Epilepsy - The VA and the Missing Order
Author: Thomas C. Weiss : Contact: Disabled World
Published: 2015-01-26 : (Rev. 2019-02-18)
Since the epilepsy I experience is service-connected, the Veterans Administration (VA) jumped to serve me...
The early 1980's found me being honorably discharged from the Army. I had experienced a heat stroke that left me with gran mal and petit mal seizures associated with epilepsy, so I was somewhat surprised by the honorable instead of medical discharge. At a fairly young age, epilepsy was very much out of my experience, so it became a learning process.
Since the epilepsy I experience is service-connected, the Veterans Administration (VA) jumped to serve me and I first dealt with the VA's medical centers not long after being discharged. What this meant to me is that everything from the cost of a neurologist to prescriptions to treat epilepsy were and continue to be covered by the VA. To be plain, the VA is not the tightest ship being run in today's world, but equally plainly - the VA has provided exceptional care that I am mostly happy with.
Then a series of things happened related to epilepsy that found something going wrong; not only with the VA, but with seizures. What happened? It appears to be a string of things.
The first thing that happened did so on January 6th. The medication I had been taking for seizures became the 3rd one since the 1980's that my body adjusted to. I started experiencing petit mal seizures and auras, so I promptly called the VA phone nurse. The nurse at the VA's phone line heard what was going on, promptly consulted another nurse in the call center, and then instructed me to immediately go to the hospital I live right behind; I did so.
While at the hospital, I experienced several petit mal, 'staring through walls,' kind of seizures. The staff neurologist at the hospital put me on a different medication to control the seizures, hopefully before I began having gran mal ones. I was discharged from the local hospital with instructions to visit my VA doctor, which I also did.
My VA doctor performed a medication review and ordered an MRI scan and an EEG, really common things after any kind of seizure activity. He did what he was supposed to, despite my visit to him being at the end of the day during his first week as a doctor for the VA. He did nothing wrong - except one thing; he forgot to write a prescription for the Depakote I had just been placed on by the neurologist at the civilian hospital.
In the meantime, I went and got MRI scanned and received authorization to visit the other hospital here in town for an EEG. I diligently waited for the Depakote prescription to arrive from the Denver VA Pharmacy, which takes around ten days. The issue is that the Depakote never arrived, even as the prescription for it from the local hospital ran out, leaving me to face how I was going to get some Depakote.
Was this my VA doctor's, 'fault' I do not think so because the poor guy looked like he had just gone through the roughest day of his life. He saw me at the end of his day, he is new to the VA medical process, and he did what he felt was right. He simply missed the prescription for Depakote.
The Denver VA Pharmacy
Did the Denver VA Pharmacy make a mistake? As mentioned, they never sent the Depakote I need to prevent seizures. However, the Denver VA Pharmacy never received the order for my prescription. The Denver VA Pharmacy did send the other prescriptions the doctor ordered, so they made no mistake.
Unfortunately, a lack of Depakote means that even as I write this article - the level of this anti-seizure medication continues to drop in my blood. What this means is that I am at increasing risk of petit mal and gran mal seizures. Is the Denver VA Pharmacy responsible for my being in this risky status on my part? I do not think so, it just happened.
The VA Phone Nurse
Then, on a Friday, with no Depakote coming from anywhere I called the VA phone nurse again. The nurse told me some Depakote would be ordered and sent to my local pharmacy, giving me some time until the Denver VA Pharmacy could mail me some. Ready for this one? It never happened, leaving me to face Saturday, Sunday and at least part of Monday entirely without medication to control seizures.
Was this the fault of the VA phone nurse I spoke with? I do not think so, she did everything she was supposed to. What happened? My VA doctor says he saw no prescription for Depakote and the pharmacy and the doctor wanted verification. I remember very clearly presenting the prescription bottle from the emergency room neurologist to my VA doctor more than once; in fact - it was the first one I showed him.
Another Call to the VA Nurse
I arrived at my local, civilian pharmacy to pick up the Depakote prescription the VA nurse said would show up there - it was not there, ready, or even verified. My heart sank into my shoes; if I go several days without anti-seizure medication, the risk of seizures increases fairly rapidly. I promptly called the VA phone nurse once again, on a Saturday, without much hope.
The VA nurse I spoke with on the phone was not only terribly busy, she couldn't do a single thing to help prevent a potential disaster. Her only suggestion was that I show up in Denver, a round trip of three hours, and visit a neurologist there. The problem? It means driving for a long distance while experiencing the risk of seizures. My apologies - I am unwilling to drive a car and risk the lives of others and myself while the level of anti-seizure medication in my blood continues to drop.
Health Care Never Stops, Even on Weekends
Health care is something that people need seven days a week, all year long, every single year. If this involved the osteoarthritis in my lower joints I would not have the slightest concern. So let us recap and consider where the, 'fault,' lies in the situation I am now in:
- It is not the fault of my VA doctor
- It is not the fault of my local pharmacy
- It is not the fault of the Denver VA Pharmacy
- It is not the fault of the VA phone nurses I interacted with
- It is not the fault of the emergency room neurologist at my local hospital
- It is not my fault because I showed the medication bottle to my VA doctor at my medication review
I learned some things though - you have a far better chance of reaching 911 than obtaining a prescription of any kind through the VA on a weekend. I learned that the VA would rather pay the bill related to any seizures I may experience between now and the time my VA doctor actually does write me a prescription for Depakote than write a prescription on a weekend. I learned that while the VA phone nurse may be available after an incredible amount of time on the phone waiting for them to answer - there is nothing they can do to obtain a prescription on the weekend either.
It is now Sunday, and the level of Depakote keeps decreasing in my system. Am I the only veteran to experience this flaw in the VA Health Care System? Most likely not; there are veterans with nearly every health condition known to humanity in America. I am certainly not upset with my VA doctor, or the nurses I interacted with.
What upsets me is that I cannot get a prescription through the VA on a weekend - the doctor is not on-call. In fact, no one with the authority to prescribe anti-seizure medication is available on the weekend. I even tried to speak with a doctor in Denver on the phone; he was short with me and refused to discuss anything medical on the weekend over the phone. Fire this doctor in Denver; please, he is a disgrace to the VA.
Here's hoping I make it to a prescription of Depakote before experiencing more seizure activity. For those wondering why I don't have a civilian doctor as well, one who could prescribe this medication to me - I am in a town that is new to me and do not have one yet. Things just added up all wrong and it might cause me some serious grief, but the VA is closed on weekends folks. The VA needs to learn that people have medical needs every single day, even on weekends.
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