I'm going to try and make a long story short.

I've been trying to get into the pain clinic for a year now. Had an appointment a year ago, was about to be seen when I had heart problems and a code blue was called on me. I have hyptertension and tachycardia, but it was extremely bad that day due to the anxiety of my pain(which I've been experiencing for the past year due to no treatment). The dr. that was supposed to see me has been telling me for the past year to see dermatology and reuhmatology. It's been a visous cycle. Once I see both of them, I call the pain clinic asking to be seen, and they tell me
I have to contact my primary care for a new appointment. My PCP writes the new consult, and then I get a phone call from the pain clinic telling me I need to be seen by dermatology and reuhmatology. My primary care didn't believe me when I told them what was going on. They assumed I Was doing something wrong. It wasn't until about a week and a half ago I got a message on my answering machine from the reuhmatology dr answering the question I had that my primary care believed me. The question for the reuhmatology dr. was; "What the hell else do I need to do before I can be seen by the pain clinic, and can you contact them and tell them you cleared me to be seen by them.". I let my primary care nurse listen to her message on my answering machine which consited of, "There's nothing I can do, I've already wrote in your chart that you've been experiencing pain, and that I recommend you be seen by the pain clinic.". I've gotten the same response from dermatology.

My question:

1. What's the VA's policy on pain management?
- I know it's got to be like other hospitals where it's supposed to be treated timely.

I've been suffering for over a year now. Before then I was getting adeqate pain control while active duty, but for whatever reason the VA decided to put an end to that. Do I have a case?


Another question:

My primary care nurse wants me to call the pain clinic tomorrow and demand an appointment. I'm sure they're going to do the same thing they've been doing. Who do I contact to get this corrected? Do I contact the patient advocate? Do I threaten a malpractice lawsuit?

I'm at the end of the rope with these guys. I've had enough. I need answers though because I have to contact them tomorrow. Thanks in advance guys, you guys are great.

Forget the Pt Advocate. I've never had any luck with them.
What about going to the ER and demanding to be seen? Show them their own copy of the Patient Rights which are posted all over the VA which states that pain is supposed to be controlled (or some language to that affect).

I've never had to deal with a pain clinic of any kind; but I've had to deal with other clinics where all you get is the run-around.

Either that or go and sit in the Director's office until someone will speak to you or help you.

File an IRIS complaint as well....use names....hold folks accountable. Do that tonight! But that's just me.....

Sounds like a claim for depression secondary to service connected _____________________. I too would go to the ER, constantly. The squeaky wheel gets the oil.

I already have depression that's in my SMR, but I believe it was misdiagnosed. Should be anxiety, but that's another post.

My thing about the ER, what are they going to do? Their not going to get me an appointment. Also, the ER is an hour and a half away. So it's not that easy.

Here's what I'm thinking about doing tomorrow thus far, unless I get any other ideas/suggestions.

1. Call pain clinic and demand an appointment.
-no results, then go to step 2
2. Call patient advocate. Threaten to get a lawyer and file malpractice lawsuit, and VAOIG.
-no results, then go to step 3
3. Call VAOIG, Congressman, and lawyer.

Sound good?

I guess I left this part out also, it's not really pertinent, but... I am getting vicoden right now, and have been for the past 4 months fromt he VA. It doesn't even touch the pain. Before I got out of the Navy, I was getting perscribed Lorcet 10/500 4 times a day, 10 mg +20mg oxycodone 1x a day. So I went from that, to vicoden 3 x's a day. I was still in pain with all those meds while I was active duty, but the dr. didn't want to give me any more than that due to the nature of my job. The point I'm bringing this up, I forgot to mention that my PCP said she can't give me any more vicoden until I'm seen by the pain clinic. So, I'll really be down and out. Not only dealing with pain, but withdraw.

This is just unacceptable in my book, and honestly sounds like a case of malpractice. I seen a new directive from the VA that was forced into law by congress back in October of last year. It states that pain is supposed to be dealt with promptley when brought before the attention of a provider. My pain was not only not taken care of promptley/at-all, but it's being neglected and they think what their doing is okay.

Any other ideas? I have to try and call them tomorrow, and want some ammunition.


Also, the malpractice suit really sounds good at this point. I could really use the money considering on the other side of the VA I'm getting screwed as well.

You could always go to a civilian ER...then have them bill the VA. I mean it all depends on how bad your pain is.

Purple,

All an ER around here will do is give me a couple days worth of meds. I'd have to keep going back every couple days. My luck, the VA would find some way to get out of paying, and I'd be stuck with all those VA bills. If there's a way something can be construed the other way for the VA, it always happens in my case.

Thank you for the suggestion/input.

As always, you guys are great!

Can you just GO to the pain clinic - and tell them you NEED to be seen? Though they may say you need an appointment - I would think they may have to see you at some point - or someone might have to do something!

Free

Sir, your latest plan seems to be in line with what is required.

My only suggestions would be to keep in mind that you are dealing with the VA and:

-make your demands for the appointment in a civil manner - you do not want to be listed as a possible problem within the the VA health circles.

-If you are not successful and you have to implement plan number 2, my suggestion would be to inform the Pt Rep that your next steps are - the VAMC Director's office, the VAOIG and then if necessary congressional assistance in gaining the required appointmnet. Stay away from the malpractice threats. First I am not sure that what you are experiencing will raise to the level needed for a malpractice action and second, in any civil action you never expose to a possible defendant your intended actions - the element of surprise is always your number one goal. I feel that with a valid consult from your PCM you will get relief at the Pt Rep level.

Just remember, no matter how pissed you are remain extermely firm but civil. I know that it is hard for those of us with pain as I suffer from Dejerine-Roussy Syndrome due to a stroke, and trust me being civil is the farthest thing from my mind at anytime of the day!!!!

Living, first assessment of your post I see you need help, like yesterday! Get that pain clinic appointment soonest.

Yes, livingrock, you need help and answers. I have an idea. Since you very well stated the medical care that you need on this post, can you cut,past and copy your concerns and needs into a letter? Then now, as you very humbly, sympathetically ask for help, thanking repeatedly everyone that will take a moment to listen to you. Now if that doesnt work, the letter will give you a means to communicate with the patient advocate by written form - stating what your needs are. Take it one step at a time, but don't cave in, start at the clinic, the patient advocate, then if needed, in emergency go then too - dont compromise your health get to the care you need.

Whatever you do, squeak, but my thoughts, dont squawk that m-practice word, sounds threatening. Of course that doesnt mean you can't write down a medics name and what they look like (red hair, short, tall or bald...). You can keep notes as you go, but the facts should be the things that count; like following a doctors or clincians orders or requests, prescriptions, pain clinic triage and emergencies. Personalities aside, you are dependent on this care and need their help.

The pharmacy should be able to help you 'intervene' with the pain clinic if needed; they are supposedly the experts on providing correct dosages under doctors orders and understanding vital prescription reactions for the veteran they serve.

Again, I believe if after your pain clinic appointment, you can address the pharmacy, the pain clinic, your PCP and patient advocate, the chaplain (whoever else you think will listen) in a letter requesting immediate assistance to prevent you from having interruption in your long standing prescription that could cause traumatic health issues if not tended to soonest.

jmho, trying to help,
Cg'up2009!

I agree with your plan of action, and I completely agree with Clown Man's advice. FWIW, each VAMC is different. My pain management clinic wasn't much help. My primary care is in complete control of my pain meds, and he prescribes as he sees fit. I think it may be time for you to step up to methadone or morphine to help with the pain and relieve the withdrawals, but I'm no doc.

Well, I guess I'm gonna be the "contrarian" here this morning.
I feel that I have been listened to by the Patient Advocate and helped more by them than by anyone in the VAMC here in Dallas.
I do feel that you need to GO to them, don't call, don't mail, GO to them and explain that you are at the "end of your rope", that you have exhausted all normal means of communication with the PCP and the other docs and that you need help and "Where would you like for me to sit and wait while you help me get this straightened out...........?"

Do NOT threaten mal-practice. Do NOT threaten to escalate your problem any further than you have. Play on their basic human instinct to help someone that is in pain. Give them the opportunity to help you. "I need help, I'm in pain and I don't know what to do and I'm gonna give you, as my advocate, the opportunity to help me."

Honey works a whole lot better than vinegar.

By all means contact the Patient Advocate- some are not too good but many are GREAT.

A local vet here had a problem that he asked me to resolve-
he gets so angry when things happen at the local VA that he becomes too belligerent and they wont listen to him-

He gave the PT advocate permission to talk to me and she got the problem resolved in a few hours.

I dont see any basis for negligence charges here-
the VA -from what I can tell- did not cause you any additional disability due to negligence----yet

one trick I used to use-if the VA gave me some crap about my husband-I would rattle off a local phone number to them and then search for change in my purse-or look for my cell phone-
when they asked what that phone number was for,
I told them it was my congressman's office in Bath NY and I was either going to the VA lobby to use the pay phone or find my cell to call him-

That often brings some action-

but try the PT advocate first.

These posters are plastered all over every VAMC.
Scroll down almost to the bottom.
Hope this helps a vet.
carlie


http://www.patientadvocate.va.gov/Rights.asp


Patient and Nursing Home Resident Rights and Responsibilities

I. Respect and Nondiscrimination

• You will be treated with dignity, compassion, and respect as an individual. Your privacy will be protected. You will receive care in a safe environment. We will seek to honor your personal and religious values.
• [/color]
• You or someone you choose has the right to keep and spend your money. You have the right to receive an accounting of any VA held funds.
• Treatment will respect your personal freedoms. In rare cases, the use of medication and physical restraints may be used if all other efforts to keep you or others free from harm have not worked.
• As an inpatient or nursing home resident, you may wear your own clothes. You may keep personal items. This will depend on your medical condition.
• As an inpatient or nursing home resident, you have the right to social interaction and regular exercise. You will have the opportunity for religious worship and spiritual support. You may decide whether to participate in these activities. You may decide whether or not to perform tasks in or for the Medical Center.
• As an inpatient or nursing home resident, you have the right to communicate freely and privately. You may have or refuse visitors. You will have access to public telephones. You may participate in civic rights, such as voting and free speech.
• As a nursing home resident, you can organize and take part in resident groups in the facility. Your family also can meet with the families of other residents.
• In order to provide a safe treatment environment for all patients or residents and staff, you are expected to respect other patients, residents and staff and to follow the facility's rules. Avoid unsafe acts that place others at risk for accidents or injuries. Please immediately report any condition you believe to be unsafe.

II. Information Disclosure and Confidentiality

• You will be given information about the health benefits you can receive. The information will be provided in a way you can understand.
• You will receive information about the costs of your care, if any, before you are treated. You are responsible for paying your portion of any costs associated with your care.
• Your medical record will be kept confidential. Information about you will not be released without your consent unless authorized by law (an example of this is State public health reporting). You have the right to information in your medical record and may request a copy of your medical records. This will be provided except in rare situations when your VA physician feels the information will be harmful to you. In that case, you have the right to have this discussed with you by your VA provider.
• You will be informed of all outcomes of care, including any potential injuries. You will be informed about how to request compensation for any injuries.

III. Participation in Treatment Decisions

• You, and any persons you choose, will be involved in all decisions about your care. You will be given information you can understand about the benefits and risks of treatment. You will be given other options. You can agree to or refuse treatment. You will be told what is likely to happen to you if you refuse treatment. Refusing treatment will not affect your rights to future care but you take responsibility for the possible results to your health.
• Tell your provider about your current condition, medicines (including over-the-counter and herbals), and medical history. Also, share any other information that affects your health. You should ask questions when you do not understand something about your care. Being involved is very important for you to get the best possible results.
• You will be given, in writing, the name and title of the provider in charge of your care. As our partner in healthcare, you have the right to be involved in choosing your provider. You also have the right to know the names and titles of those who provide you care. This includes students, residents and trainees. Providers will properly introduce themselves when they take part in your care.
• You will be educated about your role and responsibilities as a patient or resident. This includes your participation in decisionmaking and care at the end of life.
• If you believe you cannot follow the treatment plan, you have a responsibility to notify your provider or treatment team.
• You have the right to have your pain assessed and to receive treatment to manage your pain. You and your treatment team will develop a pain management plan together. You are expected to help the treatment team by telling them if you have pain and if the treatment is working.
• As an inpatient or nursing home resident, you will be provided any transportation necessary for your treatment plan.
  You have the right to choose whether you will participate in any research project. Any research will be clearly identified. Potential risks of the research will be identified and there will be no pressure on you to participate.
  You will be included in resolving any ethical issues about your care. You may consult with the Medical Center's Ethics Consultation Service and/or other staff knowledgeable about healthcare ethics.
• If you or the Medical Center believes that you have been neglected, abused or exploited, you will receive help.

[color="#ff0000"]IV. Complaints

• You are encouraged and expected to seek help from your treatment team or a patient advocate if you have problems or complaints. You will be given understandable information about the complaint process. You may complain verbally or in writing, without fear of retaliation.

As always, THANKS! You guys/gals are really great. I honestly don't know where I'd be without you.

I contacted the pain clinic this mourning when they opened up. Didn't get any answer, I got the machine. I explained to them my situation. I also politely, but firmly told them that if the issue wasn't resolved by noon that I'd be contacting the patient advocate.

I'd really like to go all out and contact the VAOIG, ect. I was def. more mad than anything last night when I was writing all that last night. I hope the pain clinic decided to resolve this situation with out me having to contact the patient advocate. We'll see, I'll keep you all posted.

Thanks again,
Tyler

I think you did the right thing. We'll know soon enough....keep us posted.

I'm getting antsy.

I don't like being this guy. The guy that gets everyone involved in trouble, but I just need to keep it in my head that this is unacceptable. Also, I need to keep in mind that I need to get this fixed so they don't do it to some other veteran.

Just tried calling the patient advocates office. I'm going to give them an hour-hour and a half and then try calling back. I'll let them know in that message (if they don't pick up again) that I'll be down at the VAMC all day tomorrow, and that I'll be in and our of their office plus the directors office.

I'm just adjitated at this point... I've had enough, and I'm not taking this crap anymore. I was hoping to have some resolution by now. My physicians nurse wants a call by the end of the day to let her and my physician know what's going on. I've been thinking about this all day, and I'm wondering how much of this is their fault. Also, their telling me that they want to help, but in the same sentence telling me their going to take me off the weak pain med that they have me on. Actually, the way she worded it made it sound like it'd be an abrupt suspension of the medication which would cause me to withdraw, now you tell me how that's helping. The know none of this is my fault, but their adding to the problem/stress. I believe I'm going to get them involved in my conversation with whomever decides to help me.

AAAAAGGGGHHHHH!! Ok, I feel a tiny bit better..

The situation is taken care off, I'll post more on it here in a little bit. I have to make a few more calls to make this happen though.

Livingrock, glad you posted on forum and asked for advice. It is frustrating to have to deal with pain and pharmacy needs. But keep standing up for yourself, you'll make it. I am sorry that you are struggling to get the care you need. I know you'll help them get it right.

Had a pharmacy issue a short while back. There is one med that I 'have to' take daily, had delayed mail delivery, traveled to the pharmacy for a 'carry-over' amount. The pharmacy clerk was stubborn mule sitting on dull hindquarters and read my computerized VA medical records for several (10) minutes ?, screen facing 'him' only, while I waited anxiously. Well, I got the 'carryover' meds, at a price. Won't do that again, that was nervewracking.

Family doc was right, be cautious about wanting medical records computerized. Hippa or not, it'd take a month of Sundays to see who had access to records at one time or another..etc. (sorry, my rant!)

Do take care, you deserve kindness and sound like you need support if not by the patient advocate maybe the behavioral health clinic. For instance, another clinic refused to release a report, my psych dr. practiced his sailors language, trotted me directly to the clinic; needless to say, I got the report. (even a telephone call woulda worked, but he was stoked). So in the future, maybe I'll use Bertas game plan and call for behavorial health backup..smiles.

God Bless and good luck,
Cg'up2009!

"Family doc was right, be cautious about wanting medical records computerized. Hippa or not, it'd take a month of Sundays to see who had access to records at one time or another..etc. (sorry, my rant!)"


Funny that you should mention this. My wife just enrolled in Northwestern University's Master in Medical Informatics. She already has her BSN and her MPh.
Looks like she'll be employed for a while to come before anyone thinks about laying her off. The President is going to throw a few Kazzilion Dollars at this speciality. Tank youse Mr. Obama!

I swear I have the worst luck. I just hit submit and I got an error, and of course when I hit the back button my post disappeared. I guess I'll try to rewrite what I had wrote.

Cowgirl, you are such a kind sweet heart. Every one on here deserves a standing ovasion(SP). I cannot say in words how appreciative I am that you guys/gals help other veterans such as your self. Even though other people may not say it, I'm sure everyone else feels the way that I do. Please keep up the good job. I really don't know where I'd be at this second if it weren't for you all. I'd probably be locked up, or in a patty wagon on my way.

Like I said, I got my problem taken care of, I'm now just waiting on my PCM to put a new consult in the system. After I called the clinic for the second time with a little 'firmer' words on their answering machine, I got a call back from the chief of the pain clinic. He was appauld at the situation, and couldn't believe this was happening in his clinic. He may have just been putting on a show, but he seemed sincere. He appoligized, and also appoligized on the 'treating' dr.'s behalf for the way he treated me. He re-assured me that I wont be having any other problems in his clinic, to make sure of this, he actually gave me his office number and told me to call with even the smallest problem.

Lessons Learned:
- A few polite, but firm words can honestly go a long way. It didn't hurt that I had proof of them mistreating me, and supposibly had my PCM backing me up.


I'm sure I'm leaving stuff out, but I'm just happy to finally have an appointment. The chief of the clinic is actually the one that scheduled me.

See, One More Battle....Fought and Won!

Way ta go!

I know, we all know, what it is to be either in pain, or to be ignored.......but, to be both in pain and ignored is JUST NOT RIGHT!

LarryJ,

It does feel really good. This must be what it feels like when you get the grant deserved from the VBA except multiplied by 10. Can't wait for that day. Hopefully it'll be some day soon.

Great!!! Glad things worked out in your favor.

Wouldn't have been possible with out you all! Really.

I know I would have done something on my own that would have had adverse affect. Guaranteed. Just like in the past.

Congratulations! Hope your claim works out as well.

I am glad that you were able to move forward in your treatment! Great job.

I really believe me being polite had a lot to do with it. I was polite but also at the same time let them know that I wasn't taking their crap anymore, and that I knew who to go to. It was def. a good experience.

You know, their playing the game again.

Since I was on here last. I had an appointment with pain management. They said they were going to prescibe some new meds, and haven't yet. I'm truely thinking about filling a lawsuit for pain and anguish.

I'll be using the same game plan I did last time, and see where that gets me. If no results, I'll be contacting a lawyer. May just do that anyway.

I'm so fed up with this VAMC clinic. This is absolute bull sH%t.

One thing I've learned with the VA over the years is that when they say they are going to do something...I have to call and make sure they did it; it's like babysitting. Sad, but true. I have to do this with my PCP quite often for med refills.
Have you tried calling them to see if they forgot? Or see if they did put in the meds and perhaps the pharmacy screwed it up?
Try giving them a call...I know it sucks and it's wrong that we as vets have to babysit the VAMCs like this, but it's often what we have to do.........................btw, keep notes.