Mental health failure by the VA. Part I. Most of the backstory from May 2017 until September 2017.

This letter is being written on September 8, 2017. There has been little to no follow up on this incident or my continuing mental health issues. No one has contacted me about the incident I was subjected to. I submitted previous versions of this message to the Patient Advocacy Department, the Patient Safety Department, and the inbox for the provider who created the message through the Blue Button system. This was done so this message could become a permanent record in defense of myself. That message was submitted on September 1, 2017, and all of the messages submitted outside of the provider, have been sent to the Columbia Missouri VA system which I was enrolled in previously.

The following is the entire message that was submitted in response to my visit on July 21, 2017, at the Lancaster CBOC in Lancaster, California. This CBOC is part of the Greater Los Angeles Veterans Affairs System. I have posted the message in its entirety. I will address the points that I disagree with and provide my side of the story.

LOCAL TITLE: LANCASTER NURSE PRACTITIONER NOTE STANDARD TITLE: NURSE PRACTITIONER NOTE DATE OF NOTE: JUL 21, 2017@13:18 ENTRY DATE: JUL 21, 2017@13:18:29 AUTHOR: *** **** EXP COSIGNER: URGENCY: STATUS: COMPLETED *** LANCASTER NURSE PRACTITIONER NOTE Has ADDENDA *** CC: This patient is a 29 year old MALE who comes in to be established as a new patient. This veteran was scheduled for an appt June 27, 2017 but because of an emergenc at home this provider had to leave and the pt’s for that day rescheduled. it was brought to my attention that the veteran came to the clinic anyway and demaned be seen but there was not an available provider to see him. he then became very upset in the lobby. he stated in a loud angry tone “yeah I am just going to go out and kill someone” and left the building. I am not sure if this incident was reported or not. he then was resceduled with me again today and I entered the room and apologized for the emergency. he stated it was ok and he wasn’t mad at me he is just mad at the whole system. I proceeded with the new pt questions and things escalated rapidly and the pt started raising his voice and becoming angry again. knowing that the previous incident happened he started making this provider nervous so I left the exam room and the pt started pointing at me and still raising his voice. I notified the security gaurd and he notified our in house psychologist who proceded to speek with the pt.

PHYSICAL EXAM:

General: 29 year old MALE in no acute distress. Vital Signs: BP: 97/60 (07/21/2017 13:07) Pulse: 63 (07/21/2017 13:07) Resp: 16 (07/21/2017 13:02) Temp:98.1 F [36.7 C] (07/21/2017 13:02)

… /es/ *** **** NURSE PRACTITIIONER, STGI Signed: 07/21/2017 14:36

“it was brought to my attention that the veteran came to the clinic anyway and”

Saying I came to the clinic anyways seems to be attempting to show some level of defiance. I called the West Los Angeles VA Appointment line at approximately 9am on the morning of the appointment. I was told by the clerk that it was necessary to go in at that time because my lab work had a fasting requirement that I was previously unaware of since my labs were scheduled at 1 pm. I went to the clinic and checked in for my labs. It was at that point that I was informed that my appointment was canceled.

demaned to be seen but there was not an available provider to see him”

I was not demanding to be seen, I was pleading to be seen. June 27 was almost two months away from when I had first been prescribed Lamictal. It was a last minute emergency step to try and treat for possible bipolar. As a combat veteran with 90% disability, 70% rated for my PTSD, I should never have had to see a primary care manager when the VA is fully aware of my conditions. This will be stated in my words as being “mad at the system,” later on. I say this statement because it feels criminal that a veteran with a behavioral health emergency is to be turned away. The news has been filled with stories about veterans killing themselves at VA clinics, this is nothing new. Regardless of that, the VA should never turn away a behavioral emergency under any circumstance. Being told that the next appointment was not for an additional four weeks was absolutely unacceptable. I was running very low on my medication, and I had already been waiting several weeks. I knew that I ran the risk of running out of medication.

“he then became very upset in the lobby. he stated in a loud angry tone “yeah I am just going to go out and kill someone” and left the building.”

I refer back to my condition at that point and how it felt to be abandoned, yet again, without a shred of human decency? I had joined the Army at 17 in 2005, knowing full well that my combat job would take me to Iraq. I was enticed by the promise of “world-class healthcare,” and that was comfort enough for me to join.

I was made to wait longer for the approval of a primary care doctor to go get a referral to go see a specialist when I am affected with severe PTSD and have a history of chronic suicidal ideations.

Yes, I was angry. In hindsight, I wish that I could have responded differently and more rationally, but I am fighting against severe PTSD, Bipolar, and a very unstable mental condition. The very first that went through my head was the burning desire to have a gun so that I could blow my head off in front of the VA. This way the employees would be forced to have the knowledge of what happened that day. This idea was based on the principle of trying to be another squeak in the wheel of injustice towards veterans and their health needs.

“I am not sure if this incident was reported or not.”

If the incident was not reported, then how did she hear about it? Surely an incident like this would not go unreported?

“he then was resceduled with me again today”

I was not rescheduled again. I was rescheduled. It seems that she wants to create this imaginary connection that I am some kind of a problem. This is shown again in the next statement.

“and I entered the room and apologized for the emergency. he stated it was ok and he wasn’t mad at me he is just mad at the whole system.”

She did not enter the room and apologize as she stated. When she opened the door, the very first sentence she said to me is “Am I going to have a problem with you?” She stated she heard what I did at the last appointment was kept repeating how she had an emergency. In the repeated storytelling, she gave me several examples of what an emergency means.

She told me how as a provider, there were no other providers when she was not present at my appointment.

She told me how if I was to drop a car off at a mechanic, I could not possibly expect the car to be ready if the mechanic had an emergency because he was not there to fix the car.

I felt like I was a 5-year-old child the way I was being talked to.

Through all this, I was completely calm and collected. I had joked with the security guard upon entering, I was relaxed with the admissions clerk and the nurse who took my medical history and vitals. She is also backing up the same storyline that I have had since the incident occurred. I was fine at this point, I was not mad at her and made it clear what I was mad at, the system. While I was trying to finish my sentence about my frustrations, she cuts me off.

“Sure, but you cannot expect me to be here if I have an emergency, it doesn’t work like that.” was her interruption.

I am sure that she might have made an apology at some point in this conversation, however, if she did it was completely overshadowed by the actual content of her statement.

I would also like to point out that she keeps referring to an emergency, while completely disregarding my own psychiatric emergency. She is aware of this emergency because she knows my history of just being a patient with homicidal thoughts.

“I proceeded with the new pt questions and things escalated rapidly and the pt started raising his voice and becoming angry again.”

She did begin the new patient questions. She had her back to me the entire time. She did not look at me until the last few minutes of the appointment. Every question was asked in a tone that felt like I was a bother to the provider. Eventually, she asked what “my problem was.” I asked for her to clarify because I have a lot of medical issues and was trying to be seen for multiple referrals since I had a 60-minute appointment. She repeated the same question again. I was becoming very frustrated at the treatment that I was once again receiving from the VA healthcare system. I was raising my voice because I was starting to break down.

What does she mean by things escalated rapidly? What was happening when things began escalating? I feel that she is purposely keeping her statements vague because it is going to be hard to remember the amount of lies and omissions she has made so far.

She states I was “becoming angry again.” This again is making an imaginary connection that I am “crazy,” or at the very least, angry over the incident the previous appointment. The two incidents had anger stemming from two completely different reasons. I was angry previously this day, so where does the word “again,” fit into this statement? This also points to her confusing stance of whether she thought I was a hazard to her prior to this point or not.

I had to go to the emergency room between the two VA appointment dates to refill my Bipolar medication because I ran out due to the inability to be considered for an emergency refill without the required referral and appointment with behavioral health. I have also stated several times that I was completely unmonitored on this new medication. It was never the intention of the provider who gave me the medication in Missouri for me to go months without follow up appointments.

“knowing that the previous incident happened he started making this provider nervous so I left the exam room and the pt started pointing at me and still raising his voice.”

This statement brings us back to asking why she would be harassing me from the very moment she walked into the room? Even taking her words at face value, she walked in, said sorry and then started asking questions and I became angry. This placed the blame on me.

She indicates that she knows about the previous incident. So why would she not ask her nurse, who was a male, or the security guard to accompany her for safety? Or have one of them standing outside of the room? What kind of training has this provider and other providers been given to respond to veterans in critical situations like my own?

Why would she sit in a room with the door shut and her back to a known patient with severe PTSD and homicidal and suicidal ideations?

Why did she never activate the rooms panic button? Do the providers wear a panic button on them? If so, was it activated?

She also exited the room with her back to me. She also proceeded to raise her voice saying “He needs to be removed immediately! He needs to go! He needs to be removed!” This is said out in the hallways, within earshot of all in the building, identifying me as a problem and removing any chance of a fair review since I am now the scary irrational angry veteran.

I was pointing at her because I was trying to tell her that it was providers like her that caused veterans to kill themselves. Because it is exactly what I felt. I wanted to no longer exist so that I could escape the anger and humiliation that I faced from her. I was able to convey my message between the crying and breaking in my voice. The entire time she is standing with her arms crossed squared off of me at about 10 feet down the hall stating “You better be careful about what you say, you better watch what you say.” Over and over she gave this taunt while she had only one other nurse around her.

“I notified the security gaurd and he notified our in house psychologist who proceded to speek with the pt.”

She might have informed the security guard, but he had absolutely no idea what was going on. He just gave me a confused look. He had seen me during my first appointment, so he was also somewhat aware of me. He never touched or engaged me in conversation.

I left the clinic and was walking towards the street when I returned to the clinic. I asked to speak with the director of the clinic. I was told she was on vacation. I asked to speak with the acting director and I was told that person was absent as well. I was then introduced to a Social Worker who took me back and I told my story too.

While I was being taken back to the Social Worker’s office, the provider was following me down the hallway. The entire time she was repeating her calls for me to be removed immediately. Nevermind the Social Worker, nurse, and security guard following.

The Social Worker attempted to help me but was limited by the constraints of the VA. I then left the clinic and returned a few moments later. I was waiting for my wife to pick me up as at this point I was unable to drive due to my conditions.

I returned to ask for anyone who might be in charge or who I could file a complaint with. I was met by a different Social Worker who brought me to her office. She tried to help as well in regards to my medication, calling two psychiatrists in an effort to get me medication. The first provider stated he stopped doing work at the Lancaster CBOC due to staffing shortfalls, having to focus only at the West LA VA hospital.

The second provider was told he was on speaker phone and that I was there with her. She asked about an emergency prescription of my bipolar medication and he stated that if I don’t have a prescription then just go to the emergency room again. This statement was made in a tone bordering disgust.

PHYSICAL EXAM:

General: 29 year old MALE in no acute distress. Vital Signs: BP: 97/60 (07/21/2017 13:07) Pulse: 63 (07/21/2017 13:07) Resp: 16 (07/21/2017 13:02) Temp:98.1 F [36.7 C] (07/21/2017 13:02)

The nurse or the provider entered these vitals, which clearly shows he was not in an aggressive mood. My blood pressure is commonly on the lower end. I was stated as being in no acute distress, but yet was portrayed to have just exploded.

Addendum:

The following is the addendum that the first provider I encounter after the incident wrote in. I do not have any objections to her side of the story, with the exception that she did not have an understanding of the situation and did not describe it properly. She said I just became agitated, which again I feel that with all the evidence proposed, shows that this was not the case. I completely understand this is possibly some rule or standard to be followed, a note of the disagreement is simply being made.

07/21/2017 ADDENDUM STATUS: COMPLETED The veteran became agitated during his appt with his PCP. He left the building and then came back in, and I spoke with him briefly in the waiting room. Brought him back to triage room. Patient stated that he just wanted “respect” and “bedside manner”. He recently moved to the area, from MO. He will be out of lamictal in 3 days. Staff contacted Dr. K. while I was with the patient. Dr. K. did not want to refill the lamictal, so we will try to get that done on Monday. The veteran denied SI/HI. He states that he has prior bad experiences with the VA and was “mad at the system”. He also has tri-care, but has not been able to find a psychiatrist in the Antelope Valley that will take that insurance. The veteran was able to calm down and asked to leave the clinic. He was given my name and contact info, and instructed to contact us on Monday, to insure that he gets his lamictal filled.

/es/ *** ****, PHD CLINICAL PSYCHOLOGIST Signed: 07/21/2017 15:11

Note: All misspellings in the message were organic to the message. I did not do it for silly points.


Photograph information.

An abandoned homesite in the Mojave Desert in California. Just to the south a few dozen miles, the California Aqueduct carries billions of gallons of water through the desert.