Thursday, September 13, 2007

VA Medical--Reckless Endangerment Whims

The NCPS was established in 1999 to develop and nurture a culture of safety throughout the Veterans Health Administration.  Patient safety managers at 153 VA hospitals and patient safety officers at 21 VA regional headquarters participate in the program.
Yesterday, 04 September 2007, day 7 of pneumonia symptoms and the first day after the long Labor Day weekend, I got to the Muskogee VA hospital Emergency Room. They expedited me through the blood-work labs, chest x-rays, and EKG. No doubt anywhere. This was a blazing case of pneumonia, with both lungs heavily involved. Combined with my insulin-dependent diabetes, hypertensive heart disease, and the chronic Reiter's syndrome atrial fibrillation, it represented a substantial threat to my 66-year-old life.


Once upon a time, not too long ago, a VA-Medical-entitled veteran with pneumonia was immediately hospitalized -- for at least the days needed to settle on the best treatment for the individual case.

Pneumonia is, after all, a virulent bacterial infection to which most Americans have little or no immunity. Best to stick the sicko in a hospital bed, while the initial load of industrial-strength antibiotics reduces the risk of spread.

On Monday, 27 August, I traveled from my home in Tulsa to the OK City VA Medical Center (hospital) to receive the results of some important blood tests. There was something really complicated hiding in among my insulin-dependent diabetes, heart problems, chronic renal failure, runaway triglycerides (documented over 1700 several times), high blood pressure, atrial fibrillation, and recurring iritis (inflammation of the eye). I'd tested positive for the genetic marker, HLA B-27, establishing chronic Reiter's syndrome, as strange an autoimmune disease-set as can be imagined.

In addition to the test results, I also received what might very well be the Perfect Pneumonia. This could not have been anything other than a hospital-groomed, antibiotic-resistant, "superbug" pneumonia.

This is my third go-round with pneumonia. From this one's first nonproductive coughing -- Wednesday, 29 August -- there was no doubt about its action. It went straight to the lungs, with a surprisingly high quantity of infected phlegm.

Yes, I might have caught it anywhere. But a very short incubation period squares with its super-strong symptoms and points to the hospital exposure of a superbug on 27 August.

Yesterday, 04 September, day 7 of symptoms and the first day after the long Labor Day weekend, I caught the VA shuttle bus to the Muskogee VA Medical Center (hospital) Emergency Room. They expedited me through the blood-work labs, chest x-rays, and EKG. No doubt anywhere. This was a blazing case of pneumonia, with both lungs heavily involved. All of my vital and critical readings were dangerously wrong. Immediate medications were required.

Then I was parked in a waiting room near the ER and left alone for over an hour -- with my frequently shrieking coughs ringing up and down the hall. The conversations that sang back from the other waiting rooms along the hall were light-weight medicine with heavy-weight social event content and laughter.

When the doctor did arrive, he was the right stuff. Dr. Craig Glenn gave the best, most graphical presentation of my complicated and interacting disease components that I've ever seen a VA doctor do. Better yet, it was done with soul and interpersonal communicating. He asked questions, listened, drew out details, and made sense of my personal medical history in ways that no other VA Medical rep has ever managed.

He showed me that day's chest xrays on the computer, pointing out how the top parts of my lungs were clear of infection, but how the infection was massed in the middle and lower parts of both lungs, and especially in the right lung's lower lobe.

Right there, my sleep-deprived brain failed me. I should have said, The lung tops are clear because at mid-day Saturday, 01 September, I learned how to use fingers and thumb to manipulate my windpipe, causing "venturi-effect" increased velocities for the coughs. Under my fingertips, I could feel long chains of phlegm chunks rising from the lungs as upper chunks were being coughed out. That went on more or less continually until ealy Tuesday morning, when my windpipe was suddenly too sore to touch.

I began compressing the windpipe right at the top of the breastbone. Results were not as good, but there was some cough production. And then, also early Tuesday, the junk being coughed out suddenly changed color. Big red flag.

Shoulda, coulda, woulda -- but I didn't say those things. Instead, I blathered on about why and how the right lung's lower lobe had been constantly infected since the 1999 pneumonia. No VA doctor had paid attention before this. The lower-lobe infection had caused night-long bouts of coughing every day or two ever since. In my sleep-deprived world, this was important.

In this 2007 pneumonia, brain had been made more than a little crazy with sleep deprivation. Unproductive coughing had replaced sleep on Thursday, 30 August. Most of the very short sleep periods -- 15 to 20 minutes -- came with me braced in an upright sitting position on the edge of my bed. Most wake-ups came from toppling over. And as soon as I was horizontal, the adhesive phlegm rolled onto the vocal chords, resulting in explosive, unproductive coughing.

Beginning Thursday or Friday, reality had been largely replaced by a secret algorithm that was translating the unproductive coughing into the continuing sagas of three or four different nightmares. The more coughing, the more story line. I needed those story lines, but, despite Herculean efforts, I could not locate the encrypted files on my computer. (???)

The sagas had replaced thinking, too. It wasn't until early Tuesday, 04 September, that the color shift of junk coughed up made me realize that I had to get to an Emergency Room.

By then, I'd lost all track of medications routinely taken for my core conditions. When Dr. Glenn told me Tuesday afternoon how bad my vitals and blood sugars were, the realization that I'd not been taking my meds was like a collision. WHAT? I always take my meds. My heart can't live without those meds.

My need for meds made no difference to the political hack in charge at Muskogee.

Dr. Glenn was prohibited from keeping me overnight. No overnight? WHAT did you say?

"Push the veteran out the door" is a constant game in VA Medical, but this was ridiculous. The serious bacterial infection skyrocketed my risk of death from the diabetes and heart-problem tandem. I needed somebody to watch for and handle emergencies. I had none of my own meds with me and needed them all -- stat. Any surprise exertion or other stress under these circumstances was likely to be deadly.

The prohibition of an overnight was laid on by some unseen VA medicrat who spews cost-cutting policy for the Regime. The Muskogee facility, he reportedly said, was under "Divert". No hospital beds were available. Period.

I asked how much of my death-risk was automatically deleted by the facility's "Divert" status. No answer from Dr. Glenn. Lots of pooh-poohing from the nurse.

Dr. Glenn went back to the political hack three times with new arguments. No budging. No exceptions. No hospital room. "I'm sorry," Dr. Glenn said on each return.

It quickly got worse. There was no way for me to rent a hospital room away from the working halls. The rental could not be done because I didn't have my meds with me. WHAT? Who's in charge of Catch 22 around here? There's no way to buy the evening and morning doses that I need? Does the VA hospital pharmacy close down rather than serve in an emergency?

Am I just to go out by some roadside and maybe survive the night?

The last shuttle bus for Tulsa is long gone. It left at 3pm. It's now 4:30pm.

Here's the deal. Injection of antibotics (Rocepin), a ten-day series of more antibiotics in tablet form (Amoxicillin), a small bottle of cough syrup, and out the door.

Meds for my now-extra-dangerous core conditions? Forget it. Anybody concerned about the 338 blood sugar? 223 points over normal -- sloshing around in an enlarged left ventricle and enlarged left atrium (established by echo cardiogram at Muskogee, April 2002), both short-circuited by Reiter's syndrome electical malfunctions between brain and heart and running in steady A-Fib? Forget it. Super-high mortality rate for men over 65, you know. Forget it. Out the door.

Diabetic visual problems mean that I've not driven anything since early 1999. Dr. Glenn picks up the phone and calls the front desk. The call is two minutes long, tops. Doctor hangs up and says I've got a ride home waiting at the front desk. His nurse whisks me off in a wheel chair.

My ride home is an independent driver volunteer who shows up at around closing time whenever his family business allows the boss to indulge himself -- three or four times a week, he recons. This could not have been a set-up just for me. Judging from his cell-phone traffic during the drive, his appearance at Muskogee VA that day had been chancy stuff. Luck of the draw.

So the nightmare continues. Three souls on board the volunteer's vehicle. Two of them don't know that they're riding with a Perfect Pneumonia in full bloom.

Home again. I wolf down my meds and inject the two different insulins, now roughly five hours later than what should have been done at Muskogee. Was it soon enough to avoid heart attack and/or stroke? Was the stress of delayed meds sufficient to trigger a heart attack or stroke at some additional stress a week or two in the future?

My experience with fast-acting and slow-acting insulins hammers the 318 blood sugar at 9:31pm Tuesday down to a 107 (normal) at 2:24am Wednesday.

I live alone. Nobody to watch over me. This should be a factor in VA Medical decisions. Clearly, it's not. Handle the emergencies your own self -- and get lucky -- or die.

VA patient safety is a feel-good fiction spewed by the political hacks for the worker bees. The reality is VA patient cost-cutting for the Regime -- where the seeming accidents of policy (e.g., "divert") and the judgment calls of political-hack medicrats can cover up the evidence.

Where the evidence can't be covered up, the VA computer-system "Progress Notes" for each patient are broadly used to diminish the patient's actual medical condition down to something that does not need urgent care. In my pneumonia case, the Musokgee "Progress Notes" are a collective effort of omit-anything-inconvenient, lie-your-butt-off, and purge Dr. Craig Glenn right out of existence.

There's more reckless endangerment of life just outside the VA hospital beds than there is in them. And the zero accountability of the political-hack players means that reckless endangerment will go on and on, no matter how many wrongful deaths it chalks up.

Well -- until we disappear the whole system.

VA Medical should have disappeared into universal health care decades ago. Low-income two-year-olds in the ghetto, barrio, or on the reservation are as much our human resources as are combat veterans. We owe them and ourselves their well-managed health.

But no, no, you can't go around doing something that capitalists can label 'socialist' or 'communist'.

No, no, first do no harm to the billionaires. Let Hillary's healthcare insurance schemes feed the billionaires with new corporations gouging everything the traffic will bear out of the middle class. That way the Democratic Party can privatize the rape of ordinary people even more than the Republican Party did with Bush Medicare prescriptions. Then the superrich will reward the Democrats with Diebold election selections -- until the Republican Party figures out an even bigger gouge-rape to feed the billionaires.

Sickenly, labels are still more important than universal health. Universal health is still comething "socialist" and evil. And we're still on the seemingly endless agenda of the superrich -- money-power first, ordinary people last. Sickenly, ordinary people are supporting that agenda in utter disregard of their own interests.

But watch your six, superrich. We're gaining on you. As Dr. Hunter Thompson started saying soon after the Election 2000 Bush usurpation, "Big dark come soon." Better brush up on your French Revolution, superrich. Such things happen quickly once the doors are open. And you've had the doors wide open for too long.


Modified Sun 07 Oct 2007, at 8:15am CDT

Originally published as "VA Medical On The Cheap"
Retitled on 22 Sep 2007

© 2007 by Stephen Neitzke