VA Disruptive Behavior Red Flag

[grayling12]

This is going to be long winded!

I just noticed in my VA treatment notes that my CBOC put a disruptive behavior red flag in my records. I'm pretty sure this stems from me sending 3 emails in the last month, to my PCP mentioning that I think she is making ethical violations and possibly falsifying my treatment records. I have gone to this CBOC for 12 years and have never had a problem till a month ago.

A little back ground. I had been noticing issues with my treatment notes both PCP and Mental Health for a while now. I wanted an appointment to see my PCP to discuss issues with my IBS and also to ask her to stop cutting and pasting my yearly physical notes from one year to the next. I called to make the appointment and the check in lady, who is not a medical professional, required me to go into detail about why I wanted this appointment, I had to tell her about my deep dark private medical issues, just to get passed on to the triage nurse. The triage nurse spent 20 minutes asking me about 40 unrelated questions, he then tells me, now I have to talk to my PCP nurse before I can get an appointment, but it's late Thursday and I'll have to wait till Friday.

Friday comes and I call my PCP nurse around 3pm, she then spent a full 30 minutes telling me that I don't need an appointment and all I need to do is guzzle some Pepto Bismol, and I'll be just fine. She made every effort to stonewall me and prevent medical care. I finally told her, If she was going to refuse me medical treatment then just post that in my treatment notes, she got snotty and said "I'm NOT refusing you treatment", I said " THEN MAKE THE APPOINTMENT". She told me, you have to call the front desk Monday to make the appointment. The front desk was the one that got this merry go round started in the first place. Monday comes along and I get a call from my PCP who's scolding me for not accepting her nurses road blocks, she lied to me and said she was sitting there and heard the whole conversation, so I asked her about some of the things we talked about and she didn't know what to say. I guess if a PA is going to blatantly lie to you, then you should never expect any kind of integrity from her. She agreed to the appointment and I still had to call the front desk lady that I spoke to originally. This makes 5 people over 5 days to make one simple appointment, it's a good thing I wasn't dying.

Her nurse Ratchet kept demanding to know exact details before she would approve the appointment. After the appointment was made I sent an email asking them not to put some of the things I mentioned to nurse Ratchet in my treatment notes. Surprise! They entered my email into my notes with the info I didn't want included. I took this as a slap in the face and decided to follow up the previous email with a new one explaining why the other one was sent in the first place. In this email I spelled out that I felt that my PA was unethical and possibly falsifying my records, I also requested that this email get included into my chart next to the previous one. 

40 minutes later, I get a call on my way to work, telling me that my appointment was double booked and I needed to reschedule, I said I was driving and couldn't do it then. Later on I'm like wait a minute, I just sent them an email calling out my PCP now they want me to change my appointment, I'm like, this is straight retaliation. I sent another email stating that this was retaliation and I was going to fight it straight to Washington DC if I had to. I then followed that one up with an email where I said if they overbooked my slot that was scheduled for 19 days already, then they needed to reschedule the other person instead of me, and pursue disciplinary actions against the employee that made the mistake. This makes a total of 4 emails over 1 month, 1 email don't count as it was only an explanation of my phone call with her nurse. I realized a few days later that the appointment that was changed was for my therapist and not my PA, oops! I sent an email explaining that that there was confusion on my part regarding the appointments and I apologized.

A week after this I went to my mental health appointments with my therapist and my shrink. When I was checking in I asked the check in lady if I had to play the merry go round game every time I made an appointment. She was confused, so I explained what happened, her supervisor heard us talking and said "can I help you", I said "sure you can", I asked her if it was common practice now to run us through the wringer when we try to schedule an appointment. Things were peaceful at this point, She had the gall to say " we have veterans with real problems that may need to be seen ahead of you"! Their theme from the beginning from everyone was that I was trying to cut in front of someone else. I had explained to all of them that I was not having an emergency, I wasn't trying to cut in front of anyone, and I had no problem waiting till next month to get in, I said repeatedly " just plug me into a vacancy". After she put me and my medical problems down and disrespected me to my face, I raised my voice about one octave above baseline, I was louder, but not yelling and screaming. She kept escalating by telling me that there were veterans with worse problems than me, wait, what, how does she know anything about my medical issues? I don't think front desk check in supervisors are trained nurses or Dr.'s, I'm pretty sure they are simply office help.

Now I see this disruptive behavior red flag in my records, one issue out of 12 years and these nut jobs lost there minds. Basically they are saying that the four emails calling out my PCP disrupted their entire operation. This flag is basically because they consider me an annoyance because I am not accepting substandard care, disrespect by their employees and I'm calling them out on possible ethics issues. I am in fact lumped into the same category as lunatics who may be assaulting patients and threatening to kill people, nuisance patients and lunatics get lumped in together, they apparently don't distinguish between the two.

I tried calling this CBOC to see what was up with this flag, I wanted some details, not only were they no help, they kindly hung up on me. I called the Saginaw VA hospital who oversees them, with no luck, apparently they are all trained in how to initiate these flags, but no one has any info regarding them. I tried leaving a message with the patient advocate but they haven't returned my call.

I did some online research, and found some info and policies regarding these flags. Every veteran in this country should be aware of how simple it is to be flagged as a trouble maker by the VA and any of it's employees. Per VA policy, if you so much as complain to a VA employee about how long it took you to get in to see your provider, they can have you flagged for disruptive behavior, If you complain that you are receiving substandard care, flagged, you don't have to raise your voice, you don't need to be upset, just the fact that you are speaking up and advocating for yourself is enough to be flagged. If they think you are bad mouthing them online, Facebook etc., Flagged. Per their policy, in order to be accused of being violent, you don't have to say anything violent or mean, you don't have to do anything aggressive, all they have to say is that they are scared by your mere presence, Flagged as a violent lunatic! I'm sure you think I'm making this up, it can't possibly be that pathetic, sure is, per their policy. These aren't the only things that will get you flagged, If you are in excruciating pain and your PCP decides that you are a dirty little pill popper, Flagged, every VA doctor from now on is only going to see you as a dirty pill popper whether you are or not doesn't matter to them.

Apparently, since they enacted a universal policy department wide, the numbers of psycho, lunatic, violent, nuisance veterans has steadily been climbing. Is the problem that all of these veterans are just trouble makers by nature, or are they just vets that are tired of substandard care by the VA and simply advocating for themselves, and the VA is trying to silence them by labeling them as dangerous nuisances and pushing them out of the VA healthcare system. It seems the VHA wants you to accept substandard care quietly, and if you do speak up, they will put a big target on your back and try to push your face back into the mud where it belongs. This is a warning to all vets using VA healthcare, if you ever try to advocate for yourself, lookout! Review your records often.

Here's some resources, read the OIG report, it is really precious in what they consider to be disruptive behavior, basically anything you say or do to stand up for yourself will get you flagged. If you think you are immune from this, remember the numbers of flagged veterans are climbing fast, so sit down and shut up, and you will be just fine.  

There is more info available on the web, I'm trying to get copies of the current policies as well.

VHA DIRECTIVE 1160.08(1)

https://www.va.gov/oig/pubs/vaoig-11-02585-129.pdf 

Since I am apparently a trouble maker, I am going to fight this as long as I can.

Questions:

1. I'm not getting anywhere dealing with my local CBOC or their parent hospital. They keep just hanging up or giving me extensions that go no where. Do patient advocates have email addresses? Do they actually do anything or are they just there to give you a warm fuzzy feeling then forget about you as soon as you walk out the door?

2. My CBOC doesn't have a patient advocate , are we able to talk to the facility supervisor? Is there someone else at the local CBOC that handles these issues?

3. Is there someone at the main hospital besides a patient advocate that can deal with patient issues?

4. I plan on going to my congressman eventually since I'm pretty sure nothing is going to happen through the VA side of things. Will they expect me to exhaust all efforts through the VA first? 

5. Are there online resources with VA phone numbers and/ or email addresses anyone is aware of?

I realize I am going to be fighting a corrupt bureaucracy and simply can't win over their corruption, but I'm not going down without a fight.

Thanks for any info!

P.S. I do understand that there are a lot of veterans out there that can't afford better healthcare and just accept what they have, so they simply don't question their VA healthcare. I do also believe that there are a lot of us that are simply tired of receiving substandard care. I'm also not trying to rock the boat with any VA employees on this site, I simply don't want to be crapped on anymore, someone has to take a stand against VA tyranny.

 

 

 

 

 

 

Edited January 21, 2023 by grayling12

[broncovet]

 I think I had a red flag in my records once also.  It went away, not sure when and who removed it.   Thanks for sharing these details, lots of people ask questions and I have to beg for details.  You gave many before I asked.  You posted:  

Quote

This makes 5 people over 5 days to make one simple appointment,

     Trust me, Im a Vets advocate.   Especially for Vets with one or more mental disorders LIKE I HAVE.  I can be especially rude.   I have been answering Vets questions on this forum since about 2007, I probably answered more than any one else here, save Tbird.  

     But, the common denominator in the above paragraph is you.  It really sounds like you went in there to argue people into giving you an appointment.  Just ask, and be nice.  

     Dont get me wrong..if I point the finger at you, 4 fingers point back at me.  I, too, have mental health issues, and have started arguements with way too many  people, and I also did not get good results.  Many times it turned into in argument, and I did not even know I started the arguments.

     Since I did it wrong for so long, sometimes I can see it when others do it like I did.   My experience has been that others can often see my faults much better than I can.  I think many people are that way.

     And, I remember, being verbally attacked on my job, when I just got there and knew nothing of the previous shift's actions.   I also kinda kept a record, and never got a good result by attacking people.  I got what I wanted much more often when I was calm, and even thankful...trying to find something that employee did right, even tho I felt like ripping them apart.  And, most of the time, that employee I attacked "was just there", they were not fully responsible, and many were unaware of it even happining.  

     I have to give credit, where credit is due, "how I got fixed" is my wife.  She models calm behaviour.  If she has to wait 20 minutes for something that should take 2 minutes, she waits.  Part of it is she is a retired nurse, and, she knows what its like to have difficult patients and family members.  

    She was a heart nurse.  Her patients died.  Many times families came in there, finding out "dad" is in the hospital.  They feel guilty for not visiting or calling dad for 3 years.  So, they take it out on the nurse. 

 

    "Dad looks cold, why dont you get him a darn blanket?  Cant you turn the heat up?  He hasnt eaten for 2 days.   Why didnt you feed him?  That bed looks uncomforble.  Cant you get him a nicer bed?" on and on and on, complaining about the care.  

      My son once suggested, if you must complain, just complain about 1 major issue.  Not 3, not 8..  Just the most important one.  And make it an "actionable" one, too.  A complaint they can actually fix, such as "Bring dad a blanket". 

      Not, "why hasnt dad eaten in 2 days".  Your shift started 2 hours ago, and you've been off for 2 weeks.  So, is this your fault?  No.  

      In the future, my advice is just be nice.  Here is how to be nice and still get your way.  

      "Thank you for treating my dad.  I know he can be grumpy at times.  Im sure glad you are here for him.   I know you are busy, but could you bring him a blanket, I saw him shivering, when you get a minute.  Or tell me where they are stored and I will bring it." 

      So, lets apply this to you.  

      "Thank you for trying to get me an appointment right away.  I know you must be booked up, but I am not well and need to see a doctor before Oct. 8.  Could you call me if someone else cancels?  I really need to see the doctor.  Thanks again."

      Or, remember, you can tell em you cant get an appointment and ask them to send you to a private doc, if your appoinment is too far away.  

       There was a president who said, "you double up your fist at me, and I will double up mine".  

This VA employee you speak to, probably makes, well not that much, except for doctors.  I have a family member who is a doctor for the Air Force.  Yea, she makes around 140k plus, but she has like 2000 a month student loan payment.  So, many people actually make more than she does after student loan burden.  

      I hope this will help a Vet.  Maybe not.  Thankfulness, patience and persistence seems to win more often than anger, yelling, or revenge.  I have tried all of these, to my regret. 

 

      Remember, a triage nurse job is to decide "who gets care now", and who can wait.  They make life and death decisions.  Much stress.  And, they make some judgement calls wrong.  All of us make wrong decisions. 

       If the appoinment maker asks too many questions, just be nice.  Blame yourself. 

        "You know, its very tough for me to discuss this.  Its hard enough telling the doctor, and you probably dont want to hear all my troubles.   Please, just make the appoinment..I cant do this twice."  

      

        

Edited January 18, 2023 by broncovet

[qwiksting]

So, I feel your pain.  I am sure I have a few red flags. My question is how did you find out you were flagged?

Last year, I had to have some disability paper work filled out by my MH provider. As luck would have it, My previous MH provider was a Dr with a license. He left the clinic, and the clinic is so short handed they are employing MH NP’s. All the previous patients of Dr were shuffled to this NP. My Paperwork requires a Dr signature with license number. I told the NP this last year, and was told it would be handled. Surprise…..when it was time to get forms filled out, NP said “No” I can’t do it and we don’t have Dr’s to do it.  I went to Patient advocate to complain, and his reply was….”we don’t want to burden the Dr’s anymore or they will keep leaving”.  He said don’t quote me on that.

 

I told him, not only am I going to quote you, I am going to make an appointment to see my Senator, Rubio.  A few days later, while in the parking lot at my Senators office (I got an appointment) I got a phone call from a Dr. In the clinic, telling me to drop off paperwork and it would get taken care of. Point is, all that had to be done was MH NP fill the papers out, give to Head Dr., because they are practicing medicine under his license. I went on and spoke to my Senator about it, and was told, they (VA) don’t like congressional involvement.  

The next appointment I had with MH NP, I was asked about it, and told them yea, it was taken care of. I also informed NP about VHA directive 1134. It spells out, the VA must and will assist veterans in filling out disability paperwork.

 

Flag me..idk

Edited January 18, 2023 by qwiksting

[broncovet]

What Ive done, in the past, with what I call "sub standard" docs, I fill out a form and ask for a new provider.  

Ive only done that once.  The doc called me back, later.  

    "Why do you want to change doctors?" she asked.  

    So, I told her, frankly, "I did not feel like you looked out for (my interests)." 

And gave her an example.  

     So, she said that was right, and promised to get me what I needed.  

     That doc gave me what I needed and when I needed it from then on.  I speculate, since she was Indian, probably in America on a work Visa of some kind,  that maybe she had had other complaints and they threatened to send her back home if there were more complaints.  

      I often think of the "3 strikes you are out".  An employee is nasty to me.  Strike one.  

They repeat it, again in 5 minutes.  Strike 2.  

     As I leave, they say, "dont come back here".  They are out.  I go to the VAMC presidents office and tell em.  Not to them.  

[john999]

I don't think James would ever say to sit back and take it.  While you pursue your claims just don't hurt yourself.  You can sue the VA for malpractice using their own tools.  One of our older posters did it when VA  killed her husband.  It is not easy and it takes a lot of evidence and patience. No one is going to be critical of you just for spite.  Probably just trying to get you on course and not waste your time fighting city hall.  The only thing you will ever get from the VA is money.  VA is a huge organization with billions dollar budget.  Just get the money if they hurt you.

[Tbird]

On 1/18/2023 at 7:11 AM, qwiksting said:

I told him, not only am I going to quote you, I am going to make an appointment to see my Senator, Rubio.  A few days later, while in the parking lot at my Senators office (I got an appointment) I got a phone call from a Dr. In the clinic, telling me to drop off paperwork and it would get taken care of. Point is, all that had to be done was MH NP fill the papers out, give to Head Dr., because they are practicing medicine under his license. I went on and spoke to my Senator about it, and was told, they (VA) don’t like congressional involvement.  

The next appointment I had with MH NP, I was asked about it, and told them yea, it was taken care of. I also informed NP about VHA directive 1134. It spells out, the VA must and will assist veterans in filling out disability paperwork.

Here's VHA Directive 1134 PROVISION OF MEDICAL STATEMENTS AND COMPLETION OF FORMS BY VA HEALTH CARE PROVIDERS

vha-directive-1134-PROVISION-OF-MEDICAL-STATEMENTS-AND-COMPLETION-OF-FORMS-BY-VA-HEALTH-CARE-PROVIDERS.pdf

[Tbird]

For what it's worth I see @grayling12point. I read through

vaoig-11-02585-129-Management-of-Disruptive-Patient-Behavior-at-VA-Medical-Facilities.pdf

and there is a lot of leeway from facility to facility.

I have been around this merry go round myself, having to explain to 3 different people why I want an appointment. Personally I think it's ridiculous to have to explain your medical issue to anyone but a triage nurse. 

I also believe that some providers will try and goad you into something they can call disruptive behavior. They will make you explain and explain again, they will answer a question with a question, they will use some circular logic and then repeat. You will become exasperated and prone to give them something to mark you as a disruptive patient.

I am not saying this is true of all providers, but I have experienced this type of bs on more than one occasion over the years.

My two cents.