Medical diagnosis mistakes impact 12 million a year
ASHEVILLE, N.C. (WLOS) — Making up for past mistakes has been a focus of the Veterans Health Administration.
Overall, there's been an improvement. But, from the front lines, from several veterans' perspectives, sometimes it is a battle to get the right diagnosis.
The Charles George VA Medical Center's rating is great, recently receiving five stars. But that’s based on the VA's data on inpatient treatment.
One mountain veteran is telling a different story, a story that lasted a year and ended up with him leaving the system.
“I feel like I'm fighting more of a battle back here than I have over there,” Chad Thomas said.
At 26, Thomas fought on Iraq's front lines. He was deployed to Iraq in 2004-05 as an airborne infantryman, assigned to the 525th Military Intelligence Brigade.
“Anytime there was a convoy, that was my job,” Thomas said.
From his Humvee gunner's post, he protected soldiers in and out of Bagdad's airport. Twelve years later, Thomas' battle has gone from the war room to an exam room.
“That's usually what I see happening, when there's an infection, I usually have all this other stuff,” Thomas said.
He's waging war on an infection that six months ago was much larger, blackening the skin.
“Where the original wound is healing really nicely continues to just be post inflammatory scarring,” said Dr. Kelly Rothe, of Mountain Medical Arts.
His doctor ties it to his service. But, despite helping in Thomas' battle, she's not who you'd expect.
“It was clear he had an inflammatory condition going on way back when he had his first labs done,” Rothe said.
You see, Rothe isn't Thomas' VA-approved doctor. The Thomases went outside the VA to Rothe after she says he received "an incomplete diagnosis."
Thomas' medical records showed for months the VA bounced him between VA care and being outsourced to Mission Hospital, while the infection spread to the other leg.
“Throwing all of the stress and anxiety stuff on me,” Thomas said.
“If Chad and Naomi were listened to really carefully, in the beginning, this would have been resolved a lot sooner,” Rothe said.
Thomas is not alone. Last year, another 3,400 hundred patients went outside the VA for other reasons. The numbers doubling from the year before. Charles George VA Medical Center's chief medical officer said some specialties aren't available, including neurosurgery and obstetrics.
“We have partnerships, not only here in the community with Mission and the surrounding areas but also regionally with Duke, Wake Forest,” Dr. Carl Bazemore, chief of staff, explained.
Some $10 billion in partnerships has been forged with other providers and hospitals to fill gaps missing in VA care.
“It's harder to get continuity there because their regulations and red tape is more than anywhere else, but it's complicated everywhere,” Rothe said.
The new VA secretary agrees the VA has work to do.
“I soon discovered that it was years of ineffective systems and difficulties and a workplace culture that led to these problems,” Dr. David Shulkin said at his confirmation hearing at the beginning of the month.
Even the VA admits between 2009-15 about 25,000 veterans were improperly tested for traumatic brain injuries, nearly 3,000 occurring in Winston-Salem. A study by VA Dr. Hardeep Singh shows more than 12 million patients are misdiagnosed a year. Singh's research blames it on doctors not getting enough time to be face to face with their patients or their medical records. The average exam time has gone from 40 minutes to 20 minutes.
Dr. Mark Graber has worked on similar studies.
“The next person down the line may not rethink the case, from scratch, you may not rethink the case. If you see them a couple months later and look at the chart and see oh, it's asthma, you don't question that, you just accept that diagnosis,” Graber said.
He serves as president of the Society to Improve Diagnosis in Medicine (SIDM).
Graber said there are steps doctors can take to catch misdiagnoses.
“Things like getting second opinions or taking a time out to consider other possible diagnoses,” Graber said, along with other diagnostic tools.
Thomas' request to the VA for a second opinion was initially denied. And News 13 uncovered that to get a second opinion approved outside the VA, it's the doctor, not the patient, who must agree.
“It's the physician who has to generate that consult to go outside. So, to say that the physician has to give permission, well the physician has to again authorize that care,” Bazemore said.
Thomas' push for answers got him labeled noncompliant, the VA saying he wasn't following its doctor's orders.
“That's documented all over his chart, that this is a noncompliant patient, a nonadherent patient,” Rothe said. She said what isn’t documented are the times Thomas' physicians canceled appointments for other emergencies or how long he sat waiting for appointments. Thomas said the wait time could be hours.
“He was complying with the orders he was given, but, really, the only intervention they were doing at the time was debriding or admitting him to the hospital and putting him on Methotrexate, which wasn't really helping him,” Rothe said.
“I've still got temporary liver failure, too, from the Methotrexate, from them putting me on the medicine to treat something I don't even have,” Thomas said.
It has left him feeling weary and as if the service he gave his country hasn't been repaid.
“It's like a roller coaster. Some days I feel great, some days I feel not. Mentally, I feel worse than I was when I started,” Thomas said.
The VA has finally agreed to pay Rothe for his treatment, but she's submitted the bill four times and has yet to get paid.
It's now affecting Thomas' care because he's hesitant to continue treatment if Rothe isn't getting paid.
Rothe said, while Chad's still not healed, he's finally improving.
News 13 has learned the billing isn't handled in Asheville, but in a central office in Virginia.
Thomas remains on disability, but his goal is to be able to work again.
We reached out to Congressman Mark Meadows' office about the issue. Here's what they told us when News 13 asked if they've heard complaints about the care the VA in Western North Carolina is providing:
"To answer your question: much like you with your reporting, we too have seen firsthand many of the problems with the VA and care of Veterans, particularly with Veterans’ benefits. One of the main things our office deals with is streamlining the process of Veterans’ receiving their proper benefits because there are often such lengthy delays in between when servicemen and women get the benefits they’re entitled to ... It’s probably the top issue we get calls about, from a casework standpoint. It’s a significant problem, and yes, we for sure support ideas to reform the process so we can get Veterans’ their proper benefits in a much more timely manner. Rep. Meadows feels very strongly about this issue."
