Bellezza V. Principi, 16 Vet. App. 145 (2002)

[allan]

Bellezza v. Principi, 16 Vet. App. 145 (2002)

The appellant appealed a BVA decision denying entitlement to reimbursement by VA for the cost of previously unauthorized medical services he received from the Southwest Florida Regional Medical Center. The veteran was transferred to that facility from North Collier Hospital for evaluation and treatment of a myocardial infarction. He stayed at the Southwest Florida facility for five days. A VA physician opined that there was a high probability that the veteran's emergency condition had resolved prior to the transfer but that, without information from the North Collier facility, he was unable to make this determination.

The VAMC disapproved the claim for reimbursement because "care and services were not rendered in a medical emergency of such nature that delay would have been hazardous to life or health." A private physician opined (1) that the veteran had been in a life-threatening situation at the time of the transfer, (2) that the North Collier facility was unable to provide the necessary care, and (3) that transferring the veteran to the nearest available facility was in his best interest.

On appeal to the Board, the BVA stated that the opinions of private physicians have little probative value and that only VA physicians are empowered to decide when a medical emergency ends.

The Court rejected the BVA's view that the opinions of private physicians had little probative value and vacated the BVA's decision. The Court cited to 38 C.F.R. ' 17.121, which requires the VA physician to decide when a medical emergency ends "based upon sound medical judgement." The Court interpreted this phrase in the regulation to require that the VA physician must consider and account for the opinions of private physicians. Thus, the BVA also has the obligation to consider whether the VA physician exercised sound medical judgement in writing his opinion. In a concurring opinion, Chief Judge Kramer observed that, on remand, the BVA is obligated to consider the benefit of the doubt rule.

[Berta]

This brings up a question I have.

Last Friday night at about 9:30 PM I heard on the 911 Police /fire/Amb scanner that a veteran had gone to the local Bath ER with severe chest pains.

The Bath VAMC Fire Department had to call Bath Ambulance and ALS onto the federal VA grounds to transport the patient to a hospital.

Dont know if the vet was SC or NSC-

Assuming he didn't die- will the VA pay for his care at the private hosp they took him too?

I told my neighbor who works there and is out- patient about this and he was shocked to learn that he better not ever go to this VAMC's ER after 5 PM at night.

The vet incurred a private hospital bill, and ALS charge and also there could be a fee from Bath Ambulance -not sure-

our local fire/Ambulance is all unpaid volunteers.

Does VA have to pay their medical bills because the ER was closed?

[Pete53]

In Dallas if I called an ambulance there is absolutely no way that it would take me to the VA. They take you to nearest available ER that clears them. Its my opinion that unless you live close to the VA they are going to take you somewhere else first.

I have noticed that at the Dallas VA they do get Veterans who are moved to the VA after being stabilized. If you are a 50% or more Veteran and you notify the Fee Service people the first business day than the VA is on the hook.

I wish that we would get Universal Health Care and give us Insurance Cards.

[allan]

>Does VA have to pay their medical bills because the ER was closed?

Hello Berta,

I can say from experience, that the VAMC ER, can refuse to treat you, even if they're open for business, than refuse to pay for an ER bill from a non-VA hospital if you seek treatment elsewere.

They can withhold your medicines untill you get a brain hemorage from it, than refuse to treat you or pay for their injuries.

If the Spokane ER was still opin at night, it would still be a risk to go their anyway if it was an emergency. First thing their going to ask you is, "is this service connected"????? If it is, they will try to put you off until the clinic opens. If its not, don't expect much in the way of treatment.