Change of Address, VA-Style

“I should have the same health care that the Senators and Congressman that sent me to war have.”

That’s what former Marine Lu Lobello said to me in an email after a harrowing experience with the Department of Veterans Affairs. It didn't have to do with filing a claim, proving the need or even the wait for benefits or medical treatment. All that had been done. This was something simpler. He was moving to Las Vegas and needed his prescription mailed to the new address. One time.

Lu had been in treatment for PTSD and degenerative disk disease at the Department of Veteran Affairs in La Jolla, near San Diego. From experience he knew that either condition left untreated would exacerbate the other. He knew that if he could manage the pain, he’d be able to keep the PTSD at bay; he’d be able to sleep and function in his school and work life, and that was important. Now in his last year of law school, he was due to start interning in a Las Vegas law office, which was the reason for the move.

Two weeks before the move he contacted his primary care physician in La Jolla to ask that his prescription be mailed early to allow for transit time to the new address. This is where it starts to get crazy.  First of all, there’s a layer of insulation between patients and their caregivers. A request is routed through a call center which leaves a message for the physician to call the patient. When several days had passed, he called again, to learn that his primary care doctor had been changed. A new message was left for the new doctor.

Hearing nothing, a week later he contacted his pain care management physician, or rather left a message for him through the call center. The doctor responded and said he’d speak to the new primary care doctor, explain the need for the prescription to be mailed out early, and asked if Lu had made an appointment with a new Department of Veteran Affairs doctor in Las Vegas. He had. Things were looking up.

When Lu was down to a couple days of meds, facing the symptoms of withdrawal, he called the VA crisis line, where he was told to go to the emergency room.  Lu knew that wouldn’t work.  The ER does not dispense medication. He’d been down this path before.  So the agent said he’d try the higher-ups, try to get someone in La Jolla to talk to someone in Las Vegas to explain the situation.  They’d call him back on the day his meds ran out, the same day he was due to begin his internship.

Lu didn’t want to leave it to chance, so he called the patient advocate as well, who told him that his doctor had not signed off on the medication and that it wasn’t due for another day.  He lost it.  He’d been calling for two weeks.  How could his situation not be in the notes? The patient advocate called him the next day to say the meds were being shipped.  Lu had just used the last of his meds, and was looking at four to seven days for the new prescription to arrive.

He called me at the National Veterans Foundation.  I called the Vet Center in Las Vegas and someone there called him back immediately, offering the ER again. Lu drove forty minutes to get there. The line to check in took thirty minutes.  After check in, he waited another hour to be seen by a nurse, then another hour’s wait to be called back to see someone. He was on the fast track, they said.  But the nurse practitioner (not a doctor) who eventually saw him couldn’t offer anything but a mild substitute for the medication he needed.

He lay awake that night next to his pregnant wife. The next morning he wrote to me, “We were expected to be perfect, selfless, honorable.  I'm shaking.  I have diarrhea.  My neck is on fire.  I have to get to work in five hours.”

Lu did get his prescription, but not before severe pain set in with the other symptoms of withdrawal.

Why is this so hard?  Where in the civilian world does it take more than two weeks to process a change of address for critical meds? It’s been apparent for some time that the VA is an unwieldy system because of its size.  So, do we just ask our vets to suck it up?  Would you?

If this is the case for what seems like a simple clerical operation, what does that mean for life-and-death situations? Oh, wait.  We already know the answer to that.

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