Martin desperately wanted to see a Veterans Affairs doctor for injuries sustained in Iraq last year.

His time at the helm of bulldozers and other big machines left the 49-year-old Charlotte man with debilitating pain in his shoulders and arms. Close calls with roadside bombs and bullets _ insurgent AK-47 rounds zipped between his legs on one occasion _ left him with mental scars.

In October, he applied to see a Veterans Affairs doctor. He said the agency lost his paperwork _ twice. More than three months later, and still no word from the VA, the N.C. Army National Guard soldier showed up unannounced at the VA hospital in Salisbury. Nearly five hours later, he left with a bottle of pills to ease his physical pain. He said no one talked to him about possible side effects. The medicine soon caused him to urinate blood, he said. At a follow-up visit in February, the VA changed his medication and scheduled his next appointment _ Aug. 16. “We’re getting shoved to the back,” he said, “and no one wants to deal with us.”

Martin’s slow odyssey through the VA reflects an overcrowded system and echoes the red-tape woes and poor outpatient care found at Walter Reed Army Medical Center in Washington, D.C.

With the VA treating more than 5 million veterans a year, overcrowding could get worse. Linda Bilmes, Harvard public finance professor and former Clinton Commerce Department official, last month issued a 34-page report projecting that at least 700,000 veterans from the “global war on terror” will flood the VA system in coming years. The total tab for the influx: about $600 billion.

Some Charlotte-area veterans, including those fresh from Iraq and Afghanistan, wait nearly a year for VA medical treatment, the Charlotte Observer found. One local man said he has waited four years for a dental appointment. Others must drive to the VA hospital in Asheville, N.C. _ a nearly 200-mile roundtrip _ for routine medical care.

Meanwhile, Robert Weeks, director of the Mecklenburg County Veterans Service Office, tells Iraq and Afghanistan veterans to always claim to suffer some sort of mental problem even if they don’t have one. It’s a trick to cheat the clogged system. “You have to,” he said, “or else you won’t get seen.”

VA directors at the state and national levels failed to plan adequately for a surge of patients, triggered in part by a flood of aging and recent veterans trying to escape the rising cost of private health care.

Charlotte is the largest and fastest-growing city in this VA region, which includes North Carolina, West Virginia and parts of Virginia. Yet compared with the population of patients it supports, the city is home to one of the smallest health care clinics in the Carolinas.

The computer technician works out of a storage closet, among the extra rolls of toilet paper. The top administrators share a tiny office and use carry-on luggage to store files.

The VA broke ground on a new mega-clinic in October, more than a year behind schedule. Officials say it will be a medical Mecca. It may be too small by the time it opens early next year _ one reason the VA is building the clinic to support a second story if need be.

The existing Charlotte VA clinic serves about 4,800 patients and is at capacity. The new facility under construction on University East Drive will be six times as large, with the ability to serve about 17,000 veterans.

VA officials expect about 16,000 vets when the doors of the new clinic open. The agency also has plans to build clinics in Franklin, Hickory and the Hamlet area.

Until then, new patients seeking care at the Charlotte clinic are put on a waiting list of more than 640 patients and sent to Salisbury, a facility that came under federal investigation two years ago. Investigators examined suspicious deaths at the 1950s-era hospital and found widespread evidence of substandard surgical and postsurgical care. At least two veterans died while receiving inadequate treatment, investigators reported. Among other findings: Doctors authorized treatment without examining patients, fabricated daily patient records and failed to conduct postmortem reviews of what went wrong when patients died.

A story about that investigation appeared in the Observer. The paper was flooded with phone calls and e-mails from veterans and families who accused VA staff of over-prescribing pain medications, misdiagnosing ailments, botching operations and providing rude service. Local Congress members have called for a further review.

The interim director at the Hefner VA Medical Center told the paper last week that the hospital has since fixed all the problems, has fired incompetent doctors and nurses, and has beefed up staffing.

Complaints about the VA are almost as old as the system itself. The VA is the largest health care network in the nation, with more than 1,400 hospitals and clinics and 235,000 employees. VA centers treat veterans for free, or for far less than what private hospitals charge.

For years, the VA had a bad reputation. Care at the VA was so substandard that in the 1990s, Congress considered shutting the whole thing down and issuing veterans vouchers for treatment at private facilities.

Since then, the VA said it has made improvements and points to recent recognition from some academic quarters, including Harvard University’s Innovations in American Government Award.

Korean War veteran Walt McBride of Sherrills Ford has been a regular patient at the Salisbury VA hospital for nearly eight years. “That facility has given me and fellow vets great care,” he said, adding that his doctor phones him at home after checkups and the staff is courteous.

The VA received federal approval for the new Charlotte clinic in 2004. Local demand for VA services was hitting all-time highs by then, even as the population of veterans in North Carolina was holding steady. In fact, numbers of veterans dropped about 4 percent to 756,216 between 2000 and 2006.

Daniel Hoffmann, director of the VA district that covers North Carolina, West Virginia and parts of Virginia, said he and other VA officials were lulled by the numbers.

“We expected quite rationally that if the (veteran population) was cresting, then visits would as well,” he said.

Rising private health care costs, aging veterans with more acute health problems and an influx of walking wounded from the wars in Iraq and Afghanistan swamped the VA. State VA officials said about 3,000 of the 60,500 veterans who sought treatment in Salisbury and Charlotte last year served in Iraq and Afghanistan.

The Charlotte clinic hit other snags.

Hoffmann, among others, vastly underestimated the cost for the new facility. When the bid came in more than 10 percent higher than budgeted, the regional VA had to return to Congress for funding re-authorization, delaying the project.

The VA relied on one contractor. The company’s co-owner was responsible for oversight of the project. He died after a car crash in February last year, causing further delays.

All that doesn’t help Martin, the N.C. Army National Guardsman.

When Martin took off work that frigid January morning and drove to Salisbury, an Observer reporter joined him.

A receptionist immediately took his information. Even though he spent hours in a waiting room in-between consultations and X-rays, he was happy to walk out as the sun was setting, bottle of anti-inflammatory meds in hand.

The tabs of Diclofenac he was given soon triggered blood to form in his urine, he said. He stopped taking the medication in February and at a follow-up visit that month was prescribed different pain medication. He wasn’t scheduled to see another VA doctor until August and grew depressed, he said.

Then Martin received three calls from VA officials on March 2 _ after the Observer had interviewed Hoffmann, and told him about Martin’s plight.

Hoffmann said the VA’s goal is to schedule appointments within 30 days, acknowledging some fall through the cracks.

Last week at a VFW hall in Charlotte, Martin smiled. He had an appointment earlier that week, with two more scheduled this month.

The new pills for his shoulder and arm pain are working well. And he has an ample supply of Citalopram Hydrobromide, an anti-depressant and mood elevator.

VA officials also gave him the direct-dial phone numbers for various staffers.

“I just want to get back to normal,” he said, “or at least as close as I can to normal.”

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EMERY “LEE” MARTIN’S VA ODYSSEY

The VA twice lost his paperwork, he said, and he couldn’t get an appointment. On Jan. 25, after more than three months of trying to see a VA doctor, Martin paid an unannounced visit to the Hefner VA Medical Center in Salisbury. The Charlotte Observer tagged along.

11:10 a.m. _ Slips behind wheel of his green Ford Ranger and begins drive to Salisbury.

11:56 a.m. _ Stops at Burger King for a Whopper-and-fries combo. The ice machine is broken. He drinks room-temperature Coke.

12:25 p.m. _ Arrives at VA hospital in Salisbury. Pleasantly surprised when a receptionist promptly jots down his name. He takes a seat in a waiting room.

12:43 p.m. _ He’s summoned to another room, where a clerk asks him his income ($35,000 a year), whether he has been in combat since 1998 (yes), and whether he has had any alcoholic drinks in the past year (one or two since returning from Iraq in October).

1:15 p.m. _ The initial receptionist escorts him to another room, where she takes his blood pressure and asks what ails him. Pain in shoulders and arms, he says. On a scale from 1 to 10, he puts it at 9.5. Returns to waiting room.

2 p.m. _ Called to Exam Room 3, where a doctor examines him. Is sent back to the waiting room.

2:45 p.m. _ Martin’s head bobs as he fights to stay awake.

3 p.m. _ Summoned upstairs for X-rays. Stacks of ancient National Geographic magazines rest on a table in the waiting area.

3:12 p.m. _ A technician calls “Emily Martin.” Martin grumbles. “Emery,” and painfully lifts himself out of his chair.

3:25 p.m. _ With the X-ray over, he makes his way back to the first-floor waiting room. “Judge Judy” blares from the television.

4:16 p.m. _ Takes a swig from his 20-ounce Coke and slips outside for his sixth smoke of the day.

4:34 p.m. _ Called to Exam Room 3 again.

4:41 p.m. _ Receives a prescription for Diclofenac, an anti-inflammatory, and heads down the hall to the pharmacy.

5:05 p.m. _ The clerk calls his name, he retrieves his prescription and heads home.

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MORE VETERANS SEEKING CARE

Salisbury and its medical satellites, including Charlotte, had the following numbers of unique visitors:

2000: 31,515

2001: 36,898

2002: 40,348

2003: 49,029

2004: 53,315

2005: 56,717

2006: 60,613

Source: Veterans Affairs

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For more information on veterans and military health issues, see McClatchy Newspapers’ “Wounded Warriors” blog: http://washingtonbureau.typepad.com/veterans/

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(c) 2007, The Miami Herald.

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