Jim,

I have been treated with excellent care by other area VA medical
facilities ever since joining the VA health care system. This year my
wife and I moved here and I had my VA records transferred. All of my
VA experiences have been satisfying and always handled professionally.
However the following complaint has been one of the most humiliating
and disgraceful experiences in my life.

On March 11, 2011 I cut my skin near my lower left chin while shaving
with a standard type razor. On Saturday March 12, 2011, and continuing
into Sunday, March 13, 2011, the cut area became swollen and red. On
Monday March 14, 2011 I went to the VA Clinic. I arrived at the
clinic at at approximately 9:30am. At that time I was concerned that
I might have a contagious type of staff infection. When I arrived I
checked in at the desk with my VA identification card, told the
receptionist about my medical complaint and took a seat in the waiting
room. After a 15 or 20 minute wait I was called into an examination
room by the triage nurse. The female triage nurse checked my vital
signs and conducted an intake interview. The triage nurse told me
that I should have gone to the area VA hospital, because I had not
attended the Clinic's orientation. I was amazed at her response. I
then told her that I was a priority one patient and that I had
visited this same clinic a week earlier for a different issue and was
treated well. The triage nurse then told me that there would be no
problem today. She then took me upstairs to the second floor , told me
to take a seat in the waiting area and that the doctor, would see me
as soon as she was finished with another patient. After a 20 minute
wait a second female nurse approached me and said " Mr ____, the
triage nurse told the doctor that she doesn't think that your injury
is infected, and that all I should do is treat it with compress."
After being told that I was waiting to see a doctor? I couldn't
believe what I was told. I then inquired to see the patient advocate,
as I wanted to lodge a complaint. A short time later a woman who
identified herself as ____ approached me in the waiting room. I told
____ that I was extremely upset about not being able to have a doctor
examine my injury. I then asked for a form to file a written
complaint. She told me that she did not have any forms and that if I
wanted to write a complaint that I would have to write it on paper.
This conversation took place in the waiting room area in the presence
of approximately four to five other patients! She then told me to
take a seat and that the Clinic's supervisor would meet with me. A
short time later a male nurse approached me and brought me into
another examination room. After a brief two to three minute
conversation this nurse then brought me into a room where he
introduced me to a male doctor. He told me that he was the supervisor
of the clinic. I do not recall this doctors full name. I do remember
that his last name began with the letter __. This doctor then told me
that since I hadn't attended the clinic's orientation that I wasn't in
their system and that there were certain things that had to be done
before being treated. I was angry, upset and humiliated at this point
and left the clinic. The VA health care booklet clearly states in the
last sentence in the first paragraph on page one under Enrollment,
"Once enrolled, veterans can receive health care at VA health care
facilities anywhere in the country."

Reply:

I'm not at all sure why you're angry?

I may be a bit biased in thinking this through as I'm retired from a
long career in health care. In any case you tell me of a relatively
minor problem that occurred...a small cut. I don't disagree that we
have to be seriously concerned about infections and so on these days
but your message doesn't convey that you had any symptoms that might
indicate that there was a significant problem.

Upon your arrival someone explained to you that there was a process
and that as you hadn't gone though the process you were supposed to be seen elsewhere. "The triage nurse then told me that there would be no problem today." Having said this to you, the process continued.

Your wound was assessed by a health care professional and you were
told that a "compress" would be sufficient treatment. In the end you
saw a physician and although you don't say it, the physician has to
have observed your wound. You were then told the process to become
properly registered as a patient and sent on your way.

I must assume that you didn't suffer any further illness or injury
from your condition. You don't say anything about the wound being
infected or that you decided to take the advice offered at the clinic
and go for treatment at the emergency room at the hospital.

Your status as a Priority Group 1 patient gives you privileges to have
your routine health care appointments scheduled ahead of others. In
general terms the PG 1 veteran will received routine primary care
appointments within 30 days of a request. Most clinics I'm aware of
are pretty good about trying to abide by this rule. Beyond that there
is no guarantee of timeliness.

The triage system is pretty consistent in all health care arenas,
whether VA, military or civilian. Patients enter the triage process in
a defined manner and are quickly evaluated for care by a health care
professional and seen in order of the seriousness of the condition.
The Priority Group of the veteran is not a consideration in triage. VA
clinics are not emergency care facilities and many patients are
automatically diverted to emergency care facilities, both civilian and
VA.

In the final analysis you apparently had a small injury that was
inconsequential to your health. You were taken into the system even
though that required that certain rules be set aside for your
convenience. You were seen by at least 3 people who could observe your injury and who came to the conclusion that little, if any, medical
treatment was required. You chose to be angry and petulant as you
misinterpreted the language of rules regarding your Priority Group 1
privileges. You left the clinic and did not seek any further care.
Your condition seems to have resolved without any further treatment
and you've suffered no health crisis because of the experience.

To be honest, if this "has been one of the most humiliating and
disgraceful experiences" that you've had in your life, you're very
fortunate indeed.

I advise you to return at your first opportunity and become properly
registered and attend the orientation required by that facility.
You'll be surprised to learn that the clinic staff are very forgiving
of misunderstandings and that you'll likely be treated with courtesy
and respect. Once you've done your part, I'd guess your future
treatment will be without any other problems.

Good luck.