Female veterans find care lacking at VA hospitals

In this June 18, 2014 photo, Army Sgt. LaQuisha Gallmon holds her 2-month-old Abbagayle Gallmon while at her home in Greenville, S.C. Gallmon said that her local VA office had authorized her to see a private physician during her pregnancy, so she went to an emergency room after experiencing complications in her sixth month of pregnancy. She said the VA has thus far refused to pay the resulting $700 bill. (AP Photo/ Richard Shiro)
In this June 18, 2014 photo, Army Sgt. LaQuisha Gallmon holds her 2-month-old Abbagayle Gallmon while at her home in Greenville, S.C. Gallmon said that her local VA office had authorized her to see a private physician during her pregnancy, so she went to an emergency room after experiencing complications in her sixth month of pregnancy. She said the VA has thus far refused to pay the resulting $700 bill. (AP Photo/ Richard Shiro)

SAN FRANCISCO -- Already pilloried for long wait times for medical appointments, the Department of Veterans Affairs has fallen short of another commitment: to attend to the needs of the rising ranks of female veterans returning from Iraq and Afghanistan, many of them of child-bearing age.

Even the head of the VA's office of women's health acknowledges that persistent shortcomings remain in caring for the 390,000 female vets seen last year at its hospitals and clinics -- despite an investment of more than $1.3 billion since 2008, including the training of hundreds of medical professionals in the fundamentals of treating the female body.

According to an Associated Press review of VA internal documents, inspector general reports and interviews:

m Nationwide, nearly one in four VA hospitals does not have a full-time gynecologist on staff. And about 140 of the 920 community-based clinics serving veterans in rural areas do not have a designated women's health provider, despite the goal that every clinic would have one.

• When community-based clinics refer veterans to a nearby university or other private medical facility to be screened for breast cancer, more than half the time their mammogram results are not provided to patients within two weeks, as required under VA policy.

• Female veterans have been placed on the VA's Electronic Wait List at a higher rate than male veterans. All new patients who cannot be scheduled for an appointment in 90 days or less are placed on that wait list.

• And according to a VA presentation last year, female veterans of child-bearing age were far more likely to be given medications that can cause birth defects than were women being treated through a private HMO.

"Are there problems? Yes," said Dr. Patricia Hayes, the VA's chief consultant for women's health in an AP interview. "The good news for our health care system is that as the number of women increases dramatically, we are going to continue to be able to adjust to these circumstances quickly."

The 5.3 million male veterans who used the VA system in fiscal year 2013 far outnumbered female patients, but the number of women receiving care at the VA has more than doubled since 2000.

All enrolled veterans can use what the VA describes as its "comprehensive medical benefits package," though certain benefits may vary by individual and ailment, just like for medical care outside the VA system. The VA typically covers all female-specific medical needs, aside from abortions and in-vitro fertilization.

The strategic initiatives, which sprang from recommendations issued six years ago to enhance women's health systemwide, have kick-started research about women veterans' experience of sexual harassment, assault or rape in a military setting; established working groups about how to build prosthetics for female soldiers; and even led to installation of women's restrooms at the more than 1,000 VA facilities.

Used to treating the men who served in Vietnam, Korea or World War II, many of the VA's practitioners until a few years ago were unaccustomed to treating menopause or giving advice about birth control.

The study on distribution of prescription medication that could cause birth defects is illustrative of the lagging awareness; one of every two women veterans has received medication from a VA pharmacy that could cause birth defects, compared with one in every six women who received drugs care through a private health care system, said the study's author, Eleanor Bimla Schwarz, a senior medical expert on reproductive health with VA.

Schwarz, who also directs women's health research at the University of Pittsburgh, pointed out that while she does not believe any of the veterans surveyed were pregnant at the time, it is critical to keep in mind that many new female veterans are of child-bearing age, a higher percentage are on medication than in the general population and the majority of these women are not on contraception.

Hayes said the VA seeks to place a trained, designated women's provider in every facility and expects to install a "one-stop" health care model that allows women to go to one provider for a range of services, including annual physicals, mental health services, gynecological care and mammograms. Until that happens, however, some VA clinics have limited gender-specific health treatments available for women.

Female veterans are more likely than their male counterparts to be referred outside the VA system for specialty care, Hayes acknowledged. Nearly one-third of all female patients received at least one day of treatment at a non-VA facility in fiscal year 2012, as compared to 15 percent of their male counterparts, according to the most recent data Hayes supplied.

Many female veterans report having to drive hours to get to a facility that offers specialized gender-specific care, while some of them tell of struggling to get the VA to pick up the tab for them to see a nearby private doctor.

Army Sgt. LaQuisha Gallmon of Greenville, S.C., whose daughter was born two months ago, said she had been authorized to see a private physician of her choice for prenatal visits and delivery. But because the paperwork hadn't been fully processed when she went to an outside emergency room for complications in her sixth month of pregnancy, VA has refused to pay the $700 bill, she said.

"I called the VA women's clinic and they told me everything was approved for me to get outside care and I should be getting the packet in the mail," said Gallmon, 32, who served six years in Iraq; Germany; and Fort Gordon, Ga. "Right after that, I wound up in the ER for complications, and a week later I received the letter saying they wouldn't pay for it."

The VA typically covers prenatal and pregnancy-related care through arrangements with community health care providers, said VA spokesman Ndidi Mojay.

According to a recent opinion by the American College of Obstetricians and Gynecologists, the VA has an urgent need to continue training providers in female reproductive health and contraception.

Hayes said the VA plans to improve its software system so physicians get a more extensive, visible warning to ask patients about their possible pregnancy status and interest in conceiving when prescribing medication that could cause birth defects.

"We want to make it right for our veterans to have the best kind of care, and women are included in that goal," she added.

In other news, an audit by the Veterans Affairs health care network in the Southwest shows officials knew years ago that employees were manipulating data on doctor appointments.

The 2012 audit and other records obtained by The Arizona Republic found hospitals and clinics in Arizona, New Mexico and western Texas chronically violated department policy and created inaccurate data on patient wait times using a variety of methods despite a national directive to stop the practices.

Top officials at the Phoenix VA, including Sharon Helman, who was suspended as director last month, have repeatedly claimed they were not aware of scheduling misconduct until whistle-blower complaints were made public in April.

Audit findings show the scheduling schemes and other violations of department policy proliferated throughout the Southwest and were common nationwide.

Officials with the VA center in Albuquerque have repeatedly denied having secret waiting lists but acknowledged only recently that the system in New Mexico has problems with waiting times.

The findings of a 2013 investigation triggered by another whistle-blower complaint show schedulers in Albuquerque received scripts to follow when negotiating appointment times with veterans. There were also lists in which schedulers would cancel medical appointments and remake them to reflect acceptable wait times.

"These documents ... were distributed solely as lists to be used to 'clean up' or 'fix' appointments that did not fall within acceptable wait time parameters," according to a report of the internal investigation obtained by the Albuquerque Journal.

The report also stated that the inappropriate scheduling practices had been going on for a decade or more.

Information for this article was contributed by staff members of The Associated Press.

A Section on 06/23/2014

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