Tuesday, October 30, 2012

Trip to the VA

You’ve heard me mention going to the Minneapolis VA hospital for health care services on several occasions. Ever wonder how a health care system this big operates? I’ll attempt to give you a blow by blow day-in-the-life narrative. Hopefully, it might end some myths about VA healthcare and call attention to how it’s growing faster and faster with the return of soldiers that were called in Iraq and Afghanistan. Not every Veteran has the same experience. There are problems and I believe that is expected in a system this big.

Driving there

I have to get there. I live almost 40 miles away. There are no busses or public transportation. I can drive about half the distance, then take a series of busses to the new light rail system, catch that and it will take me to the VA. The ride takes a long time because of the three bus connections that have to be made. 

When I have an appointment for getting blood work early in the morning, there is no chance to catch busses and get there on time. Scheduling blood draw for later in the day would mean the blood results the doctor needs to treat me would not be available.

So, I drive my car. The Minneapolis VA hospital is located between St. Paul and Minneapolis, MN. I live East of St. Paul, so I have to get through the entire city during rush hour traffic. The 40 mile trip, when taken after 9:00 AM takes about 50 minutes. When I leave 50 minutes before my scheduled blood draw time of 8:15 AM, I am late because of the traffic. I can leave earlier, but then have to wait for my appointment at the VA.

I usually leave early, miss the big traffic rush hour and go sit and wait for my appointment at the VA. I also get a parking spot if I arrive early in the morning.


There is a very large parking area. Most of it can be used for outpatient and visitor, as well as employee parking. Without a handicapped sticker, parking could be as far as ¼ mile away from the outpatient entry door. There is a shuttle, but sometimes you could wait a half hour until it circulates around the parking lot and gets down the aisle.

I’ve been coming to this facility for a long time. Since before the second Iraq war and Afghanistan war even started, I’ve seen the traffic and parking get busier and busier. The VA now has plans on building a multi-story parking ramp, and to do so will take over 250 parking spots away until its completion in 2014.

So, I get there early and park closer, or get here late and walk a long distance, but only after I drive around and around the lot waiting for someone to leave and be lucky enough to be driving down the aisle and finding a spot. Some people follow Veterans that are walking out to the parking lot so they can claim a spot.

When I get to the door, I have to walk a long way to get to my appointments as the building is huge. And, there is more walking back and forth while waiting for appointments in the cafeteria or going to another clinic when two or more appointments are scheduled for the same day.

Checking In

So, I drove here and parked. I walked to the Outpatient Entrance and entered the building. I walk down the halls after taking an elevator to where my first appointment is. I swipe my Veterans ID card and the screen tells me either to sit down and wait for my name to be called or go to the clerk at the desk and stand in line. This choice seems to be random. Sometimes I stand in line, sometimes I get to sit down.

If I am real early, I go to the cafeteria and have a cup of coffee. If it is a fasting blood draw, I drink water. I get down to the blood draw room and check in, then I sit and wait for my name to be called.

Eventually, my name gets called and they verify all the information thoroughly that I am indeed the person whose blood they are drawing. I finish that and then wait about another hour or so for my appointment with the doctor. Now, I can go back to the cafeteria and eat something or have a cup of coffee.

On days when it is hard to walk, I just go to the next appointment and wait, sometimes over an hour. If I need to, I can request a volunteer come and shuttle me in a wheel chair. When I suffered with the Congestive Heart Failure and Atrial Fibrillation, I used this option.

I go to the clinic where I am to be seen and give my ID card to a clerk that scans it and tells me, “Okay Mr. Spado, you are all checked in. Have a seat and the Doctor will call you when he’s ready.”

I wait there. How long I wait varies, depending on how busy he is and how long the lab is taking to process the blood samples and report the results. Sometimes the Doctor is over-booked because here are so many that need services in a particular clinic.

Before I take a seat, I am given a list of all the medications the VA doctors and clinics have prescribed and I am currently taking. This is for my own reference. I am asked to check it over and make changes if I need to.

The Appointment

The doctor calls me in and goes over the blood report for the blood work I had done earlier that morning. This is the warfarin clinic. Warfarin, also called Coumadin, is a medication that thins the blood and helps to stop blood clots from forming in the veins and arteries. There is a certain level that is measured where it is desired. 

If I have achieved this level, I am sent away and another appointment is made for 4 weeks later to do the same check. If I have not achieved this level, my medication is adjusted and I am sent away. Another appointment is made for 2 weeks later to do the same check.

I go back to the clerk and she sets me up with another appointment. She gives me paper telling me when the next appointment will be after I agree with the date and time she gives me.

I ask her for a travel voucher. She fills out  a small pink slip designed for this purpose and I leave the warfarin clinic.

If I attend a different clinic, I may be asked to get Xrays or a C/T scan. My Primary Care Physician will refer me to other Specialty Clinics as needed, like Podiatry, Hearing, Cardiology, etc.

Checking Out

In my case, and in the case of any Service Connected 100% disabled Veteran, I am compensated mileage for getting to and from the VA for scheduled appointments. I have this kind of Service Connected disability designation.

I take my Veterans ID card, the pink travel voucher and go to a room on the first floor. I get a number, like the kind you would get at an old fashioned butcher shop while waiting your turn in line, then I find a seat if there is one, or wait in the hall, standing. 

I have gotten through this line quickly and slowly. Last time I was there, I got number 82. They were on 68 when I got there. I find a seat and wait until my name is called.

The process goes like this:
I hand the clerk my ID card, the voucher and the number tab. The clerk throws the number tab into a waste receptacle and asks me, “How did you get here today?”

I answer, “I drove.”

Then, he or she types a few things into the computer and hands me my Veterans ID card. They verify the name and numbers, the date and time, throws the voucher into the trash, grabs a paper from from a printer, initials it with red ink and hands it to me. There is sometimes a salutation of hello/goodbye and a question asked or comment spoken, but that happens while the clerk waits for the paper to come out of the printer. 

I am usually told, “Have a nice day.”

I always respond, “Thanks, you do the same.”

I take the paper and proceed down the hall 40 yards or so to the cashier’s cage where I wait in a line. When it is my turn, I slip the paper under the glass and show my Veterans ID up to the glass where the cashier can see it.

The cashier verifies my name on the paper and counts out the money. They hand me the money under the glass. I put the money and my Veterans ID back into my wallet.

My next stop is pharmacy. I don’t always have to stop at pharmacy, but if I do, the process is to stop there BEFORE I go to the travel office and take a number. When my number is called in pharmacy, I go up to a window and identify myself with my Veterans ID card and tell the pharmacist that I need to fill a prescription.

The pharmacist verifies the prescription that the doctor has typed into my file when I was down in the warfarin clinic and tells me to watch the screen for my name.

I then go get my travel money and return to pharmacy and wait, all the while watching a small TV monitor. When my name appears on the TV screen, I get up and get in line by a window similar to the cashiers window and wait.

I get up to the window, and identify myself with my handy dandy Veterans ID card. The prescription is found in an alphabetically labeled bin system. I am asked my full name, full social security number and my home address. The label on the prescription is scanned and my name pops up on a handy device similar to a credit or debit card payment center at a store. I sign my name and the prescription is passed under the window to me. The usual salutations are made and I am now free to leave the building.

Going Home

I walk out to my car, get in and drive home. If I have any chores or errands to perform while in the big metropolitan area of Minneapolis/St. Paul, I do so. I usually stop for a cup of coffee and a visit to my friend’s coffee shop, J&S Bean Factory in St. Paul. Sometimes, I stop in where my youngest daughetr works and chit chat with her a few minutes if she has the time

I head home and wait until the next appointment.

Currently, I am seeing the clinician for my Diabetes and another clinician for my Congestive Heart Failure. I am regularly attending the warfarin clinic every 4 weeks and also seeing the Podiatrist for some problems, stemming from Diabetes, with my feet.

Throw in a visit with my Primary Care Physician, the Dentist and the occasional Cardiologist appointment and I get to the VA as many as 6 times per month. I haven’t even mentioned the fact that my olfactory senses are gone and I have constant ringing in my ears. I’d also like to get permission to go to the gym to get some exercise as in Winter, it is very hard for me to breath the cold air and ride a bicycle outside. I have not sought referrals for these problems as of yet.

I also get treated for my eyes. Eyesight, cataracts and retinopathy. This is done at the University of Minnesota Eye Clinic on campus. Probably as far as the VA, but in a completely different place in the city.
To get reimbursed for travel here, I have to make a separate visit to the VA or wait until I am there on another appointment. If I turn in two vouchers on the same day, one for my VA visit and one from the University Eye Clinic, they only pay me for one and the other is automatically deposited into my bank account after the paperwork is processed.

There you have it. A blow by blow description of what happens at the VA. They do a fabulous job of taking care of the Veterans. Many complain, but usually, those that do don’t bother to learn the ins and outs and subtleties of the bureaucratic system that is needed to run an organization that is so huge and stressed to the maximum to care for Veterans.

In my opinion, the medical care is second to none, and great inroads have been made in hiring and training clerks to be patient, knowledgable and understanding to the problems and concerns of this large system.

My ID card allows me to go to any VA facility and be identified and get health care while traveling or living seasonally somewhere away from home.

I was told when I was nineteen years old that I would never have to worry about health care because I was a US Veteran and served my country.

That is the case at this point in my life and I am grateful. Thank you America.



Mel said...

*grumbling* Bit irritated that I seem to be losing posts courtesy of the Moof Monster.
CAN'T be that I'm doing something wrong, of course. LOL HAS to be the Moof Monster.

That being said, I'm amazed at how things have evolved at the VA Hospitals here. I used to be of the belief that it was a bit below the mark. I no longer believe that, given a whole LOT of changes that have been put into practice. And that's a very, very good thing.

Pamela said...

Thank YOU Joe.

Lea said...

I'm thinking about how at each point of this maze... you have touched someone, whether in your car, or through these long corridors. I echo Pamela. Thank you Joe.