VA health care: One man’s story

Frank Miller Jr. on patrol in Vietnam, November 1969

Health care has been in the news and on the minds of Americans lately with the Affordable Care Act, also known as “Obamacare,” taking center stage in the political theater. While civilians wonder how the act will affect them and whether the changes might be positive or negative, veterans already struggle with health care issues of their own. Local clinics without emergency services and hospitals with multitudes of patients are some issues veterans face when navigating the potentially perilous pathway to good health through the veterans health care system.

One veteran shared the story of his journey through that system. Frank Miller served with the Marines in the Vietnam War. Miller spent 13 months trekking through jungles, fighting for his life on behalf of the United States of America. Because he is a veteran, Miller receives his medical care through the Veterans Administration (VA).

On Monday, Feb. 27, 2012, Miller awoke in pain and bleeding at 3:22 a.m.

“It was a nosebleed,” Miller said. “I woke up bleeding and tried to stop it. I called my sister, Donna. She came over, and we tried to stop the bleeding but couldn’t. We called an ambulance, and I went to St. Elizabeth’s Hospital in Beaumont.”

Miller said once the emergency room staff stopped the bleeding using balloons in each nostril, he was considered stable and able to be moved to the Michael E. DeBakey VA Medical Center in Houston (MEDVAMC).

Bobbi Gruner, public affairs officer with the VA, confirmed the procedure regarding the emergency health care needs of veterans.

“The standard of care is if you have an emergency as a veteran, you go to the closest ER,” Gruner said. “If the hospital says you are stable but you continue to need inpatient care, once you are stabilized, you will be transferred to the closest VA hospital for continued care.”

Gruner said Beaumont has a clinic for veterans, but the clinic can only provide general care and urgent care, not emergency care. She said the requirement to visit the closest emergency room is important to the welfare of veterans in need of immediate care.

Miller said he was transported to MEDVAMC in Houston via ambulance. He said he arrived about 1:30 a.m. on Feb. 28. Once there, he was put in the emergency room. While he was in the ER there, he started bleeding again. ER personnel attempted to stop the bleeding.

“They kept me in the ER on morphine,” Miller said. “I was throwing up blood. They just kept inflating the balloons. They used something, I think silver nitrate, on a Q-tip and tried to cauterize it.”

Miller said he was weak to the point of stumbling due to the amount of blood he had lost by that time. When a specialist finally saw him at around 6 or 7 a.m., Miller said he was told he would not be admitted.

“Dr. David Cuthbertson, the (ear, nose and throat) doctor there, said it would cost too much to admit me,” Miller said. “He wrote me a prescription for 500 mg Cephalexin, an antibiotic. By this time, I had probably lost around 6-7 pints of blood.”

Miller was with his family and friends when the doctor told him he would not be admitted into the hospital. He went downstairs to the hospital pharmacy to have his prescription filled. While waiting, his nose began bleeding again. He said he was sitting in a wheelchair in the hallway with hospital personnel walking by without stopping.

“The maintenance worker was the only one who offered to help,” Miller said. “I have no idea why they would not admit me. That’s just what he said.”

Dr. James Scheurich, medical center deputy chief of staff at MEDVAMC, nurse’s notes indicated that an ER physician saw Miller at 2:35 a.m. He said there are doctors on staff in the ER and on the hospital floor around the clock. At 3:30 a.m., Scheurich said hospital records indicate a resident applied silver nitrate to Miller’s nose to cauterize it and stop the bleeding. Miller said from what he recalls, the silver nitrate was not applied until after he saw the specialist in the morning at around 6 a.m. Scheurich said Miller was under observation for several hours at the facility. He said the notes indicated staff did not see focal bleeding when examining Miller, which Scheurich said would be a clear sign of potential arterial bleeding. He said Miller was released at about 1 p.m. after the bleeding had stopped for a period of two hours.

“It doesn’t make sense to me,” Scheurich said regarding Miller’s assertion that the doctor he saw told him he would not be admitted due to cost. “It would not be any more expensive for us. … We never run out of beds.”

“It didn’t make sense to me either,” Miller said. “It didn’t make sense to any of us standing there. I’ve never heard a doctor say something like that.”

Scheurich said if the hospital staff had believed Miller’s bleeding stemmed from arterial bleeding, he would not have been released. Miller was, however, released from MEDVAMC and sent home. On his was from Houston to his home in Vidor, the bleeding started again. He said he was close to the College Street exit ramp on Interstate 10 in Beaumont when it started. His daughter was driving and took him to the nearest ER at Baptist Hospital. Upon arrival, the family stopped near the ER entrance and two EMTs from a nearby ambulance offered assistance in getting him into the ER. Miller said ER staff at Baptist told him he had to be admitted immediately due to blood loss.

“By the time I got to Beaumont, they were not going to release me until they got some blood back into my system,” Miller said. “I was guessing I had lost 6-7 pints earlier because I had lost 8 pints by the time I got to Baptist.”

Miller said the hospital did not have an ENT doctor on staff. A friend referred him to Dr. Carey Jordan of Southeast Texas ENT. Dr .Jordan went to Baptist Hospital to treat Miller. He was diagnosed with epistaxis, a nosebleed that in this case was caused by a ruptured artery. Dr. Jordan performed an interior maxillary artery ligation to stop the bleeding. Miller said he was hospitalized for seven days while receiving blood transfusions at the hospital. He credits Dr. Jordan and Baptist Hospital with saving his life after the VA hospital facility almost killed him, he said.

“The VA Hospital in Houston is just way, way, way overloaded,” Miller said. “All they need are doctors. It was strained already with the guys from World War II, Korea and Vietnam. Now, with the veterans from Iraq and Afghanistan, it’s just flooded.”

MEDVAMC has 397 beds, according to the Houston VA website. For fiscal year 2012, running from October 2011 to September 2012, 128,387 veterans were enrolled in the system serving Angelina, Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Grimes, Hardin, Harris, Jasper, Jefferson, Liberty, Matagorda, Montgomery, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Trinity, Tyler, Walker, Waller, Washington, and Wharton counties in Texas. During that time, 13,301 veterans were admitted to MEDVAMC. In Houston, 879,222 went for outpatient visits. Gruner said she could not confirm the exact number of patients whose care each doctor provides but that if there is a need for a physician, the facility will bring in a doctor.

“If we don’t have the staff for whatever reason, we fee base it out,” Gruner said. “If we find a problem, we fix it.”

She said MEDVAMC has a close relationship with the Baylor Medical Center next door.

“We are a teaching hospital,” she said, and because of that, there is a lot of opportunity for research and a variety of techniques in use at the facility. “We have some of the best doctors in the world here.”

Gruner said MEDVAMC was recently given the “go ahead” for a breast cancer center, which the facility is currently lacking. She said soon, MEDVAMC will be able to perform liver and kidney transplants at the facility. She said the hospital is one of five VA hospitals in the nation that will have the ability to perform kidney transplants.

Gruner said there is light at the end of the tunnel for veterans seeking faster, better and more convenient care. She said when she started with the VA 11 years ago, there were only two veterans medical clinics in the area, one being the Beaumont clinic.

“Since then, we’ve opened up a number of clinics in the area,” Gruner said. “Next year, we are opening clinics in Katy and Tomball. We will have nine outpatient clinics to service veterans closer to where they live.”

She said the clinics would provide outpatient care for veterans so they do not have to go exclusively to MEDVAMC for care. She said by alleviating the number of veterans seeking care at the hospital, staff would likely be able to see patients hoping to receive rapid care or in need of emergency care in a timely manner. If veterans are able to access local clinics, they would not be forced to travel to MEDVAMC. She said the VA is also looking into staffing the local clinics with more specialists. She indicated the facility receives government funding and more is always welcome.

Miller said he feels more needs to be done to provide better care for veterans’ health care. He hopes his story will bring attention what he says are serious deficiencies in Texas, particularly.

“I’m not the only one who has had problems with the veterans health care system,” Miller said. “I have several friends who are veterans. They feel the VA is so bad in Texas they are willing to go to other states for care. One friend goes to the VA hospital in Louisiana. … I would like to help veterans get better benefits and better medical treatment. If this opens some eyes, then good.”