UPDATE: Since publishing this article, Veteran Voices For Fibromyalgia (VVFF) founder Kristal Kent, received correspondence via email, on this issue from Congressman Max Miller's office. VVFF will provide updates on this issue, and any future correspondence from Congressional Representatives, or the News Media.
As the VA Healthcare System moves towards a more technologically driven healthcare model of services, it is to be expected that technological issues will arise, at no fault of the VA and its’ healthcare providers. However, in many instances we are seeing an influx of technological connectivity issues with the Veteran Affairs Telehealth services. This, in turn, leads to Veterans not receiving the medical care they need in a timely manner, Veterans running out of medications, and/or no medical support provided when a Veteran is experiencing a medical heath or mental health issue. These factors diminish the continuity of care, delays needed medical care i.e., referrals, lab orders, refills of prescriptions etc., while simultaneously reducing a Veteran’s overall physical and mental health baseline, and healthcare outcomes.
CASE IN POINT: Army Veteran, and Founder of Veteran Voices For Fibromyalgia Kristal Kent, experienced on multiple occasions VA providers not being able to follow through with scheduled Telehealth appointments on July 14th, 2021, August 11th, 2021, and again on August 2nd, 2023. In July 2021 and August 2021, this led to the Veteran running out of prescribed anxiety medications. Despite several attempts by the Veteran to rectify this issue and obtain refills, no one in the Parma, Ohio VA Mental Health Department, nor the Patient Advocate, assisted in circumventing this issue. The Veteran also reached out to the Parma VA Pharmacy. While the pharmacy was extremely helpful and diligent in assisting the Veteran, the Parma VA Pharmacy also had issues with obtaining refills due to non-responsiveness by the medical provider, and the mental health department. As a result, it was 6 business days before the VA Parma Pharmacy was able to obtain a refill request from the assigned provider. The resulting consequence, due to non-response from the mental health provider, the filling of and delivery of medication was grossly delayed. The Veteran went without Anxiety medication for 10 business days (approx. 2 weeks’ time). This led to immediate and severe withdrawal symptoms, a reduction of the Veteran’s mental health baseline, and mistrust of the VA healthcare system. Once the Veteran was able to receive the Anxiety medication, it was approximately 6 weeks until the Veteran’s anxiety symptoms and overall mental health stabilized. Unfortunately, the Veteran’s current mental health baseline is now lower than it was prior to the incident of running out of anxiety medications.
Due to lack of assistance through the VA, the Veteran, Kristal Kent, reported in writing the issues that occurred on July 14th, 2021, and August 11th, 2021, to the Parma, Ohio Patient Advocate. The Patient Advocate failed to follow up on this issue. Therefore, Kristal reported this issue in writing to the Veteran Liaison, for Congressman Anothony Gonzales (OH). In addition, when the Kristal again experienced this issue on August 2nd, 2023, she spoke directly with Congressman Max Miller, on August 3rd, 2023. Kristal then coordinated an independent poll through Veteran Voices For Fibromyalgia. After receiving the results of this independent poll, Kristal followed up in writing, via email, to Congressman Miller's Veteran Liaison on September 8th, 2023, and again on September 28th, 2023. Kristal's written correspondence included an outline of the VA telehealth medical appointment issues along with the results of the independent poll. Despite her continual follow up, Kristal has not received a response from Congressman Miller's team regarding issues with the VA Telehealth medical services.
The following are the results of Veteran Voices For Fibromyalgia's Independent Poll and an outline of issues/solutions:
An independent poll of 518 Veterans, conducted by Veteran Voices For Fibromyalgia from August 7th, 2023 – September 7th, 2023, found the following:
Of the 518 Veterans polled, 62% of Veterans reported their VA Medical Provider either did not connect for their scheduled Telehealth appointment, or the VA Medical Provider cancelled their Telehealth appointment at last minute.
Further of the 518 Veterans polled, 52% reported they needed medication refills, and as a result of their VA Medical Provider either missing or cancelling their Telehealth or in person medical appointment at last minute, they ran out of medications.
Connectively issues of medical telehealth appointments leads to reduced overall health and wellness, especially when VA Providers do not follow up by
Mental Health Admin Support Staff do not always assist Veterans to circumvent issues such as needing medication refills.
For Mental Health appointments, no engagement by the assigned Provider of the Veteran to check mental health status, diminishes the therapeutic relationship between Veteran and Medical Provider
Other than rescheduling their appointment when a provider misses a telehealth appointment, there is seemingly no protocol or “back up” plan in place, to follow up with the Veteran, to ensure continuity of care and/or identify any immediate medical needs of the
Connectivity issues with VA Telehealth appointments leads to reduced continuity of care for Veterans. This in turn can lead to reduced health outcomes for the Veteran. In addition, this diminishes the Veteran's trust in the VA Healthcare System. Moreover, this can negatively impact a Veteran's overall physical and/or mental health which can increase risk of death or suicide.
IDENTIFIED INTERIM SOLUTIONS:
When possible, the Medical Provider should call the Veteran to conduct the appointment via phone.
When a provider is in-office providing telehealth medical appointments, the department must have “back-up” laptops on site, so a provider can sign out a laptop to use for the day, to ensure delivery of telehealth appointments and continuity of
If the first 2 options are not possible, if there is another healthcare provider available in the department, the Veteran should be connected to that provider to ensure continuity of care, mental health crisis assessment, and medical need assessment i.e. medication refills, answer immediate medical concerns, etc.
(Non-Primary Care Appointments) If the Mental Health provider is unable to connect or call the Veteran, and the Veteran is in need of medication refills, the Dept. Admin Support staff should request another prescriber within the department, to assist the Veteran to obtain medication refills.
Non-Primary Care appointments) If there is not another Mental Health prescriber within the department, VHA staff should assist the Veteran, by messaging their Primary Care Team, requesting a refill of the Veteran’s mental health medications.
Create MACT Teams, similar to PACT Teams in Primary Care Departments, comprised of a Mental Health Licensed Prescriber (Psychiatrist/APN), a Therapist (if assigned), a Mental Health Nurse, a Mental Health Case Worker, and/or Mental Health Peer Support Specialist, for added mental health support for Veterans, help mitigate issues with access to care, identify the immediate needs of the Veteran, promote continuity of care. and improve Mental Health outcomes for both Veterans and VA Healthcare
The VA Healthcare system as a whole, needs to upgrade their technology and their connectivity provider, to reduce issues with failure to provide medical care via Telehealth Medical Care.
In closing, neither the Veteran Health Administration nor Congress can bury their heads in the sand and ignore this problem. Both the Veteran Health Administration and Congress need to cohesively work together to address this ongoing problem. They need to conduct a national poll to identify the prevalence of this issue and create a strategic plan to resolve the systemic problems with the delivery of the VHA Telehealth Medical Services.
Written by Kristal Kent - Disabled Army Veteran, Founder of Veteran Voices For Fibromyalgia, and Humanist