Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SATURDAY, June 26, 1993 TAG: 9306260059
SECTION: VIRGINIA PAGE: C-1 EDITION: METRO
SOURCE: By CAROLYN CLICK STAFF WRITER
DATELINE: LENGTH: Long
But the sister of Vickie Ogletree, 37, said an apology "doesn't cut it with what they put us through."
Becky Brown said she brought her sister, who suffers from a traumatic brain injury and cervical cancer, to be admitted to the VA hospital Monday night. They were forced to wait as doctors debated whether to admit Ogletree.
Dr. Rajiv Jain, the hospital's chief of staff, said the decision not to admit Ogletree was a mistake based on a series of miscommunications between the patient's family and staff.
"It was a very unusual case," said Jain. "I personally feel very bad that it happened. There were some other things that could have been done."
Ogletree, a Pulaski County native, suffered a brain injury 4 1/2 years ago in a horseback-riding accident. She underwent rehabilitation at centers in Virginia, South Carolina, Texas and Denver, Colo., before she was diagnosed recently with cancer and placed in a Denver nursing home for 28 days.
Because her cancer had worsened, family members decided to bring her back to the Roanoke area for treatment. They looked at the VA hospital because Ogletree was a Navy veteran.
Brown said she had held several talks with a VA patient representative before Ogletree's arrival in Virginia.
"We didn't get any promises," Brown acknowledged, but she said the tone of the talks led her to believe admission was likely.
She said a VA hospital social worker and patient representative remained supportive throughout the family's ordeal.
Jain agreed that those prior discussions may have contributed to the confusion and to Ogletree's lengthy wait in the VA emergency room.
"I think unfortunately that may have created an expectation that we would some way guarantee admission," he said. "But the decision to admit is an independent decision made by the admitting physician."
Complicating the case was Ogletree's condition. Because of her previous brain injury, she required admission to a locked ward for her own protection. These rooms are in scarce supply at the VA, Jain said.
"They said they couldn't admit her to the psychiatric unit because someone might hurt her and they couldn't admit her to the nursing unit because she might hurt someone else," Brown said.
And while Ogletree is a Navy veteran, her injuries were not connected with service, thus automatically putting her on a lower priority than other veterans. Also, when she was taken to the VA, it was believed Ogletree had no insurance coverage. It was later learned she was covered under Medicare.
Nevertheless, in an emergency situation and in her condition, Jain said she should have been admitted.
Once he reviewed the situation, Jain said he apologized to family members and offered to admit her this week.
Brown said he did apologize but there was no concrete offer to have her sister, who was finally admitted late Monday night to Lewis-Gale Hospital, transferred back to the VA.
As of Friday, Ogletree remained in the psychiatric unit at Lewis-Gale, although no course of treatment has been started.
Brown said she does not know if she will reconsider the VA if the hospital is indeed willing to take her sister.
Jain said he does not plan to issue any reprimands for the way the Ogletree case was handled. But he said the case provoked changes in emergency procedures.
"It is a rare case," he said. "But we are planning to change the procedures. I have asked the staff in complicated cases to get me involved and to get as much information on patients beforehand if we can."
Brown said she hopes her family's experience will help bring change to the VA.
"Maybe it will help the next person who comes in in a critical condition with a family who doesn't know which way to turn," she said.
The incident came at a time when the Department of Veterans Affairs is coming under scrutiny for the medical treatment it provides female veterans.
A recent study determined that VA hospitals still provide inconsistent care for female veterans, who make up about 4 percent of the nation's 26 million veterans.
The study conducted by the VA inspector general found that only one of the eight VA medical centers surveyed offered full medical services for female veterans.
The Salem hospital, which was not among the eight reviewed, has operated a women's clinic since June 22, 1992, although Jain said he would like to expand its services.
"The program has gone ahead full steam but still we don't have a full-time GYN [gynecological] physician," Jain said. "A lot of it has to do with the number of female veterans we see. If the number grows, we might be able to expand."
Since the opening of the clinic there have been 412 visits involving 338 female veterans.
Barbara Zicafoose, the Women's Health Clinic coordinator and one of the clinic's three nurse practitioners, said she is particularly pleased at the level of preventive care the clinic provides.
"We have never turned down a female veteran who has come in and requested a preventive screening," said Zicafoose, who described the procedure as extensive. It includes pap smear and pelvic exam, breast exam, mammography, colon and rectal screening, and tests for hypertension and cholesterol, among others.
An internist at the VA is on call to resolve immediate problems. The clinic also contracts with the Lewis-Gale OB-GYN clinic. Zicafoose said she hopes to expand the clinic to include female health maintenance.
by CNB