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

[RetiredVetFlagged]

You are in VISN10 so what everyone else said may be valid where they are but not for you. VISN10 has no DBC policy and does not follow VHA policy or 38 CFR § 17.107 . Best estimate is Michigan has over 4000% more flagged patients per 1000 than any other VA systems. The policy as of last month currently in use is VA Ann Arbors and was identified by the national program manager over a year ago as being non compliant. The fact you are on here asking proves it, you should have a letter and instructions (you only have 30 days) in which to challenge it, they are reviewed in 2 year cycles or as directed. The DBC is unlike any other program in VHA, it is non amendable and has no designated oversight mechanism including from the national program manager or the OIG. How were you informed of your flag? What does your flag instruct VHA staff to do? You need these answers and your PATS-R so you need to FOIA, a chunk of all the FOIA officers in VISN10 have been recently replaced so it should save you money. Go to the system site, foia and call the foia officer. They will give you the system foia email and you can scan and sign the request (written on any paper) for the dates you want. Do a second one for the flag, take the report number for the DBC you saw in the system and request all documents and the risk assessment for it, with the report number it shouldn’t cost much is anything for this one. If you are past 30 days there are a few options but that will require more steps. Understand that the VHA DBC program in Michigan is WAY the hell on the other side of the compliance/civil rights violating line and it is being unraveled but it is a slow process but because it is known taking those first steps will likely get it resolved before having to go much further. The VA OIG has many reports on VISN10 flag noncompliance and is working it. Go to their page and do a report or call the hotline once you get those documents. The threat analysis will have disruption “cost” or impact, if it is 0 as ALL I have seen out of VISN10 than the OIG will send a letter and you flag will disappear, not actually using the actual process but by some other means I haven’t figured out yet. Understand that veterans in Ohio, Michigan and Indiana have been prosecuted using this programs “findings” and the clinical “history” of violence it establishes. That isn’t to say in those cases the Vets shouldn’t have been prosecuted but the bulk of the evidence was from the DBC records not VHA police and vets were testified against by the social workers, not police, the same ones running the secret noncompliant program with no oversight.

 

 

[grayling12]

So, I have an update,

Broncovet,

I appreciate the advice, I just want to clarify a few things. I understand the triage nurse asking medical questions, but why would I have to discuss my bloody puss filled hemorrhoids with the check in lady, she's not a medical person? I would think if I have to speak to a triage nurse anyway, why would the check in lady need to know my medical details, she could just transfer me and let the triage nurse take over.

Remember, I explained to everyone I talked to that I wasn't having an emergency, I didn't need to get in right away and I had no problem waiting a month or two for the appointment. Everyone of them acted like I was trying to cut in front of someone else, even though I kept telling them I could wait, no hurry. It got very frustrating when they kept pushing the narrative that I was trying to cut in line when I wasn't.

I'm not sure if anyone can understand how frustrating it is when your trying to make a very simple non priority doctor appointment, and your doctors nurse spends thirty minutes telling you that you don't need the appointment, just guzzle some pepto and you will be just fine! That's thirty full minutes of blatantly refusing medical care. Is this considered acceptable when dealing with VHA appointments? I'm asking because this was my first time making a random appointment and it really caught me off guard, this is a serious question, I'm not trying to be sarcastic, just a VHA appointment making virgin.

I didn't totally lose my cool till I talked to the front desk supervisor and she said " there are veterans with real problems that need to get in ahead of me", I wasn't aware that front desk people had access to our medical records? I might need anger management classes because that statement and her attitude lit me up. Is that how all VA staff look at veterans, like our medical problems are in our heads and no big deal? Do you see the narrative that keeps playing out with all of them, that I am trying to cut in line even though I am not? I just don't think it is possible for me to get kicked in the balls by VHA employees and just smile and say thank you, may I have another!

I've been nice to them for twelve years now, and haven't had any issues before, that's why I'm confused about this situation. The advice you gave is good solid advice, but I'm pretty sure if you had been standing next to me throughout this entire adventure and witnessed first hand how I was treated, and witnessed how this played out, I'm pretty sure even you would have said dump these a-holes, go to another clinic and get a new doctor. I get frustrated easy but I don't typically get that angry very often, they worked overtime to make this happen.

I'm not trying to be defensive, I just want to make sure that it's clear that I acted in good faith up until I realized that my earned benefit of being able to use VA healthcare was being denied to me,( the nurses refusal for thirty minutes to allow me to receive VA medical care), remember this was not going to happen until I stopped being nice and told her to just note in my treatment records that I was being refused medical care. I truly feel sorry for the veterans that can't go anywhere else and have no choice but to accept being disrespected, put down and accept substandard care.

Well, this is getting long winded, so I'll move on to part 2 of the update. Broncovet, I do appreciate the advice and wasn't trying to be defensive, I do like to hear other people's views and opinions. 

[jamescripps2]

Quote,  I do like to hear other people's views and opinions.

Well brother, this is my opinion. From reading your post it sounds like you accused the VA employees, including your PCP of many things including substandard treatment. It appears that you tried to tell them how to run their clinic. Nobody is going to take that kind of behavior, neither civillian or VA.

You might try being a little more understanding, but I think that by now you hve already crapped in your nest and you will need to change your PCP and possibily change your facility. You are not going to make them do anything, not by reporting to your Senator or by going to Washington.

Broncovet is trying, in a nice way, to tell you to mend your ways and learn to be a little more tactful. I agree, and I honestly wish you the best of luck.

[grayling12]

I tried adding part two but accidentally deleted it. I'll try again tonight.

Jamescripps2,

 You have to understand, the VHA is here to treat our medical conditions, not deny us treatment, unless something has changed that I'm not aware of. You are telling me, I have no right to question poor medical care or address issues with my PCP? So, you think we should sit down and shut up when we receive substandard care, so, if my VA PCP misdiagnosis my cancer as a pulled muscle until the cancer is no longer treatable, you believe I should sit down, shut up and die quietly, you would think I am an A hole for questioning the lack of care I received from the VA? Interesting!

I believe, when I have the proof in black and white, it is no longer an accusation but rather a fact. Nope, now your simply adding drama to the mix, never once did I tell anyone how to run their clinic. I think you are right about crapping in my nest, the VA don't take kindly to peasants standing up to them and asking for good healthcare and a little respect.

Trust me I know my complaints are going to fall on deaf ears, the VA is a bureaucracy, nobody cares how corrupt bureaucracies are, they are protected from the inside out. I am going to forward my info to whomever, as long as it makes me feel good about myself, that's all that matters. 

I appreciate Broncovet and your feedback, and I appreciate any criticisms or feedback anyone wants to send my way. I do like the feedback, it might prove that I am wrong in all this, I'm not sure, but I don't think I am. I hope part 2 helps to put things into better perspective. There really is a moral and point to this story that all veterans need to be aware of.

to be continued in part 2.

 

Edited January 21, 2023 by grayling12

[grayling12]

john999,

I do understand the advice, not to go deeper into the rabbit hole. The main issue I want to fight for, is the fact that the VA can initiate these flags, that are meant to push you out of the VA healthcare system, without so much as a warning. I, like probably thousands of other vets now have a note in my records which is the foundation of the house they are trying to build. Any further complaints or frustration escalates to a flag, once you are actually flagged, they can limit and restrict the days and times that you can be seen. If that conflicts with your work schedule then you are effectively denied care. They can force you to get treatment only at a VA hospital, which for a lot of us might be two hours away, effectively denied care. And, they can require you to be escorted by a VA cop so if you complain one more time, he just beats your brains in with his billy club, I guess now, we just don't need the care anymore.

My point is, if these flags are tools to end our ability to receive VA medical treatment, then shouldn't they be required to inform us that we are doing something that's going to put a permanent target on our back. Go to the myhealthevet site and look for yourself, there are no warnings at all that by using that instant messenger you are risking losing your VA healthcare benefits permanently. Is this right? Forget me, what about the thousands of other vets out there that have gone down this rabbit hole inadvertently and are now permanently marked for life, this policy really is a tool to silence any vet that isn't happy with substandard healthcare or rude and disrespectful employees. I would probably be happy and content if we peasants could initiate flags on VA employees too, but unfortunately, the VA is the second largest bureaucracy in the US and corrupt from the inside out, there are no checks and balances in place for them, just us.

My complaint isn't about an actual injury or compensation, I would be very happy if the VA's policy was updated to require a warning on the myhealthevet site, that if you make the mistake of using this instant message system, this can and probably will get you marked for life. These notes and flags are permanent, so if you are a young veteran and they target you, you are now screwed for a very long life. In my case, I've been at this clinic for 12 years with no problems, disagree with my PCP one time, and marked for life. Really? No warning, or way to have the notes or flags ever removed? 

I am going to make it a hobby of mine because I really don't have a life, to send the packet I'm putting together to anyone that I can think of, will this accomplish anything, absolutely not! But, if someone listens somewhere, and I can get the policy updated to require warnings and provide for a way to get flags and notes eventually removed, then I would call that a huge victory for all veterans being abused by the VA.

I do appreciate your and everyone else's advice. I'm putting this out for public consideration so if after I post part 2, there's a consensus that I am 100% in the wrong and the VA should take no blame at all for this situation, then I will reevaluate how I look at things, since, I may be truly wrong. But, for anyone that wants to put full blame on me, do me a favor, reread my entire post carefully and digest it, and answer any questions posed from your perspective to support your opinion.

Thank You

 

 

 

Edited January 22, 2023 by grayling12

[grayling12]

Part 2,

I had my appointment with my PCP, on Wednesday. After I checked in I requested a chaperone other than her personal nurse, since she was the one that got the ball rolling to begin with. I will never deal with a VA PCP again without a video recorder or at least a chaperone for my personal protection.

I asked my PCP about the note in my records and she said that she initiated it. I asked her what evidence she used to classify me as an annoying, violent, lunatic. She said " you sent 7 messages which was an abuse of the instant messenger system".

I told her that I counted them and there were only 6 messages sent by me, and 3 of them were legitimate use of the system. The first one explained the problem I had trying to get the appointment and let her know what I wanted to talk to her about. (Proper use). Another one, explained that I had confused a canceled appointment with her appointment and I apologized for the two previous messages sent. (Proper use). The last one sent asked what my active diagnosis's were? (Proper use).

That left 3 messages that could be questionable, so she needed to include the other messages to fluff up her claim that I abused this system. She also stated that she felt that I threatened her nurse because I mentioned her name with quotation marks around it. Really? VHA employees honestly believe that punctuation marks are a sign of violent, deranged, oh, and don't forget annoying behavior? I must have been confused, because I thought that punctuation marks emphasized something or ended a sentence etc., and the fact that I was telling her that her "nurse" was the reason that we now had more of a problem to work out than before, was simply emphasised. I guess I didn't pay attention in english class when they taught us that quotation marks mean violence, and exclamation points mean rape, and periods mean theft? This VA stuff is very confusing.

So to sum up, my PCP felt that I abused the messaging system because I sent 3 questionable messages in the three years that she treated me, and the fact that I used quotation marks around a name in one of those messages. This is really all that it took to get a permanent note put into my file indicating that I am annoying and possibly dangerous! Remember, these notes and flags are meant to eventually push you out of the VHA system if you keep questioning your substandard healthcare, being disrespected and abused by VHA employees. This fact should scare all veterans, remember, this is my only issue in 12 years at this CBOC, and I received no warnings at any time prior to the permanent note.

Per VA policy they don't need to warn you, so instead of de-escalating problems, they can geek you up, then target you if you don't sit down and shut up. My warning to all veterans that use VHA healthcare, is use caution when interacting with nut job, morally corrupt VHA staff. VHA staff are encouraged to lie and manipulate the truth if that's what it takes to silence a veteran that has the gaul to stand up for their healthcare rights, this isn't an opinion but rather a fact.

Read the links I included slowly and carefully, they spell out just how much power VHA employees have to target and silence you! VHA policy towards patients is: sit down and shut up, if you don't like how we treat you then crawl out into the street and die, there's 10,000 more to replace you.

 If there's a consensus that I am 100% in the wrong and the VA should take no blame at all for this situation, then I will reevaluate how I look at things, since I may be truly wrong. But, for anyone that wants to put full blame on me, do me a favor, reread my entire post carefully and digest it, and answer any questions posed from your perspective to support your opinion.

I'll even make it easy on anyone reading this, below are the questions I pose:

1. Why does the front desk, check in lady, need to know details about my bloody, puss filled hemorrhoids, when she doesn't have any medical training, just to pass me on to the triage nurse that's going to ask the same questions? Wouldn't this be a HIPPA violation? Is this situation acceptable to everyone?

2. Is it normal and acceptable nowadays for a PCP's nurse to refuse treatment for thirty minutes, until you tell them to put a note in your file that they are refusing medical care? 

3. Is it common now to have to talk to 5 employees over 5 days to get one non-emergency, nonpriority appointment, is this the new normal and acceptable?

4. Is it normal and common now for all of these VHA employees to accuse you of trying to cut in front of other patients, even though you have reassured all of them that you are "not" asking for a priority appointment, and you can be scheduled whenever there is an opening? It seems like they have a narrative they follow when trying to deny treatment.

5. Is it now common and acceptable behavior for the front desk supervisor to disrespect veterans and put their medical issues down and treat them like second class citizens? How would a check in supervisor even know anything about your medical conditions? Would you simply smile and say thank you for your thoughtful opinion?

6. Do you believe that sending three negative messages in three years is abusive? That’s how long she has been my PCP. Do you truly believe that three negative messages that include no profanity, no threats of violence and no harassing intent should result in a permanent negative mark in “your” record?

7. Do you honestly believe that putting quotation marks next to someone’s name implies that you are going to violently assault or rape them? Does using punctuation marks imply violence to a normal, sane “non VHA” person?

8. Does informing your doctor that you plan on taking your complaints up the chain of command constitute a physical threat of violence to a normal, sane “non VA” person?

9. Do you believe that veteran's shouldn't have a right to have a medical treatment ending note or flag removed at some point? 

If you still believe I am the problem here and not the VA, then explain to me in detail, the proper technique for sitting down and shutting up per VHA policy, when you are being denied healthcare treatment, forced to discuss your erectile dysfunction with the check in lady, forced to wait five days to schedule a simple non priority appointment, how to properly smile when being put down by the front desk help, and how to appreciate your PCP for getting a bug up her a** and lying and manipulating the system to put a target on your back. Also, I would love to hear about the school that you attended that taught you how to properly weaponize punctuation marks!

I look forward to the feedback, my feelings don't get hurt easily but I do get defensive if I believe I'm right. 

There's info on these flags on this sites archives as well as online, review what I included carefully.

Remember, since they consolidated this policy the numbers of crazed veterans has steadily been climbing, per online sources, or, is it that the number of fed up vets has steadily been climbing?