Veterans, families call WBTV for help with delays at VA medical centers

OYS: Veterans Affairs investigation
Published: Feb. 22, 2016 at 10:51 PM EST|Updated: Feb. 26, 2016 at 3:58 AM EST
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SALISBURY, NC (WBTV) - An On Your Side investigation has uncovered new delays in treatment at area VA medical facilities after receiving multiple calls for help from area veterans.

The veterans who called for help were treated across multiple facilities and, in some cases, faced different types of delays. One common theme, though, is each veteran's frustration with a system they say doesn't work and fails veterans.

For months, On Your Side Investigates asked questions of spokesmen at local VA medical centers to little avail.

What our investigation has uncovered has prompted U.S. Senator Richard Burr (R-NC) to call for the accountability of the agency's top leader.

Failure to communicate

Todd Hilderbran first called On Your Side Investigates for help out of frustration. It had taken months—and countless phone calls—to finally be approved by the VA to see a private eye surgeon.

Hilderbran qualified for the VA Choice Program, which was created in the fall 2014 to address a massive backlog of patients waiting to see specialists at many VA medical facilities.

The program allows veterans who need specialty care but who would have to wait more than 30 days to see a VA specialist to receive treatment from a private medical provider instead.

In Hilderbran's case, he needed to see an eye surgeon about a buildup of fluid and pressure in the back of his eye.

Medical records provided by Hilderbran show an eye doctor at the Hickory VA clinic referred him to a specialist on October 29, 2015. A VA specialist wouldn't be able to see him until mid-January, which meant he qualified to see an outside specialist through the Choice Program.

"The very next day, October 30, they got a hold of me—bam, real quick," Hilderbran recalled. "I was like 'hey, this is going to be a pretty easy way to slide this time' you know?"

What seemed like smooth sailing turned into anything but. The call Hilderbran received on October 30 told him to call the Choice Program's third-party administrator in seven to ten days; the time it would take to transfer Hilderbran's eligibility information to Health Net, the private company that administers the Choice Program.

But when Hilderbran called Health Net 12 days later, they still didn't have his information in their system.

A representative told him to call back in another ten days, which he did, with still no luck.

"They had never signed me up yet," Hilderbran said in disbelief.

Hilderbran finally saw a private eye surgeon through the Choice Program on December 29, exactly 60 days from the date of his referral.

"Once the eye clinic up here finally found out that I needed to get in, it took a week to get me an appointment. That's all it took—one week!" Hilderbran said. "The only thing that slowed this down was the VA."

In response to questions from On Your Side Investigates about the VA's delay in transmitting Hilderbran's information to Health Net, a spokeswoman for the Salisbury VA Medical Center insisted his information was sent on October 30.

But an entry in Hilderbran's medical records show his information was actually sent on November 25, nearly a month after he received a phone call saying he qualified for the Choice Program.

"I'm thinking, is it getting so bad that I'm going to lose my eyesight in my eye before I get to the ophthalmologist?" Hilderbran said.

The Salisbury VAMC spokeswoman ultimately acknowledged the delay in transmitting Hilderbran's information to Health Net after On Your Side Investigates brought the notes in Hilderbran's medical records to her attention.

Hilderbran's message to the VA leadership about the Choice Program is simple.

"It's not working. It doesn't work at all," he said. "It's another incompetent bureaucracy."

WE WANT YOUR FEEDBACK:  If you've had issues with the VA, make sure you read the entire story. At the bottom, there is a way for you to tell us your story.

Unpaid Bills

Marine veteran Jim Bancroft is angry. He's angry it took more than a year for him to be referred to see a specialist and, now, he's angry that problems with the VA Choice Program has forced one private specialist to say it cannot treat him for any new problems.

Bancroft was diagnosed with several spine- and nerve-related conditions, among other things, in the fall 2014 but doctors at the Dorn VA Medical Center in Columbia, S.C. didn't refer him to a specialist for more than a year.

Instead, it took months of pleading and a call to his congressman to get a specialist referral.

"That's unacceptable," Bancroft said. "That's not healthcare. That's complete neglect and it has nothing to do with my veteran status. It has to do with neglect of a patient."

Bancroft finally got an appointment to see a doctor at Carolina Neurosurgery & Spine Associates through the Choice Program in December.

But when he asked to be examined for a second neurology-related issue, he was told that the practice was no longer taking new VA Choice patients or treating existing VA Choice patients for new ailments.

Why? The Choice Program, Bancroft's doctor said, had stopped paying its bills.

"We have tried for some time to work with VA Choice and have devoted significant resources to this effort," Carolina Neurosurugery CEO Mary Cloninger said. "However, due to the complexity of VA Choice's pre-approval process for providing care and the deficiency in claims processing for healthcare services we have provided, we have determined we could no longer continue to see patients who are using VA Choice to pay for their healthcare."

A spokesman for Health Net, the company that is responsible for paying the private medical providers who see VA Choice patients, issued the following statement in response to our questions:

"We have reached out to the health care provider to let it know that we are working with its leadership to address and resolve the issues that have surfaced. While it is our hope that the provider continues participating in the Veterans Choice program, local veterans should know that our Charlotte-area Choice network includes 10 other neurosurgery providers.

Health Net Federal Services is working closely and collaboratively with the Department of Veterans Affairs (VA) to improve the pace of provider reimbursement by streamlining VA's claims processes.

In addition, we are educating the providers who participate in Veterans Choice on claims payment requirements, which speeds the reimbursement process.

In the recently released "Plan to Consolidate Programs of Department of Veterans Affairs to Improve Access to Care," VA calls for a simplified provider payment process. We agree with that recommendation, and we believe it will help reduce confusion and payment errors by standardizing reimbursement practices with the Medicare program, which is more widely accepted by physicians.

Health Net Federal Services is indebted to the men and women who have bravely and selflessly served our country, and we are committed to administering a program that pays their doctors timely."

Bancroft, who has private medical insurance and pays for his treatment through the VA, said he has been shocked and discouraged by the VA's handling of his medical treatment.

He has a simple message for the VA's leadership.

"Retire, resign or be thrown out. You are not leading an organization that is showing any positive concern for the veterans you're supposed to be serving," he said.

Report identifies deficiencies

A report released by the VA last October highlights many of the problems experienced by Todd Hilderbran and Jim Bancroft in their quest to get treatment through the VA Choice Program.

"Currently, VA's process for referrals and authorizations to coordinate care, manage clinical utilization, and improve health outcomes is largely manual," the report reads. "This causes delays in care and inconsistency in reviews."

As a result, the report says, it aims to automate the transmission of patient information from VA medical centers to Health Net.

WEB EXTRA: Read the VA's report on improvements to the Choice Program

The report also blames problems paying claims from private medical providers on an outdated and inefficient process.

"The current VA claims infrastructure and claims process are complex and inefficient due to highly manual procedures, and VA lacks a centralized data repository to support auto adjudication," the report says.

The report also points out there are 70 claims processing centers processing claims across 30 different claims systems, which can mean inconsistent results.

As a result, the report pledges to seek a simplified process that includes standardized processes, improved reimbursement processes and productivity standards for employees.

Veteran died waiting for a diagnosis

The VA's pledges to improve are little comfort to the family of Charles Earnhardt.

Earnhardt, an Army veteran who served at the tail end of Vietnam, died on December 2 of liver cancer that had spread to his brain.

Earnhardt had sought a diagnosis from the VA in late October. Despite that, nobody at the VA told Earnhardt he had terminal cancer prior to Thanksgiving Day, when he was rushed to the emergency room of a hospital in Lincolnton.

Earnhardt's son, Chuck, said his dad decided to see the doctor after experiencing a loss in energy and an extreme and sudden weight gain. Chuck said his dad no longer had the energy to ride his bike around town and had lost more than 30 pounds.

Records provided by Earnhardt's family show he was originally scheduled to see a doctor at the VA clinic in Hickory on October 30. Medical records provided by the Salisbury VA Medical Center show Earnhardt had another appointment on November 6 and was seen by a doctor in hopes of diagnosing his condition.

According to the medical records, doctors suspected metastatic cancer and wanted to confirm the diagnosis with an MRI. But nowhere in the records does it show an MRI was ever performed.

The only mention of a confirmed cancer diagnosis in Earnhardt's VA medical records comes in a report from the outside hospital Earnhardt was rushed to on Thanksgiving Day. A nurse from the hospital in Lincolnton called the VA to notify them of Earnhardt's terminal cancer and to facilitate hospice care.

An appointment card provided by Earnhardt's family shows he had an appointment with a VA specialist on December 15, roughly two weeks after he died.

"It bothers me that they treat the veterans this way," Chuck Earnhardt said. "He was in a whole lot of pain. He had six days to get his whole confused life in order and then he passed away."

A spokeswoman for the Salisbury VA Medical Center, where the MRI was ordered, told On Your Side Investigates the medical records showed a doctor called to tell Earnhardt he had cancer on November 9. But the only entry for that day is from a doctor saying he suspected cancer and wanted to schedule more tests to confirm a diagnosis.

When pressed for further clarification, the VA spokeswoman blamed the delayed MRI appointment on Earnhardt's request to delay the MRI that doctors said he needed as soon as possible.

Earnhardt's medical records show he requested the MRI be scheduled ten days after November 9 so that he could assist his family with a move.

The VA spokeswoman was not able to explain why an appointment was scheduled for December 15, nearly four weeks past the window Earnhardt has requested the VA wait to schedule the MRI.

Earnhardt's son acknowledges that his dad would have died whether the VA had provided a more timely diagnosis of his dad or not. But he wishes he had had more time to prepare for the death that came suddenly and, ultimately, with little notice.

"There's no excuse for that. He didn't say 'wait to go fight your war.' They shouldn't tell the veterans wait, I'll take care of you later," Chuck Earnhardt said.

Calls for change, accountability

Senator Richard Burr said cases like what happened to Charles Earnhardt shouldn't happen.

"I wish I could tell you it's an isolated case," Burr said. "It's not acceptable to me."

Burr said he would like to see a future VA in which employees operate under a customer service-oriented culture.

Ultimately, Burr said he holds VA Secretary Robert McDonald responsible.

McDonald, the former CEO of Procter & Gamble, was nominated to fill the position by President Barack Obama in the wake of revelations of wide-spread and system problems within the VA.

Burr said he would like to see McDonald bring the positive change he was nominated to the position to instill.

"He's the one in the chain with not only the power to transform VA but the authority to do it," Burr said of McDonald.

A spokesman for McDonald did not provide a response to Burr's comments by press time.

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