Breakdown in VA Choice program leaves some veterans permanently injured

Veterans get surgery but no rehab
Published: Jul. 14, 2016 at 9:22 PM EDT|Updated: Jul. 20, 2016 at 9:09 PM EDT
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(Source: WBTV/File)
(Source: WBTV/File)

STATESVILLE, NC (WBTV) - A breakdown in the VA program meant to speed veterans' medical treatment has led to some veterans left permanently disabled, an On Your Side investigation has found.

On Your Side Investigates has been fighting for veterans since February, when we first exposed flaws in the VA Choice Program that left veterans waiting months for an appointment.

The Choice Program was created by Congress in the wake of media reports exposing long wait times for specialty care at VA medical facilities.

Veterans who live far away from a VA medical facility or who would have to wait more than 30 days to see a VA doctor are eligible for the program.

That's how Brian Cooper came to be treated through the Choice Program. A VA doctor told him he needed to see an orthopedic specialist for his shoulder and, since the wait to see a VA specialist was so long, he qualified for Choice.

Cooper eventually saw a surgeon in the Davis Hospital system and had surgery in July 2015. His procedure required months of rehab to ensure a full recover; rehab that came too late.

"It was October before I finally got the authorization for the physical therapy," Cooper said. "So I had that but by that time the way my shoulder had re-healed it's now overly done so I've lost permanent range of motion. It's gone, I'll not get it back. It's like 78 percent of normal."

Cooper said he worked with his doctor to try and do rehab exercise at home to little avail.

"I'd call the doctor and say ok what I can do at home? Tell me something and he was absolutely outraged at how long it was taking," Cooper said.

Doctors are powerless to speed the system along and get their patients help, according to Dr. Chris Prato at Carolina Orthopedic. Prato didn't treat Cooper but he has had his own experiences with patients who were authorized for surgery but did not immediately receive the authorization for necessary rehab.

"Is there anything you can do as a care provider to get them to speed the process up?" On Your Side Investigates asked. "Uh, beg?" Prato answered.

Prato said often times he schedules a patient for surgery when it appears their authorization for rehab is on its way.

"Suddenly, afterwards, there's no approval and you're waiting and waiting," he said.

The Choice program is administered locally by a California-based company called Health Net.

A spokesman for the company issued the following statement:

"Health Net Federal Services is committed to improving the veteran experience. We continue to enhance our network and operating performance.To this end, we are rapidly expanding operations and services to meet the demand in an effort to avoid situations like the one you describe. Some of the changes we have already made in collaboration with the VA include:

  • Expediting follow-on care for more timely delivery of needed treatments
  • Authorizing primary care and follow-on care simultaneously (e.g. surgery and physical therapy), rather than requiring separate processing of authorizations for both
  • Adding customer service representatives to assist with call volume and expedite appointments
  • Continuing to expand the number of health care providers within our networks – in North Carolina alone we are now working with nearly 11,500 providers

Health Net Federal Services has no higher priority than the fulfillment of our Veteran's Choice program. It is not just our responsibility, but our honor to serve the veteran community. In the event a veteran does not receive timely access to care under the Veterans Choice program, we encourage individuals to call our customer service area at 866-606-8198, and we will strive to address their specific issue and provide the high quality of care they deserve." 

For his part, Cooper, the veteran who has loss permanent use of his shoulder as a result of Health Net's failure to authorize his rehab in a timely manner said he will never use the program again.

"No, absolutely not," he said.