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Follow-Up to A Warning

By John Ketwig

In the Memorial Day issue of The Veteran, I offered a long article regarding my problems with the VA's "Choice" program and especially a company called Health Net that has been employed by Congress to assist the VA in administering health care via the civilian, or non-VA health care network. There are a number of criteria that must be met to qualify for Choice Program coverage, but basically it covers vets who live more than forty miles from the nearest VA clinic or hospital, or the nearest hospital does not have the qualified staff or equipment to address the veteran's medical needs. In my case, the VA hospital in Salem, Virginia did not have a neurologist or spine specialist on-staff to deal with my stenosis of the spine. It would be necessary to get approval from Health Net, but for weeks they were totally unresponsive, both to me and to the VA! I wrote to my Senators and Congressman, and Senator Tim Kaine (you may have heard of him) contacted Health Net on my behalf. Finally, my spine specialist received authorization to perform the surgery.

It should have been a fairly routine procedure. I went to the hospital eagerly, anticipating relief. Of course, I had been warned that "there is a risk with every surgery." For the first few days after I came out of the anesthetic, I was overjoyed. Then the pain increased, my teeth chattered, and finally I was rushed to the Emergency Room. A CT Scan showed an abscess on my spine. I don't know how it happened, whether someone failed to wash their hands or sterilize an instrument, but somehow they had introduced a virulent infection into my spine! The doctor performed another surgery to clean away the infection. The pain was excruciating now, far beyond any discomfort I had ever imagined. An MRI showed the infection was still present. I was utterly miserable, aflame in pain, blazing out of control like a California brush fire roaring across the drought-dried hills. My strength was gone. I doubted I would ever see my home again. My wife told my newly-married daughter if she wanted to see her Dad she should catch a plane. The hospital brought in their chief infections doctor, and he later admitted that he was not at all confident I would make it when he first saw me. I underwent a third surgery. I was on IV morphine and handfuls of oxycontin and oxycodone, plus a number of other pills and IV antibiotics. My aging body was ill prepared for this type of challenge.

I lost more than forty pounds. Slowly, I began to recover. After weeks in the hospital and then in a rehabilitation facility, I was allowed to go home. Every day for seven weeks we returned to the hospital twice a day, every time the clock said eight o'clock, for two-hour infusions of powerful IV antibiotics. Finally, I was able to cut back on the pain pills. When I quit them altogether, I experienced withdrawal that was like an acute flu that lasted for weeks.

I'm doing much better now. I am unsteady, walking with a cane. My legs are weak, but I've been doing rehab physical therapy. I have problems balancing. I still feel some discomfort, but ibuprofen usually makes it livable. I am getting stronger every day. The doctors predict it will be a long time before I'm back to normal. My greatest fear is that the infection will return. Two vertebrae and the disc between were infected, and the doctors tell me infections often lurk in bone for years before reappearing when you least expect it.

Recently, despite the "authorization" from Health Net, I've received a number of statements indicating that the VA has declined to pay for my medical procedures or medicines. The VA has sent explanations, more like legal position papers, including a number of reasons why my claim will not be paid. The primary reason cited is that "treatment was emergent according to the prudent layperson standard." Whatever that means. The letter assures me that I can appeal. I have another appeal with the VA pending. After three years, I had an in-person hearing last December. The very nice lady told me to expect a decision within 8 to 10 weeks. When I didn't hear anything in six months, I called to inquire and was told decisions on appeals are currently taking more than five years!

Fifty years ago, in 1966, the Draft caught up with me. I had no interest whatsoever in becoming a soldier, but they systematically and all too quickly choked off my attempts to avoid conscription, and ultimately I enlisted "to get my choice of training"on December 30th, 1966. I was assured that I would have benefits; that Uncle Sam would look after me. No one told me how hard it would be to access those benefits!

John Ketwig is a lifetime member of VVAW and Author.