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Jan 21, 2009, 06:50 PM
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This has been a long frustrating week and I do not want to get into every detail so to make it easy I am going to post both an email I sent to someone last night and a link I was sent that has me quite upset. This all relates to what I have been dealing with concerning inproper care by the VA for my husbands PTSD....any thoughts, insight would be appreciated!
Dear _____ and _____, I am sending you both an article I was told about by a young Iraq vet at the Veterans Center today concerning deaths of some of our young soldiers here in WV. I was floored reading this and it helps me understand better that I am not nor was I ever wrong or alone in my complaints to the VA about my husbands medicines and care. In fact I have attended two doctors appointments with him now, one in December and one two weeks ago and I was very upset with what I heard and learned. They could not answer me (or him) about actual diagnosis, treatments or medications properly and neither of those two doctors said they could even order a sleep apnea test for and he had to wait until another appointment with another doctor. After many telephone calls and finally getting my husband to sign a release form I think they are trying to cover a few mistakes up and reading this article makes me wonder even more. Today was another day of, gee what is going on now? We received a new prescription in the mail from his doctor at the VA he saw on January 14th at his appointment. My husband was never told by the doctor that he was sending him a "new" prescription and that the other two medicines he is currently taking were discontinued in December and Jan? The doctor only asked him if he needed more medications and that his blood work came back with him having a lower kidney function creatine level of 1.6 and higher cholesterol of 236 from the 201 it was back in July 08. Now if my husband had taken this "new" medicine (Prozac) with the others he is currently taking (Celexa, Wellbutrin and Seroquel) could he have overdosed? Imagine that! I called and demanded the doctor call me or him to explain why he has this new medicine. Funny how at the two appointments the one on December 18th when we asked about these medications specifically and again on January 7th for the doctor (s) at both those appointments to tell us he was still suppose to be taking the two medicines. Well today his doctor tells me and a nurse and the desk clerk those two medicines he is taking now were discontinued in December 2008 and Jan 2009??? so I am really confused now but the paper work online shows all were discontinued in September? Not only that I had the nurse at the main hospital try to tell me today that they (the VA) did not even prescribe him the one anti depressant and it was not showing in their system, yet it shows in the local clinics computer system? More confusing. Since April 2008, my husband was getting so many bottles of meds he had a 6 month stock pile here at the house due to the VA pharmacy and doctor continuously ordering more even when the other medicines were not near being gone. This continued until I called the main pharmacy in November 2008 and demanded them NOT to send anymore medication he had plenty. Yet at every appointment they continue to ask him, do you need more medications? Uhmmm try looking in your system and computer??? So today I I tried getting some answers and wow, the computer systems are showing new dates as to when the medicines were discontiuned....like as of yesterday now and as of his appointment on the 14th? Funny that the main pharmacy could tell me it is the same doctor going into the system changing these things and I printed up the online papers and compared them to the papers I printed in October and everything is different. The bottles that we got in the mail some are not even showing on the screen and others dates have changed of the date they were mailed out from the papers I have from October...... I am MAD! So here below is the article I was sent that talks about 4 men from here who went to the same clinic and took similar meds as my husband was up until yesterday when they stopped them all. Vets taking PTSD drugs die in sleep Hurricane man's death the 4th in West Virginia A Putnam County veteran who was taking medication prescribed for post-traumatic stress disorder died in his sleep earlier this month, in circumstances similar to the deaths of three other area veterans earlier this year. A Putnam County veteran who was taking medication prescribed for post-traumatic stress disorder died in his sleep earlier this month, in circumstances similar to the deaths of three other area veterans earlier this year. Derek Johnson, 22, of Hurricane, served in the infantry in the Middle East in 2005, where he was wounded in combat and diagnosed with post-traumatic stress disorder while hospitalized. Military doctors prescribed Paxil, Klonopin and Seroquel for Johnson, the same combination taken by veterans Andrew White, 23, of Cross Lanes; Eric Layne, 29, of Kanawha City; and Nicholas Endicott of Logan County. All were in apparently good physical health when they died in their sleep. Johnson was taking Klonopin and Seroquel, as prescribed, at the time of his death, said his grandmother, Georgeann Underwood of Hurricane. Both drugs are frequently used in combination to treat post-traumatic stress disorder. Klonopin causes excessive drowsiness in some patients. He also was taking a painkiller for a back injury he sustained in a car accident about a week before his death, but was no longer taking Paxil. On May 1, the night before he died, Johnson called his grandfather, Duck Underwood, and asked if he could pick up his 5-year-old son and take him to school the next day. Johnson and his wife, Stacie, have three children, all under 6 years old. Their car had been totaled in the accident the previous week. When Underwood arrived to pick up the boy the next morning, his knocks were not answered at first. He heard Stacie Johnson screaming. She opened the door and told him she couldn't wake her husband. They called paramedics, who could not revive him. Doctors did not declare an immediate cause of death. Toxicology and autopsy results could take as long as 60 days, authorities told the family. "I want to know the cause of death," said Ray Johnson, Derek's father. "Stacie said he was fine that night. Everything was normal. He kissed her goodnight and went to sleep." Stan White, father of soldier Andrew White, has become an advocate for families of returning veterans with post-traumatic stress disorder. During his son's struggle with the disorder and since his death, White has tracked similar cases. He knows of about eight in the tri-state area of Kentucky, Ohio and West Virginia. He and his wife, Shirley, introduced themselves to the Johnsons and Underwoods at Derek's funeral and offered their help. He is in contact with the office of Sen. Jay Rockefeller, D-W.Va., who is a member of the Veterans' Affairs Committee. Rockefeller requested an investigation into these deaths, which is ongoing, said Steven Broderick, the senator's press secretary. "When I talked to his family about Derek, I realized it was the same old story," said White. "It was all too familiar. He was taking those same drugs as the others, and, yes, I believe they are still prescribing that combination." After speaking with family members, White wonders if the patients are taking the medicine as prescribed. He said PTSD patients suffer short-term memory loss and shouldn't be relied upon to track their medications. Georgeann Underwood agrees. "You shouldn't put vulnerable, mentally unstable people on drugs like that," she said. An outgoing, personable young man who worked at several jobs to support his young family, Johnson frequently was offered other jobs by customers in the stores where he worked, Underwood said. In 2006, he returned from the Middle East depressed and short-tempered. Johnson had operated an M249 Squad Automatic Weapon, or rapid-fire machine gun, and rarely spoke about his experiences there. After his military prescriptions ran out, Johnson's medications were prescribed by private physicians because he refused to go the VA hospitals where he said he was required to wait long periods of time for appointments. His grandparents paid for his medications. "He had a very short fuse," Ray Johnson said. "That was the biggest difference in his personality after he came back." Until his death, he worked 12 or 16 hours a day. He was an electrical apprentice at the John Amos Power Plant until he was let go when his work hours approached the union limit for apprentices. He was on his way to apply for another job when the car he drove was rear-ended on April 24. Johnson died May 2. |
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#2
Jan 23, 2009, 06:03 AM
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After spening the last few days dealing with the VA BS I recieved a call from two of the familes here where I live who are the loved ones of the men mentioned in both the news article and this repoort below. What I never expected in both telephone calls was to hear how similar thir experineces are to what my husband and I have been going through almost word for word, symptom for symptom. Report No. 08-01377-185 August 14, 2008 VA Office of Inspector General Washington, DC 20420 My husband served in Iraq with one of the men and his widow, both were in his unit. She told me about her husband wetting the bed, his behavior and how the VA treated him and she was scared for my husband as was the other families father. They are telling me to get him a complete physical with a private doctor based on his symptoms and treatment. I think the VA is to overwhelmed to properly care for these men, lack the proper treatment and services here where we are at and is this just a freak thing? The widow I spoke to her husband was being treated at the same clinic my husband has been to by the same doctors....is this all just a freak thing or not I have to wonder?? The report below borth families say is incomplete and not accurate, but of course who did the inspection? The VA! Food for thought I guess.... Healthcare Inspection Quality of Care of Two Deceased West Virginia Veterans To Report Suspected Wrongdoing in VA Programs and Operations Call the OIG Hotline – (800) 488-8244 Quality of Care of Two Deceased West Virginia Veterans Executive Summary The VA Office of Inspector General (OIG) was asked by Senator Rockefeller to review the care of two West Virginia combat veterans who were being treated for severe post-traumatic stress disorder (PTSD) and who died in their sleep. The Senator asked that the review take into account the medications prescribed and explore the possibility of any pattern in these tragic deaths. We reviewed these patients’ medical records and visited the Huntington VA Medical Center (VAMC), Charleston Community Based Outpatient Clinic and Vet Center, and the Cincinnati VAMC PTSD Residential Program. We interviewed the families of the patients and the providers at each site who had been involved in the care of these patients. We reviewed the autopsy and toxicology reports for both patients and discussed the findings with the Chief Medical Examiner for the State of West Virginia. We concluded that the care provided for these patients at the Charleston community based outpatient clinic, and the VA facilities in Huntington and Cincinnati met community standards of care. VA’s Pharmacy Benefits Management Services program and its Center for Medication Safety (VAMedSAFE) conducted a nationwide data pull of all-cause mortality during 1998–2008 for patients prescribed the combination of quetiapine, paroxetine, and clonazepam. Additional analyses examined other combinations of mental health medications, including an analysis by age of patients with and without PTSD. There was no apparent signal to indicate increased mortality for patients taking the combination of quetiapine, paroxetine, and clonazepam when compared with patients taking other similar combinations of psychotropic medications. The direct impact of non-prescribed medications in these patient deaths cannot be determined. VA mental health providers describe the use of non-prescription medications as growing area of concern in the treatment of young veterans. Returning war veterans may have multiple mental health conditions in addition to PTSD. Restriction of admission to the Clarksburg Residential PTSD Program for patients taking clonazepam and related medications may decrease access to appropriate treatment. We recommended that management evaluate exclusion criteria for admission related to medications for newly-diagnosed patients to the Residential PTSD Program. VA Office of Inspector General i D EPARTMENT OF VETERANS AFFAIRS Office of Inspector General Washington, DC 20420 TO: Director, Veterans Integrated Service Network (10N4) SUBJECT: Healthcare Inspection – Quality of Care of Two Deceased West Virginia Veterans Purpose The VA Office of Inspector General (OIG), Office of Healthcare Inspections was requested by Senator Rockefeller to review the care of two West Virginia combat veterans who were being treated for severe post-traumatic stress disorder (PTSD) and who died in their sleep. The Senator asked that the review take into account the medications prescribed and explore the possibility of any pattern in these tragic deaths. In addition, patients’ families expressed the following:
Background In 2008, two veterans (Patient A and Patient B) unexpectedly died in their sleep. Both were men under the age of 35 who had recently served in Iraq. Prior to their deaths both patients had been taking three prescribed psychiatric medications—paroxetine, clonazepam, and quetiapine. Scope and Methodology We interviewed the families of Patient A and Patient B. We visited the Huntington VA Medical Center (VAMC), Charleston Community Based Outpatient Clinic (CBOC) and Vet Center, and the Cincinnati VAMC PTSD Residential Program. We interviewed providers at each site who had been involved in the care of these patients. We reviewed the autopsy and toxicology reports for both patients and discussed the findings with the VA Office of Inspector General 1 Quality of Care of Two Deceased West Virginia Veterans Chief Medical Examiner for the State of West Virginia. We also reviewed VA medical records and Vet Center progress notes. For Patient A, we interviewed his private psychiatrist and the non-VA psychiatrist who cared for him during hospitalization at a state hospital; we also reviewed non-VA medical records. In May 2008, in response to media reports of the death of these patients, the Veterans Integrated Service Network (VISN) 10 patient safety officer asked mental health clinic managers to review the medical records of patients who were currently prescribed the combination of quetiapine, paroxetine, and clonazepam to determine if any adverse drug events had occurred. We reviewed the facility responses and interviewed the psychiatrist who had performed these chart reviews for the patients at the Cincinnati VAMC. In response to these deaths, VHA conducted an analysis of all deaths from any cause among patients who were prescribed the medications addressed in this report, and we reviewed that analysis in detail. We also searched the medical literature for reports of unexpected deaths in young adults related to these medications and general studies on accidental drug-related deaths. We conducted the inspection in accordance with Quality Standards for Inspections published by the President’s Council on Integrity and Efficiency. Case Histories Patient A Patient A was initially seen for a mental health evaluation at the Charleston CBOC in 2007. The patient had served a 9-month tour of duty in Iraq in 2005. After this deployment, he experienced chronic depression, severe anxiety, social withdrawal, feelings of emotional distance, hyper-vigilance, sleep disturbance, intrusive thoughts of combat, poor anger control, alcohol misuse, and inability to maintain stable employment. Prior to evaluation at the CBOC the patient’s family physician had prescribed an antidepressant, but this was discontinued after one week due to sedation. At the CBOC, the patient was treated with citalopram and trazodone for depression, anxiety, panic, and insomnia. Because of nausea, citalopram was discontinued after one week and paroxetine was prescribed. Trazodone was felt to be ineffective and was discontinued. He subsequently presented with suspiciousness, agitation, irritability, and insomnia, and quetiapine was prescribed. Although paroxetine was somewhat effective, after a few months it was discontinued because of side effects and mirtazapine was prescribed. After he reported tearfulness, poor sleep, nightmares, and feeling that his "medicines were not right," mirtazapine was discontinued and paroxetine was re-started. Several weeks later, the patient reported extreme anxiety and admitted having had past thoughts about killing himself. VA Office of Inspector General 2 Quality of Care of Two Deceased West Virginia Veterans Clonazepam was prescribed to be taken at bedtime and quetiapine was discontinued. At a subsequent conversation, the patient admitted that he was still taking the quetiapine and his psychiatrist agreed to continue/re-start the medication. By the fall of 2007 the patient on his own increased his dosage of quetiapine to 1200 milligrams (mg). At that time he was also taking paroxetine 40 mg per day and clonazepam 3 mg per day. His psychiatrist documented "…reinforced the plan to eventually become med. free, although will allow him [the patient] to play a major role in determining when. I did inform him that there are limits to the amount of medication he can depend upon." In late 2007 and early 2008, the patient saw a private psychiatrist. His psychiatrist increased the paroxetine dose to 60 mg and later to 80 mg; he also increased quetiapine to 1600 mg and clonazepam to 4 mg per day. Valproic acid was started by the private psychiatrist for irritability and explosive outbursts. Although he was reportedly less irritable and his anger was better controlled, he also reported diarrhea and valproic acid was discontinued. Subsequently, the patient was reportedly non-compliant with medications. He displayed increasing irritability and isolation and spent an excessive amount of time alone in his room. During that time, he presented to a non-VA facility. He became agitated after waiting several hours in the emergency department and was involuntarily admitted to a state hospital for two weeks. During that hospitalization, the patient was treated for a bipolar disorder with psychotic features and PTSD. Paroxetine was discontinued, escitalopram was initiated, the quetiapine dose was reduced to 800 mg per day, and clonazepam was discontinued. In addition, while at the state hospital he was started on oxcarbazepine. On the day after discharge from the state hospital, he was seen by a psychologist and a psychiatrist at the Huntington VAMC. The psychiatrist noted that the "…Pt. and his mother believed he was responding better to former medications so I agreed to return him to previous medications." In addition, the patient had apparently developed a tremor after initiation of oxcarbazepine. The oxcarbazepine dose was tapered off, clonazepam was restarted, the quetiapine dose was continued at 800 mg, escitalopram was discontinued, and paroxetine was re-started. A week later the patient was seen by a Huntington VAMC psychologist for individual therapy. At that visit he did not report side effects related to his medications and indicated compliance with his regimen. The patient was found dead at his home less than one week later. The autopsy report of the Chief Medical Examiner of the State of West Virginia stated that the patient died as a result of combined drug intoxication. The involved drugs included paroxetine, quetiapine, and a non-prescribed medication. No contributory natural diseases or physical injuries were identified. VA Office of Inspector General 3 Quality of Care of Two Deceased West Virginia Veterans Patient B Patient B was deployed to Iraq in 2003. After his return home, he attended group sessions at the Charleston Vet Center and in mid-2006 was referred to the Charleston CBOC for mental health evaluation. He reported having nightmares and feeling paranoid, anxious, depressed, and irritable. He endorsed difficulties with anger and feeling constantly on guard. He described himself as a different person since his return home. He was started on paroxetine, quetiapine, and clonazepam. A few weeks later the patient reported feeling better and having a new full time job at a manufacturing plant. Over the next nine months, the patient’s therapist spoke with him by phone noting the patient’s concern that the policy of his employer was that new employees were allowed to miss only 3 days of work during the initial year or face termination. The patient re-presented in the summer of 2007. At a mental health appointment with his therapist, he reported feeling "ready to explode." He discussed significant marital stress and complained of headaches. Primary care and psychiatric medication appointments were arranged. Laboratory work was obtained at a primary care appointment. Paroxetine and quetiapine were re-initiated. In the fall of 2007, he was seen by a primary care provider for chronic knee pain. Physical therapy was recommended and he was prescribed gabapentin. The patient told a provider that he was taking 30 mg of paroxetine a day instead of the 20 mg prescribed. He had also increased his quetiapine dose; the higher dose helped him sleep. The patient was irritable and reported getting into fights. The dose of paroxetine was increased to 30 mg and the quetiapine to 300 mg, and he was continued on clonazepam. At that time, the patient was seeing a social worker at the Charleston CBOC for therapy and attending group sessions at the Vet Center. The patient experienced difficulty sleeping, and increased nightmares, anxiety, anger, and irritability. He expressed concern that he might lose his temper and end up in jail. He no longer had a job and reported financial stress and feeling desperate to find work. His paroxetine dose was increased and valproic acid was started to target his irritability and anger outbursts. He was seen by primary care because of frequent headaches, and ibuprofen was prescribed. His family reported that he had gained weight and that his face and hands appeared swollen. In late 2007 the patient entered the 8 week Residential PTSD Program at the Cincinnati VAMC. A nurse practitioner performed a baseline history and physical examination and an electrocardiogram, chest x-ray, urinalysis, and thyroid blood test were obtained. Prior blood work from the Charleston CBOC was reviewed. His paroxetine dose was increased in week 3 due to ongoing depressive symptoms. The quetiapine dose was reduced several times after the patient reported over-sedation. At VA Office of Inspector General 4 Quality of Care of Two Deceased West Virginia Veterans one point, because of ongoing difficulty with sleep and nightmares, the patient re-increased the dose on his own to 400 mg. Early in the program the nurse practitioner discontinued the gabapentin because it was felt that it might be contributing to dry mouth and the patient did not feel that it had been effective for his chronic leg pain. Later, the nurse practitioner ordered ibuprofen and Tylenol. The clonazepam dosage was decreased during the first week and then ordered to be given at bedtime only if needed. The valproic acid dose was increased and, during the 6th week of the program, the patient admitted taking more than prescribed when he felt anxious. He was advised against this practice and was told that an extra dose would not provide any immediate benefit. Also during the 6th week of the program, the patient complained of ongoing difficulty with nightmares and sleep paralysis. He was prescribed prazosin at bedtime and reported resolution of nightmares during the last week of the program. The patient reported some improvement in mood, but more improvement in irritability, energy, interest, and concentration. Toward the end of the program a reduction in PTSD symptoms was noted on the Clinician Administered PTSD Scale (CAPS) and the PTSD Checklist (PCL). His family reported that when he was home for Christmas, he had tremors; and he appeared tired, heavily medicated, forgetful, and "foggy," with slurred speech at times. In addition, his voice was described as deep and raspy, different from his normal voice. The patient met with the nurse practitioner a few days before completion of the program to review discharge planning. He reported plans to follow-up with his primary care physician at the Charleston CBOC. Progress notes written during the program do not indicate problems with sedation, hoarseness, cognitive impairment, or nausea. On the day of discharge, he had a few episodes of vomiting after arriving home. He reportedly took 2 quetiapine pills (dosage unclear) and fell a sleep on the couch, where early the next morning he was found unresponsive. The autopsy report of the Chief Medical Examiner of the State of West Virginia stated that the patient died as a result of combined intoxication with paroxetine, quetiapine, and two non-prescribed medications "…under circumstances significant for fatal over-use of prescribed paroxetine…" with apparent misuse of non-prescribed medications of uncertain intentionality. VA Office of Inspector General 5 Quality of Care of Two Deceased West Virginia Veterans Inspection Results Issue 1: Quality of Care for Two Veterans: The care provided for these patients at the Charleston CBOC, Huntington VAMC, and the Cincinnati VAMC met community standards of care. Patient A Medical record progress notes indicate that the patient and his providers discussed medication options, dosing, desired and adverse effects, as well as possible drug-drug and food-drug interactions. Providers documented medication side effects. Food and Drug Administration-approved prescribing information for quetipaine states that in clinical trials "…the majority of patients responded between 400 to 800 mg/day. The safety of doses above 800 mg per day has not been evaluated in clinical trials." However, depending on a patient’s presentation, in clinical practice it is not unusual for psychiatrists to prescribe medications in doses above the recommended dose range. In the fall of 2007, the patient’s VA psychiatrist agreed to increase the quetiapine dose to 1200 mg after the patient had self-increased the dose. The dose was again increased while the patient was under the care of a non-VA psychiatrist. After hospitalization at the non-VA hospital, the patient was seen again by the VA psychiatrist, at which time the prescribed quetiapine dose was 800 mg. The patient was seen by a primary care physician at the CBOC and at the Huntington VAMC multiple times, and was evaluated by a non-VA physician in Huntington. He was also seen by a social worker for therapy and case management at the CBOC, and he attended individual and group sessions at the Vet Center. The patient’s social worker reported that he was frequently difficult to engage in the treatment process. Treatment was also complicated by the patient’s other mental health issues. The social worker reported that she had frequently suggested hospitalization or at one point admission to the Residential PTSD Program at the Clarksburg VAMC, but the patient declined. After he was committed to a state hospital, there was discussion between the patient’s family and Huntington VAMC staff about possible transfer to a VA hospital. However, the only VA hospital in West Virginia with a locked inpatient psychiatry unit, which the patient required, is in Martinsburg, more than 350 miles away. During the hospitalization, a Vet Center therapist told a family member that patients taking clonazepam or similar medications would probably be ineligible for admission to the Clarksburg PTSD Residential Program. During the patient’s stay at the state hospital, his psychiatrist discontinued the clonazepam after learning that it might interfere with his acceptance in the PTSD program. Ultimately, the patient was not accepted because he VA Office of Inspector General 6 Quality of Care of Two Deceased West Virginia Veterans was felt to be not stable enough to participate in the intensive trauma-focused program. Toward the end of his stay at the state hospital, there was discussion about possible admission to another non-VA psychiatric hospital, but the patient declined. After discharge from the state hospital, the patient was seen by a psychologist at the Huntington VAMC. The psychologist noted that the patient had limited coping skills for self-management of PTSD symptoms; consequently, he planned to see the patient weekly to begin cognitive-behavioral therapy. The Associate Chief of Staff at Clarksburg verified to the OIG that the Residential Program at Clarksburg historically does not admit patients on benzodiazepine medications (clonazepam is a benzodiazepine). Patient B The patient participated in an 8-week Residential PTSD Program at the Cincinnati VAMC. The focus of the program is improvement through structured individual and group evidence-based psychotherapies. Medication is viewed as serving an adjunctive role to reduce symptoms so that patients are better able to engage in therapy. For example, difficulty sleeping not only negatively impacts quality of life but also interferes with participation in therapy. At initial evaluation and as patients progress through the program, staff reported that they aim to eliminate medications, reduce doses, and simplify regimens if clinically appropriate. Our review of treatment records for this patient showed that staff did attempt to reduce medication doses. Several clinical providers told us that the patient actively participated in therapy, did not appear sedated or ill, interacted appropriately with peers, and appeared committed to recovery. Blood and urine tests, an electrocardiogram, and a chest x-ray revealed no heart or kidney disease. Issue 2: Role of Medications in Death of Two Veterans The Medical Examiner found that these patients died from combined drug intoxication involving prescribed and non-prescribed medications. In the presence of PTSD, other mental health conditions, and uncertain use of medications by patients, we are unable to draw conclusions about the relationship between medication regimens and these deaths. The toxicology report for one of the patients showed a markedly elevated blood level of paroxetine, even though the patient was prescribed an appropriate dose. The patient did not display signs of suicidal ideation in the weeks prior to his death. Paroxetine is not known to be substantially affected by the presence of the other prescribed medications, and genotyping of liver tissue revealed no significant abnormality in the ability of the liver to metabolize paroxetine. Paroxetine can adversely interact with one of the non-prescribed medications. However, the impact of this potential interaction is unclear. VA Office of Inspector General 7 Quality of Care of Two Deceased West Virginia Veterans In May 2008, the VISN 10 patient safety officer asked mental health clinic managers to review the charts of patients currently prescribed the combination of quetiapine, paroxetine, and clonazepam for documentation of any adverse drug effects. No deaths or significant adverse events were reported. VHA’s Pharmacy Benefits Management (PBM) Services program and its Center for Medication Safety (VAMedSAFE) conducted a nationwide analysis of all-cause mortality during 1998–2008 for patients prescribed the combination of quetiapine, paroxetine, and clonazepam. Additional analyses examined other combinations of mental health medications, including an analysis by age of patients with and without PTSD. The VA analysis was essentially a series of data queries, and is limited by inability to determine specific cause of death or adjust for medical co-morbidities. There was no apparent signal to indicate increased mortality for patients taking the combination of quetiapine, paroxetine, and clonazepam when compared with patients taking other similar combinations of psychotropic medications. VHA researchers are studying mortality in elderly patients taking antipsychotic medications in combination with other psychotropic medications. They will be able to determine cause of death using National Death Index data. VHA’s VAMedSAFE is working with the primary investigator to expand the study and has recently applied for funding to include younger patients. Although antipsychotic medications have been identified as possible causes of cardiac rhythm disturbances, a 2001 review in the medical literature found no association with olanzapine, quetiapine, or risperidone and Torsades de Pointes (a fatal arrhythmia) or sudden death. The authors did caution that all antipsychotic medications may cause serious adverse events, and balancing risks and benefits is a challenge for psychiatrists. The authors also recommended that clinicians ask patients if they have had fainting or have relatives who died suddenly at a young age. For elderly patients, especially those with known heart disease or those already taking non-psychiatric drugs that prolong the QT interval (part of the heart electrical conduction cycle), a pretreatment electrocardiogram would be appropriate.1 In the absence of known cardiac disease, we are unaware of any clinical practice guidelines recommending baseline or periodic electrocardiogram monitoring in young, healthy patients on quetiapine. Clinicians have described a tendency of young returning veterans to self-medicate using non-prescribed prescription medication obtained from friends, family members, and co-workers. These behaviors have also been observed among non-veteran patients treated for mental health conditions at private facilities. In addition, media reports during the past year describe the use of non-prescribed prescription medications by patients at military treatment facilities. 1 Glassman, Alexander H.,M.D., and Bigger, Jr., J. Thomas, M.D., Antipsychotic Drugs: Prolonged QTc Interval, Torsades de Pointes, and Sudden Death, The American Journal of Psychiatry, 158: 1774-1782, November 2001. VA Office of Inspector General 8 Quality of Care of Two Deceased West Virginia Veterans Conclusions These two Iraqi war veterans served honorably in Iraq. After returning from the Middle East they suffered with symptoms of PTSD and other mental health conditions. Their deaths are tragic. The health care provided for these patients met community standards of care. VHA’s Pharmacy Benefits Management Services program and its Center for Medication Safety (VAMedSAFE) conducted a nationwide data pull of all-cause mortality during 1998–2008 for patients prescribed the combination of quetiapine, paroxetine, and clonazepam. Additional analyses examined other combinations of mental health medications, including an analysis by age of patients with and without PTSD. There was no apparent signal to indicate increased mortality for patients taking the combination of quetiapine, paroxetine, and clonazepam when compared with patients taking other similar combinations of psychotropic medications. The direct impact of non-prescribed medications in these patient deaths cannot be determined. Returning war veterans may have multiple mental health conditions in addition to PTSD. Restriction of admission to the Clarksburg Residential PTSD Program for patients taking clonazepam and related medications may decrease access to appropriate treatment. VA mental health providers describe the use of non-prescription medications as growing area of concern in the treatment of young veterans. Recommendation We recommend that the VISN Director ensure that the Clarksburg VAMC Director evaluate exclusion criteria for admission related to medications for newly-diagnosed patients to the Residential PTSD Program. Comments The VISN and Medical Center Directors agreed with our findings and recommendations and submitted an acceptable improvement plan. (See pages 10–12 for the full text of comments.) We will follow up on the planned actions until they are completed. (original signed by  JOHN D. DAIGH, JR., M.D. Assistant Inspector General for Healthcare Inspections VA Office of Inspector General 9 Quality of Care of Two Deceased West Virginia Veterans Appendix A VISN Director Comments Department of Veterans Affairs Memorandum Date: August 6, 2008 From: Network Director, VISN 4 (10N4) Subject: Healthcare Inspection – Quality of Care of Two Deceased West Virginia Veterans To: Deputy AIG for Healthcare Inspections (54) 1. Attached please find my approved plan to address recommendations identified by the Office of Inspector General (OIG) to improve the quality of care provided to veterans residing in the State of West Virginia. The action item identified by OIG has been completed. 2. The insights and observations provided by OIG are appreciated and a valuable resource for improving services provided. If you have any questions, please do not hesitate to contact me. (original signed by Bradley P. Shelton, Deputy Network Director) MICHAEL E. MORELAND, FACHE VA Office of Inspector General 10 Quality of Care of Two Deceased West Virginia Veterans Appendix B Medical Center Director Comments Department of Veterans Affairs Memorandum Date: August 6, 2008 From: Director, Louis A. Johnson VA Medical Center, Clarksburg, WV (540/00) Subject: Healthcare Inspection – Quality of Care of Two Deceased West Virginia Veterans To: Deputy Chief of Staff, VA Central Office, Washington, DC (10B) Thru: Network Director, VISN 4 (10N4) 1. Attached please find the Louis A. Johnson VA Medical Center’s approved action plan to address the recommendation identified by the Office of the Inspector General (OIG) in their draft report regarding Quality of Care to Veterans residing in West Virginia. 2. The insights and observations provided by OIG are appreciated and a valuable resource for improving services provided. If you have any questions, please do not hesitate to contact me at (304) 623-7602. (original signed by :) WILLIAM E. COX Attachment VA Office of Inspector General 11 Quality of Care of Two Deceased West Virginia Veterans Louis A. Johnson VA Medical Center, Clarksburg, WV Director’s Comments to Office of Inspector General’s Report The following Director’s comments are submitted in response to the recommendations in the Office of Inspector General’s report: OIG Recommendation Recommendation. We recommend that the VISN Director ensure that the Clarksburg VAMC Director evaluate exclusion criteria for admission related to medications for newly diagnosed patients to the Residential PTSD Program. Concur Target Completion Date: October 1, 2008 Actions: Louis A. Johnson VA Medical Center has reviewed the admission criteria for PRRTP and is revising the criteria to eliminate barriers to access related to medication profiles. A new policy is being developed and all staff associated with the residential rehabilitation programs will be educated on the revised criteria for admission. We will also inform VA Medical Centers who refer patients to our programs of the changes in admission criteria. VA Office of Inspector General 12 Quality of Care of Two Deceased West Virginia Veterans Appendix C OIG Contact and Staff Acknowledgments OIG Contact VA Office of Inspector General 13 Quality of Care of Two Deceased West Virginia Veterans Appendix D Michael Shepherd, M.D., Medical Consultant (202) 461-4660 Acknowledgments Patricia Christ Jerome Herbers Christa Sisterhen Report Distribution VA Distribution Office of the Secretary Veterans Health Administration Assistant Secretaries General Counsel Director, VISN 5 Director, VISN 6 Director, VISN 9 Director, VISN 10 Non-VA Distribution House Committee on Veterans’ Affairs House Appropriations Subcommittee on Military Construction, Veterans Affairs, and Related Agencies House Committee on Oversight and Government Reform Senate Appropriations Subcommittee on Military Construction, Veterans Affairs, and Related Agencies Senate Committee on Veterans’ Affairs Senate Committee on Homeland Security and Governmental Affairs National Veterans Service Organizations Government Accountability Office Office of Management and Budget U.S. Senators: Robert C. Byrd, John D. Rockefeller IV U.S. Representative s: Shelley Moore Capito, Nick J. Rahall II, Alan B. Mollohan This report is available at http://www.va.gov/oig/publications/reports-list.asp. VA Office of Inspector General 14 |
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#3
Jan 23, 2009, 09:07 AM
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I dealt with the VA for many years with my late husband. he died from liver disease. part drinking, probably mostly the drinking, but he also took alot of medication the VA prescribed for him which of course does liver damage. how far do you live from the nearest VA? if it is over a certain distance you can see an outside dr. I would take that friends advise. It isn't that the VA is overwhelmed hon. They just don't care much. If you do happen to find a good one they transfer them out. please try to find him some good drs that care.
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He who angers you controls you! |
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#4
Jan 23, 2009, 09:35 AM
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Quote:
I set him up for a full medical physical being he was taking these medications off and on, his last blood work came back bad so time to get him checked out and taken care of outside the local clinic. I do not care if we have to pay for it, his life is worth a lot more then what the cost is. |
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#5
Jan 23, 2009, 10:45 AM
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you bet it is hon! do you have a copy of the bloodwork? if so take it to the outside dr. keep us posted hon.
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He who angers you controls you! |
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#6
Jan 24, 2009, 06:13 AM
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I was contacted by the father yesterday of one of the men who died here and he had me type up a time line using the progress notes we got from the VA to send to the Inspector General of the VA. I was told when I called the IG that even though the Inspection that was done on two of the men who died came back inconclusive or with no findings of fault that does not mean there is not a problem with the care or medications. If no one reports, they will not catch this.
So below is my Time Line if anyone cares to read it. The thing that bothers me the most is this denying crap. I gave them Red Flags concerning my husbands well being, yet they were not listening, only listening to my husband, who could not see what I was seeing. It amazes me! Time Line Part 1 Dear Representative 32: vaoighotline@va.gov Below is a basic time line of what we feel has been a serious issue concerning my husbands care and treatment for his PTSD since 2006. When my husband returned from Iraq in March of 2005 and before his retirement from the Army National Guard in 2006 I began seeing changes in his behavior that ranged from angry outbursts, problems sleeping, nightmares and fear of noises etc. It was at that time we sought marital counseling through Kanawha Pastoral Services and tried to figure out what was going on. We were told at that time to seek help through the VA. It was sometime in the early part of 2006 my husband began getting help through the VA. "Referring to the copy of all his progress notes we have treatment notes begin in 5/06." My husband's medical conditions known at that time were Asthma of which he was prescribed and was taking Singular before bed every night and carried a puffer and used when needed for breathing problems. His military records included past documented history of clinical depression and past suicide attempt while in the military. Progress Notes: June of 2006 the VA Clinic in Charleston WV began a medication treatment for his PTSD symptoms and possible depression consisting of Citalopram Hydrobromide (Celexa) 20 mg BID, Quetiapine Fumarate (Seroquel) 25mg QHS and Clonazepam (Klonopin, Rivotril) 1mg QHS Immediately after he began this "treatment" I noticed a huge increase in what I suspected was over sedation but being he was under care I thought may be in time it would level out. My husbands mood seemed to improve a bit being he was more catatonic then normal and he seemed to be confused or more forgetful then normal. I also began noticing when he did fall asleep at night or after work it was difficult to rouse him for any reason. He had an extremely difficult time getting up for work at 6am and told me he had almost fallen asleep driving numerous times. His breathing at night became louder more snorting and times I thought he may have stopped breathing. The increase in snoring was so bad many nights the only way to get sleep myself was to constantly make him roll on his side at night. My husband began loosing interest in the family, his hobbies, was acting paranoid at times, and his behavior was not only confusing for me and the kids but scary at times. He almost fell asleep driving with the family in the car that I began driving instead of him if the family went anywhere and continue to do that to date. Progress Notes: 8/2/2006 due to the extreme sleepiness, erectile issues and issues my husband was having with nerves the Charleston clinic started him on Bupropion hydrchloride (Wellbutrin/Zyban) one 75mg tablet every morning. It was at this time I began noticing another increase in his PTSD symptoms and the continuing sleepiness or over sedation. Anger outbursts became more frequent, his snoring continued and I feared he might stop breathing at night. I began complaining to him I thought he was overly medicated which caused problems between us. I was confused as to "what" treatment he was actually getting but this being his medical care I was not informed. Progress Notes: November 02, 2006 the Charleston clinic lowered his Seroquel and told him to cut his pills in half. The pills were still in the 25mg form, but he was to use a pill cutter to get the proper doses. He was still on Celexa 20mg BID, Wellbutrin 75mg Qam, Seroquel 12.5 mg Qhs and Clonazepam 1mg Qhs. I began suspecting it was the Clonazazepam causing him the most issues based on even cutting the pill in half was not helping. By this time his symptoms had increased to bed wetting, which he was highly embarrassed to tell anyone, and sleepwalking. I was watching and monitoring both the night time medications to make sure he was not taking more or cutting to large of a piece then he should based on his serious sleepiness, mood changes and forgetfulness. I did not find him to be abusing these medication but his mood and behavior was not improving and the sleepiness was getting worse. In late December 2006 after he had wet the bed again and the last straw for me was finding he had sleep walked into our younger child's bedroom sometime in the middle of the night and was sleeping in that bed. It scared me so bad I told him if he did not call the doctor I was going to call and report the bed wetting incident. He placed a call on Jan 2007 per notes to request stopping the Clonazepam. Progress Notes: Feb 7th, 2007 the doctor decided to stop the Clonazepam due to over sedation per notes but he was to continue other medications. By this time our marriage was having more serious problems due to his PTSD symptoms, medications and the side effects it seemed he was always tired no matter how much sleep he got and I started wondering if he was telling the doctors about these things. I still wondered if he was over medicated and what other "therapy" was he getting besides medication? My husband was more and more distant that I even suspected he was having an affair, this did not help our relationship nor the family. Progress Notes: 3/29/2007 There is noted in progress notes of a suicide call or report concerning my husband that was taken by the staff at the Charleston Clinic with the Sheriffs dept coming to my home to check on my husbands well being. I was unaware of any suicide threat and my husband was later found to be at work and fine. It is possible he had been thinking about it due to my threats of divorcing him during this time frame due to the relationship issues this was causing the family and our marriage. Progress Notes: 5/24/2007 was one of many telephone calls I would make to the clinic and began voicing my concerns about over medication and behavior speaking with his therapist who appeared to not have any issues at that time in addressing my concerns and in fact confronted my husband at that counseling appointment later that day of my concerns. Progress Notes: 6/18/07 My husband was seen for 20 minutes for treatment of PTSD per notes , in the notes there are medications showing my husband was taking of the following: 1.Azithromycin 250mg tab take two tablets by mouth 2.Bupropion HCL 75mg Tab take one tablet by mouth every morning by mouth for mood or smoking cessation 3. Citalopram Hydrobromide 40mg Take 1/2 tablet by mouth twice a day for mood 4. Gentamicin Opth Soln .3% Instill 1 drop in left eye 5 times a day 5. Ibuprofen 800 mg tab take one tablet by mouth 3 times a day for pain or inflammation 6. Montelukast NA 10mg tab take one tablet by mouth every evening for asthma 7. Quetiapine Fumerate 50 mg tab take one-half tablet by mouth at bedtime for mood. Progress Notes: June 20th, 2007 a note can be read concerning increase in medication done by John Hipes a doctor at the Charleston Clinic. He recommended an increase in my husbands Celexa from 40mg daily to 40 mg Qam and 20 mg every evening. He was to continue taking the 75mg Wellbutrin in the morning and in the notes and I am not sure when the medication Seroquel went from 12.5mg back in November 2nd 2006 back up to the 50mg pills and my husband cutting them in half again to take that half pill at night. Progress Notes: July 19th, 2007 my husband medical review for his disability was done in Huntington Progress Notes: Aug 2007 aggressive behavior and sleepiness continued. I was overwhelmed with me taking over most of the home chores, child rearing, bills, driving and this added more stress. At no time did I get any calls from the VA to possible follow up on behavior or meds etc... Progress Notes: September 18th, 2007 per notes his medication for Celexa was changed from 40 mg in am and 20 at night to 40mg in the morning and another 20mg at noon. Progress Notes: September 20th, 2007 per notes, at the VA Charleston clinic gave patient some 25mg tabs of Quetiapine to try a 12.5 mg dose and see if this still effective without daytime grogginess. Thanksgiving day 2007 my husband during a heated argument pulled a knife and threatened me with the knife. I called the Charleston VA clinic sometime after that incident to again voice my concerns about his behavior, sleepiness and forgetfulness and what I felt was him being over medicated. Progress Notes: 1/16/2008 my husband discussed his concerns about his sleep and skin. Requested a sleep apnea test to be done. Notes as to his serious snoring where he was trying breath rite strips to help are noted. Heart palpitations, nightmares, anger issues. No sleep apnea test was EVER ordered until recent request Jan 14th 2009. This test was only ordered after getting an outside civilian doctor to recommend one and we brought the request on December 18th, 2008 and Jan 7th, 2009 appointments for us to be told both times to bring it to the Jan 14th, 2009 appointment. Of course during this time things had gotten terrible and we were fighting everyday almost, him yelling at his job, the kids, me and I was fed up! I began searching the Internet for help and support from others to deal with his moods, behavior and medication issues. I researched everything I could on PTSD and this upset my husband when I tried to discuss this with him. He did not want me involved and blamed me for all his issues. I began suffering medically and emotionally as did our children. He became more and more physical in chasing me around when made and making threatening gestures, things he NEVER did since we began dating in 1996. This was NOT MY HUSBAND! I did not know who he was anymore. Every month it seemed he would tell me another doctor at the VA Clinic was gone and they had a new one. Medications seemed to just come in the mail at weird times and we even got two bottles of Motrin 800 mg from the VA each bottle having 270 tablets in them...more Motrin then I could take in a year! In fact we still have both bottles one issued in May 2007 and one in July 2007 I did not see my husband using more medication then he was prescribed being I was watching at this point and that made him mad to. He hated me treating him like a child as he would say. He did not realize I was frustrated and scared of his condition and his health and my own. Progress Notes: 3/4/2007, I called the Charleston clinic and spoke with Mary Smith telling them he was getting worse, how he is even more agitated, irritable violent and I was afraid and at my wits end. He was drawing his fist back like he wanted to hit me more and more. Reported he was more forgetful that I felt the meds were not working he might loose his job. Their answer was marriage counseling suggested. The person I spoke with at the clinic called my husband at his job to confront him about the call from me and it was then my husband stated he did not want anymore information shared by them with me. He assured them he was fine. This caused more problems for me and our relationship. Progress Notes: 3/14, 2007 per notes Advocate George Brawn called Charleston clinic after receiving a call from me requesting help. Marriage help was not an option being my husband was not willing and this would only be available through the VA, not outsourced and covered by the VA being they had marriage counseling avail, though not at convient hours for either me or my spouse. Progress Notes: March 20th, 2007, some confusion in the notes about Celexa dosage. Appears Doctor Moxness from the Charleston clinic may have told my husband to increase his medications on a 3/13/2007 appointment, though no notes in file for that date. He was taking Celexa at the dosage of (1) 40mg tablet in morning and (1) 40 mg tablet at night now along with his other medications. Progress Notes: April 4th, 2007, I went to my husband job to share lunch with him at his desk with our 5 year old son. After an argument and my refusing to leave at that moment he grabbed my throat and attempted to strangle me in front of our son. This began a series of even more problems for us. It was at that time a protective order was filed and granted allowing us to only have contact concerning the children and during counseling. Progress Notes: April 8th -April 10th 2007 notes are add in's done on May 11th 2008 at 15:25, they are very inaccurate and not a real picture in anyway of how things actually happened or of what was said. There was not an appointment scheduled On April 8th as stated in the notes. The appointment was April 11th at the VA clinic after my husband called them, though the notes try to say I went there on the 8th. I did not see SW Richard until April 11th, 2007. From March 2008- May 1st, 2008 per notes my husband was not seen. During the time frame of April-July 2008 my husband and I began seeking marital counseling in the evening as well as I began seeking treatment for depression. During this separation the friends he was staying with did not note him deviating from his medication, but did notice his behavior was not good nor his thinking at times. I noticed he sounded more drugged up during telephone calls, still was sleepy, more paranoid, stressed out and I continued to call the VA Charleston with my concerns that he might hurt himself or others. The VA notes from May- November reflect an inaccurate picture of how I acted. I was highly upset yes, but they do not make note of the valid concerns I was trying to make. Suddenly more medication were coming via the mail to the home, my husband still seemed over medicated and his dosages were increased. He appeared possibly suicidal based on information he gave me and others and his calling the suicide hotline numerous times as can be noted on May 30th, 2008. Progress notes: from are limited to non existent but I do see that in June 2008 and July 2008 reports note he has called the suicide hot-line numerous times. I am not sure when his medications were actually increased again being he is not being seen regularly during this time even though his stressors have increased. Based on the progress notes his medications as of 8/4/2008 were as follows: Citalopram 80 mg Qam, Quetiapine 50mg Qhs (bedtime) and Wellbutrin 75mg Qam My husband returned home in July and we began working on our marriage and trying to take steps to get proper care for his illness. In September the Kanawha county court agreed with me in getting him an outside evaluation away from the VA clinic and evaluating his medications as well as attending 32 weeks of domestic violence classes as the terms to dismissing his case. Progress Notes: After September 3rd, 2008 to December 1st, 2008 there are no progress reports in our file. It appears that my husband is being seen one time per month on average since April 2008, even though his behavior has increased in irritability, violence and excessive sleepiness. Also it was not until the court order and we began seeing another outside counselor that my husband begin accepting there might be a serious issue with his medications and care with the VA. At least he appeared open to investigating that finally. I also made a few calls asking the VA as to what actual "therapy" was my husband getting (so infrequently) besides medication to help in his PTSD? I never have gotten a straight answer except the standard, he is getting therapy but if he is that bad have him committed if you feel he is a real danger to you or others, or he can go to the Clarksburg PTSD program. Last edited by workingitout; Jan 24, 2009 at 07:50 AM. |
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#7
Jan 24, 2009, 06:14 AM
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All are just stupid answers! This is my problem alone? I did not create this mess, I am asking them to look into medication issues, to sort this out because by now it can not all be because of me! There is good therapy out there and yet it is not offered or available to my husband neither through the VA or outside the VA? Medication is only a band aid to mask the symptoms or lesson them, this will NEVER cure them. PTSD is NOT curable, only manageable with proper therapy and even medications used responsibly!
The VA's own PTSD website sites the following therapies for PTSD: Cognitive Behavioral Therapy EMDR Eye movement desensitization and reprocessing (EMDR) Medication Group therapy Brief psycho dynamic psychotherapy Family therapy In November 2008 after receiving "another bottle of pills", that my husband did not order bringing my husbands medicine up I think to almost 3 months overstock, another issue we were having with the VA medications. I had both called the clinic, but no notes are available and confronted my husband as to why why he was still getting bottles of medication when he was told by me he did not need anymore. He could not explain it to me except stating they always ask him if he is low on his meds and he is not sure when at his appointments and may have said yes and they reordered them? It did not explain his getting so many bottles of pills in the mail since March 2008 so I called the VA Pharmacy at that time to explain the situation and have them look into it. They again refused to answer any direct questions due to no release form to speak with me, which by this point I was so sick of hearing about the release form I could have screamed! That was the answer I got every time I called anymore! I am not asking for information at that point they now have information to check into it! So I told the VA pharmacy to no longer send anymore medications and that I had 3 months worth already on hand and to find out what was going on. They put a hold on my husband medicines at that time. It was that same day I decided to throw out every bottle of the Serquel I had in the house after speaking to a few people about the whole situation. They were using the Serequol for sleeping and yet it is a medication for Bi-polar/Schizophrenia? I also began monitoring his medication even more closely as to watching the mail for more medications from now on. One thing I immediately noticed the first week was an improvement in his mental process and even though he still stated he had trouble sleeping I monitored his sleep and did not note any real serious deviation except him being a bit more restless but at least I could rouse him finally if I needed. Before when he was taking all these medications if a fire had broken out I feared I would not be able to wake him up to save him if I had to, he slept so deep on these medications sometimes I swore he had stopped breathing. To help him with his sleep he started taking the natural sleep aid, melatonin which appeared to help him relax before bedtime and sleep better. Late November or early December 2008, I also had my husband request a copy of his progress notes and medical information to take to an outside evaluation we finally were able to schedule. At that outside evaluation at CAMC they wanted my husband to #1 get a sleep apnea test done right away based on symptoms. Progress Notes: December 2008, make no note of the telephone calls about the medication coming via the mail in November, nor do they address this issue at anytime in any of the progress notes I have read. We took the sleep apnea prescription to my husbands appointment on the 18th of December 2008 when we went to see his Social Worker/Therapist who appeared very surprised to see me at the appointment. It was at that time I requested to know what medicines he was on, how much and why? She noted in the computer his meds where to be 80mg Celexa in the morning, 75 mg Wellbutrin in the morning and that he had told her at the appointment in November I had tossed out all the Serequel. I then began asking why he was getting so many medications. She again went into the system and stated that his medications were all on hold and he should only have what he needs for the month. I told her I had them put on hold is why they were on hold and then I proceeded to take 6 full bottles of pills out of my purse to her surprise. She could not answer that except to state may be he was not taking them? I stated I have been counting these since May and that is not the case! She could not get the sleep apnea test ordered nor answer the medicine questions so she said for us to take these questions to his next appointment Jan 8th, 2009 when he saw the "another new" psychologist. I did not leave there happy with her answers including me asking what his complete diagnosis was being the VA report mentions a possible (and most likely) co-existing personality disorder? When were they going to address the personality disorder issue? She stated she had noticed and suspected he might have something else going on and she was going to start addressing it next year, referring to 2009. So what have you all been doing for the last 3 years then? Lastly she also began making references to the marital issues being the problem and inferences as to may be me and my husband might want to think about a divorce. This upset me quite a bit and trying to make me appear to be off balance mentally was even worse. This appears to be what they have done in their notes based only on meeting me once, and the things my husband, who is not seeing clearly anything, see the problem to be me. It was sometime after that appointment in December 2008, again I am not sure the exact date. I called the Huntington VA hospital and requested to speak with a patient advocate. I left him a voice message which he did return leaving a message when my husband and I were not home. We did not hear from him until January 2009. Jan 7th or 8th 2009, not clear on the date with no recent progress notes, I went to that appointment, with my husband now seeing what I have been telling him and we asked the "new" psychologist specifically what medications is he to be on, and why? The answer for the Wellbutrin was for smoking....excuse me my husband has been smoking 4 cigarettes a day for years now and your own notes back in 2006 do not say for smoking cessation. He as well would not request the sleep apnea test, seemed not to know much about my husbands personal history, medications and no mention was made to switching medications, or further treatment options. My husband got his blood work drawn and had them make a copy of the prescription for his sleep apnea testing so the doctor could order it before his next appointment. We both left frustrated and realizing this is not working! We finally heard from the patient advocate again and it was at this time I explained to him the problems we were having with the Charleston clinic and he seemed like he did not understand my concerns clearly. He said to have his other doctor at his next appointment to order the sleep testing and that the psychologist and social worker probably could not. He did not really say much more then that and again it seemed like a telephone call that went no where. Finally, and I may have missed some things, but this is long to write, my husband goes to his appointment of January 14th, 2009 with his primary care doctor Dr Carroll. Who BTW is the main name on all the prescriptions my husband gets. I did not attend this appointment but my husband left with a note marked with the questions I wanted him to ask and get that release form done for me to be able to speak to the VA clinic or others. He called me immediately after as he always does lately and discussed what went on. No mention was made to him at that appointment to changes in medicine. He was told about his blood work, face cream for spots on his face that started to get bigger while in Iraq, and that the sleep apnea test was ordered, not date given though. then on the 20th of January 2009 a package comes in the mail, gee what is going on now? My husband received this new prescription in the mail from his doctor at the Charleston clinic VA (Dr Carroll) who never told my husband on January 14th at his appointment he was sending him a "new" prescription. Now if my husband had taken this "new" medicine with the others he is currently taking could he have overdosed? Imagine that! Thank goodness I was watching this for my husband and demanded the doctor call me that day to explain why he has a new medicine. They really did not even want to talk to me but the Vet directly until I told them there is a release in the file for them to talk with me! My husband can barely remember what day it is half the time anymore so talking to him would just have confused him even more. Well today when I call about this new medicine (Prozac) a VA nurse in Huntington and the desk clerk at the Charleston Clinic pull up the computer notes to tell me that his other two medicines he was taking were discontinued in December 2008 and Jan 2009??? Then another person tells me they all were discontinued in September?? so I am really confused now. Not only that I had the nurse at the Huntington hospital try to tell me that they (the VA) did not even prescribe him the one anti depressant (Celexa) and it was not showing in their system, yet it shows in the Charleston clinics computer system? More confusing. Since April 2008, my husband was getting so many bottles of medications he had a stock pile here at the house due to the VA pharmacy and doctor(s) ? continuously ordering more even when the other medicines were not near being gone. Medications are not showing on the MyHealtheVet account yet I have bottles in a bag shipped from the Huntington VA Pharmacy and order by Dr Carroll for the months of July and Aug 2008 yet they do not show up in the MyHealthEVet the system? This shipping of medicines continued until I called the Huntington pharmacy in November 2008 and demanded them NOT to send anymore medication he had plenty. They are trying to say my doing that made them discontinue....I thought that was what the words "on hold" was for in the system? So today I realize that possibly if my husband had taken this "new" medication in combination with the other medications he is currently on he could have died? Thank goodness I spoke with an Iraq vet at the VA support center and he told me about his own experiences and the men who have died but he only mentioned 2 of them. He told me to talk with the families and maybe we all can do something. The VA has refused to address my concerns with my husband medicines and the "cocktail" they had him on and it appears they are just now possibly monitoring him after realizing his wife now has a release form to talk with them and I am calling people to find out what is going on. I suspect they are covering themselves and I wish I had known about these other deaths months ago to maybe speak with the families as to what they know and what I now know and suspect. This has to be looked into before others die. After the week I have had I am mad and frustrated and not sure what else to do being the Huntington Director Office (has not returned my call I made the 21st) I personally drove to the Charleston clinic on the 21st and was told the office manager was at lunch. After waiting 45 minutes with my 5 year old son in tow I asked again to be told still at lunch, finally a nurse came out to speak with me saying the manager was in Huntington, yet no one in the office knew that? This nurse who could not answer my questions anyway, appeared not to happy to speak with me. Her answer was for me to start coming to his appointments because my husband must not be listening to what the doctors are telling him? Excuse me? My husband may forget things true but I made a check list when he went in on his last appointment and he did everything on it to the “T” and even called me right after the appointment to discuss what was said. My husband told me everything, from the Dr. asking my husband if he needed more medication ordered again, that he was ordering the sleep apnea test, and that his cholesterol was over 230 and his kidney function was at 1.6 which is high. His next blood work test is scheduled for July? and told my husband he was sending a cream for the spots on his face to remove them even though they have never been checked as requested to see “what” they actually are. The cream came in the mail and after looking it up it appears it is suppose to be for precancerous or cancerous cells and yet they have been had a dermatologist actually diagnos these spots and have been telling my husband since he had them looked at in Iraq they are age spots? Needless to say I am NOT letting him put stuff on his face till a "real" dermatologists sees him which I scheduled an appointment with one for my husband in March. What upsets me even worse was there was no mention of stopping his current medications and no mention he was changing them yet the pharmacy's computer system shows the doctor ordered the Prozac on the 14th. Since when can the family care doctor order the psychiatric medication and change them? This is the same doctor that went into the system the 21st of January, 2009 after I was calling on the 20th to find out when was this new medication ordered, when where the old ones stopped, why and by whom? It appears someone changed the dates on when his prescriptions were discontinued? Of course NO ONE told us until after I called after receiving the "new" medication on the 20th of Jan. I printed up my husbands medication page back from My HealtheVet account that the VA provides for Veterans to track their medications back in October 2008 and asked the pharmacy directly today how everything is now changed on the old paper compared to today's print out? Someone it appears changed the file in the computer to show they told my husband as of September to stop taking all his medications. Yet when I call I get three conflicting stories of when the medications were discontinued? Was it September? December or Jan??? This list below is from October 2008 and is missing all the bottles I have in my possession of Celexa, Wellbutrin and Serquel that were shipped in July 2008 and August 2008. There may have been more from other months but initially I threw a bunch away before I started saving them. My husband NEVER accessed the web, he never knew the password and so he could not order them online anyway. RX# 4772336 is the Seroquel (quetiapine fumarate) (1) 50mg bedtime RX# 4771548 is the Albuteral RX# 4771550 is the Wellbutrin (Bupropion hydrchloride) (1) 75mg am RX# 4771554 is the citalopram hydobromide (2) 40 mg am RX# 4771555 is the Singular 5 items found, displaying all items Refill Status Refill Submit Date Fill Date Refills Remaining Prescription Facility Select to Refill Active 9/29/2008 1 RX#4772336 HUNTINGTON VAMC Active 9/28/2008 1 RX#4771548 HUNTINGTON VAMC Active 9/28/2008 1 RX#4771550 HUNTINGTON VAMC Active 9/28/2008 4 RX#4771554 HUNTINGTON VAMC Active 9/28/2008 1 RX#4771555 HUNTINGTON VAMC 5 items found, displaying all items Prescription History Information: 9/29/2008 RX#4772336 Active HUNTINGTON VAMC 9/28/2008 RX#4771548 Active HUNTINGTON VAMC 9/28/2008 RX#4771550 Active HUNTINGTON VAMC 9/28/2008 RX#4771554 Active HUNTINGTON VAMC 9/28/2008 RX#4771555 Active HUNTINGTON VAMC 6/7/2008 RX#4641923 Discontinued HUNTINGTON VAMC 4/24/2008 RX#4585323A Discontinued HUNTINGTON VAMC 4/24/2008 RX#4724930 Discontinued HUNTINGTON VAMC 4/24/2008 RX#4724932 Discontinued HUNTINGTON VAMC 4/22/2008 RX#4585364 Discontinued HUNTINGTON VAMC 2/7/2008 RX#4585324 Discontinued HUNTINGTON VAMC 1/23/2008 RX#4585323 Discontinued HUNTINGTON VAMC 1/4/2008 RX#4641922 Discontinued HUNTINGTON VAMC 10/10/2007 RX#4549449 Discontinued HUNTINGTON VAMC 9/20/2007 RX#4585325 Expired HUNTINGTON VAMC 9/6/2007 RX#4531470 Discontinued HUNTINGTON VAMC 9/2/2007 RX#4069650C Expired HUNTINGTON VAMC 8/18/2007 RX#4480514 Discontinued HUNTINGTON VAMC 8/18/2007 RX#4521933 Expired HUNTINGTON VAMC 8/17/2007 RX#4480512 Discontinued HUNTINGTON VAMC 5/30/2007 RX#4480513 Discontinued HUNTINGTON VAMC 5/30/2007 RX#4521862 Expired HUNTINGTON VAMC 5/30/2007 RX#4521864 Expired HUNTINGTON VAMC 3/5/2007 RX#4331708B Discontinued HUNTINGTON VAMC 3/5/2007 RX#4331761B Discontinued HUNTINGTON VAMC 3/5/2007 RX#4365704A Discontinued HUNTINGTON VAMC 1/19/2007 RX#4331763B Discontinued HUNTINGTON VAMC 11/29/2006 RX#4331763A Discontinued HUNTINGTON VAMC 11/12/2006 RX#4365704 Discontinued HUNTINGTON VAMC 9/13/2006 RX#4069650B Discontinued HUNTINGTON VAMC 9/10/2006 RX#4331708A Discontinued HUNTINGTON VAMC 9/10/2006 RX#4331761A Discontinued HUNTINGTON VAMC 8/11/2006 RX#4331763 Discontinued HUNTINGTON VAMC 8/11/2006 RX#4358383 Expired HUNTINGTON VAMC 6/22/2006 RX#4331708 Discontinued HUNTINGTON VAMC 6/22/2006 RX#4331761 Discontinued HUNTINGTON VAMC 6/21/2006 RX#4316207 Discontinued HUNTINGTON VAMC 6/21/2006 RX#4316208 Discontinued HUNTINGTON VAMC 5/24/2006 RX#4316206 Discontinued HUNTINGTON VAMC 5/23/2006 RX#4069644B Expired HUNTINGTON VAMC 5/12/2006 RX#4069650A Discontinued HUNTINGTON VAMC 11/23/2005 RX#4069644A Discontinued HUNTINGTON VAMC 11/21/2005 RX#4069650 Discontinued HUNTINGTON VAMC 3/22/2005 RX#4069644 Discontinued HUNTINGTON VAMC 3/22/2005 RX#4069645 Discontinued HUNTINGTON VAMC 3/22/2005 RX#4069649 Expired HUNTINGTON VAMC 12/5/2003 RX#2888493I Expired HUNTINGTON VAMC 9/17/2003 RX#3689765 Expired HUNTINGTON VAMC 6/27/2003 RX#3643286 Expired HUNTINGTON VAMC 5/27/2003 RX#3643285 Discontinued HUNTINGTON VAMC 2/18/2003 RX#3367411A Discontinued HUNTINGTON VAMC 1/27/2003 RX#2888493H Discontinued HUNTINGTON VAMC 7/15/2002 RX#2888493G Discontinued HUNTINGTON VAMC 6/2/2002 RX#3367411 Discontinued HUNTINGTON VAMC 4/8/2002 RX#2888493F Discontinued HUNTINGTON VAMC 10/2/2001 RX#3242424A Discontinued HUNTINGTON VAMC 9/26/2001 RX#3360519 Expired HUNTINGTON VAMC 9/20/2001 RX#2888493E Discontinued HUNTINGTON VAMC 9/12/2001 RX#3242424 Discontinued HUNTINGTON VAMC 2/8/2001 RX#3057695B Discontinued HUNTINGTON VAMC 8/30/2000 RX#2888496E Discontinued HUNTINGTON VAMC 7/28/2000 RX#2888493D Discontinued HUNTINGTON VAMC 2/29/2000 RX#3057694A Expired HUNTINGTON VAMC 2/29/2000 RX#3057695A Discontinued HUNTINGTON VAMC 1/28/2000 RX#2888496D Discontinued HUNTINGTON VAMC 12/2/1999 RX#2888495C Discontinued HUNTINGTON VAMC 11/30/1999 RX#3057694 Discontinued HUNTINGTON VAMC 11/30/1999 RX#3057695 Discontinued HUNTINGTON VAMC 10/31/1999 RX#2888493C Discontinued HUNTINGTON VAMC 10/19/1999 RX#2888496C Discontinued HUNTINGTON VAMC 3/8/1999 RX#2888496B Discontinued HUNTINGTON VAMC 12/16/1998 RX#2888493B Discontinued HUNTINGTON VAMC 12/16/1998 RX#2888495B Discontinued HUNTINGTON VAMC 11/12/1998 RX#2888496A Discontinued HUNTINGTON VAMC 10/28/1998 RX#2888495A Discontinued HUNTINGTON VAMC 10/1/1998 RX#2902037 Expired HUNTINGTON VAMC 10/1/1998 RX#2902132 Expired HUNTINGTON VAMC 10/1/1998 RX#2902133 Expired HUNTINGTON VAMC 9/14/1998 RX#2888493A Discontinued HUNTINGTON VAMC 9/14/1998 RX#2888494A Expired HUNTINGTON VAMC 8/24/1998 RX#2888493 Discontinued HUNTINGTON VAMC 8/24/1998 RX#2888494 Discontinued HUNTINGTON VAMC 8/24/1998 RX#2888495 Discontinued HUNTINGTON VAMC 8/24/1998 RX#2888496 Discontinued HUNTINGTON VAMC 8/24/1998 RX#2898460 Expired HUNTINGTON VAMC Below is the January online screen: View Prescription History Information Last updated [01/23/2009 at 1237] Help | Printer Friendly 89 items found, displaying 1 to 10 First/Prev 1 2 3 4 5 6 7 8 9 Next/Last Number of rows to display per page: 10 25 50 100 Fill Date Prescription Status Facility 1/21/2009 RX#4881718 Active HUNTINGTON VAMC 1/21/2009 RX#4881719 Active HUNTINGTON VAMC 1/14/2009 RX#4877881 Active HUNTINGTON VAMC 1/14/2009 RX#4878072 Active HUNTINGTON VAMC 11/27/2008 RX#4771554 Discontinued HUNTINGTON VAMC 9/29/2008 RX#4772336 Discontinued HUNTINGTON VAMC 9/28/2008 RX#4771548 Discontinued HUNTINGTON VAMC 9/28/2008 RX#4771550 Discontinued HUNTINGTON VAMC 9/28/2008 RX#4771555 Discontinued HUNTINGTON VAMC 6/7/2008 RX#4641923 Discontinued HUNTINGTON VAMC Lastly, Yesterday Pat the manager of the Charleston Clinic returned the call I had left her but was not very helpful and got very irritated whenI began asking direct questions about these issues to the point she told me she no longer felt comfortable speaking to me about any of this. When I pressed on she then stated she wanted to speak with the veteran first and I told her at that time I am the one keeping track of these issues not him and I had a full release in that office on file in which my husband wrote that they may speak to me about his care, medications and anything else. She at that time tried to say they did not have a copy but again I took my copy he had brought home and read it to her word for word and she then stated it must no be scanned into the system yet. She also made a statement that Dr. Carroll told my husband about discontinuing his other medications on his Jan 14th appointment. This is a bald face lie. No one would tell my husband to just stop taking any of these medications due to the withdrawal symptoms. In fact when doctor Carroll called me that same day when I got the new medication I specifically asked him about possible withdrawal symptoms and he said there would be no problem at all, to throw the others away and just take the one. Well guess what, my husband is currently experiencing them and they are serious headaches. Pat in a telephone call to my husband that same day said he is having headaches most likely from withdrawal and his throwing the other medications completely out was not advisable. That the doctor had most likely changed the medications on the 14th and wanted my husband to cut back on the others until he received the new medication to prevent withdrawals. This my husband told her was a lie. She also kept trying to say, but he called, but he called you all. Yes Dr. Carroll called AFTER I received the new medication and I had called the clinic and the Huntington hospital and spoke with a nurse. In fact he even called the next morning at 6:40 am to speak with my husband, it appears he forgot he had called me the day before and had already spoke to me? This is just a small part of the problems I and my husband have experienced with the VA here and gives you an idea of possible errors and poor care being given by the Charleston clinic. This combination of medications being given and the amounts and increasing, decreasing is a deadly game of Russian Roulette. These medication and their long term effects needs to be addressed and looked into before another soldier dies needlessly! My husband is on many of the same medications that the other soldiers who died were on and his symptoms are almost identical to one of the other soldiers who died. What's even worse is my husband served in Iraq and in the same unit with this man and his wife and this has him quite upset especially after us both speaking with the widow in length. She is concerned about my husband based on the symptoms as to behavior, medical issues, side effects being they matched many of her husbands before his death. This treatment in my opinion is not therapy, this is over medicating or sedating a person to death with very little monitoring or checks. These combination of drugs are more experimental and are not proven by reading I have done to be a good or valid treatment for PTSD. In fact many of these drugs can and do kill, either by building up to high and toxic levels if not taken properly. My husband does not drink, take other drugs unless prescribed and yet my fear has been if he died the VA would say he killed himself, it was not the therapy or medications. In fact his blood work is not the same as 6 months ago and I am getting him a complete physical to include a recheck of his kidney function being that was way high and can be a sign of early renal failure. I hope all these medications have not already had negative long term effects on his health! I have two son's in the military currently serving our country and my husband served honorably for over 20 years, they all deserve better then this! Please feel free to contact me directly if you need to I appreciate any help in this matter Last edited by workingitout; Jan 24, 2009 at 07:49 AM. |
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#8
Jan 24, 2009, 11:21 AM
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wow you have really done your homework! I wish more wives were as proactive as you hon. alot has changed since I dealt with the VA. I am not familiar with the charleston wva VA. do they have a specific ptsd program? a few years ago they cut many of the ptsd programs and it stinks they did that. I would try to contact vet centers and organizations like DAV, VFW, and American Legion, or anything related to vets and petition or advocate for ptsd programs be restarted. new wars new vets. it is really needed right now.
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He who angers you controls you! |
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#9
Jan 24, 2009, 01:39 PM
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Thank you so much for your kind words. The problem is they "claim" they have PTSD programs and on paper I suppose they do so that proper funding is given? Not sure how that works though in the VA system. They have a residential treatment program in another city, but every vet I have spoken to including my husband will not go to it voluntairly due to the deaths of a few men that went there on their return home. They can not afford to take the time off work and possibly loose their civilian jobs and how are they suppose to pay bills and support the family while they are gone for 6-8 weeks? The residential program will not take anyone that is on vertain medications, that may have changed but not sure to date. They will not take anyone that has any issues with criminal such as domestic violence charges etc...so to be honest it makes it a difficult chioce. Many of these guys are finding it hard to get appointments on a regualr basis at during hours that do not conflict with jobs. It is hard to explain to your boss you have to be at a counseling session once a week during work time due to a mental illness. Many are afraid they will loose thier jobs. I was also told by my husbands own social worker/therapist that the VA clinic its self here can not fit people in for more then two counseling sessions a month and getting that takes an act of congress it appears. They love to refer you to the PTSD support group and to the Clarksburg residential program if you are unhappy with your treatment it appears. Why is it if they are so overwhelmed they can not outsourse for mental health care in the city? There are plenty of good doctors and therapists that would work with the vets I am sure but you have to pay for outside care out of pocket in order to get it. Remember these guys that died it appears all have had something in common: Same clinics, doctors, therapists and or hospital care, same or very similar medications, sleep apnea and lack of intervention. My suspicion is that things like asthma, breathing issues, weight gain and the sleep apnea is a culprit in many of these deaths. Cluster deaths are not normal, that is a red flag in itself. My husbands own experience could have left him being another local story in the news? I will just keep documenting things and this new physical might uncover something of importance... |
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#10
Jan 24, 2009, 04:01 PM
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I don't know how far you live from the VA centers but it use to be if you were over I think either 50 or 75 miles they would outsource treatment. I know what you are saying hon and I do agree many don't seek treatment for the reasons you stated. my husband became unable to maintain his job. it took awhile to get benefits started though. it was not easy. whew!
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He who angers you controls you! |
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#11
Jan 24, 2009, 05:08 PM
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Service connected compensation and pension claim, you can get the form at regional va office or DAV VFW and also these .orgs provide representation. The last time I was denied I asked for a resubmission and did that on line through a represenitive. It may be possable to file a C&P claim on line.I have spent a few years dealing with the big bad wolf. I had just located MORE evidance to support my claim,and am still in the process.I am recieving food stamps and am on subsidized housing. My wife is EX, and my children talk to me sometimes.I go to group therapy on tuesdays(ptsd)va and after that I do a one on one with board certified expert in traumatic stress(B.C.E.T.S.)Phd. outside of the va. I go on thursday for another one on one. I practice complementary alternitive medicine with a healthy diet and daily exercise with a belief in something greater than human.I used to work and provide for my family. I lost my family but I am alive.This is the most difficult thing I have ever dealt with. Last edited by Anonymous37819; Jan 24, 2009 at 05:34 PM. |
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#12
Jan 25, 2009, 02:01 PM
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#13
Jan 30, 2009, 08:25 AM
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http://www.rxlist.com
this will give you some info on the meds your hubby has been on and are now on. don't know if this will help you but it covers a lot of good info.
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Do not let your fire go out, spark by irreplaceable spark, in the hopeless swamps of the approximate, the not-quite, the not-yet, the not-at-all. Do not let the hero in your soul perish, in lonely frustration for the life you deserved, but have never been able to reach. Check your road and the nature of your battle. The world you desired can be won. It exists, it is real, it is possible, it is yours..~Ayn Rand |
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#14
Jan 30, 2009, 12:50 PM
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My experience with VA has been from atrocious to excellent, depending on the individuals and the facility. In recent years the service has improved hundreds of percent but the capability of some of the medical team makes me wonder where they get these people.
One thing you might not know is that the physicians on staff do not have to have a state medical license. Some get their degrees overseas and apply for jobs with the federal government. Federal employees do not have to have state licenses. So, we take our chances on the ability and capability of people trained in medical schools that do not have the same scrutiny as here in USA. That's not to say that every USA trained person is capable either, just that there is not the oversight as some of the domestic systems. You've probably already engaged your congress person. VA gets a lot of congressional inquiries, but they still hate to deal with them, and a congressional inquiry usually gets attention. (Only if you've gone through the procedural steps - otherwise, VA simply replies that you have to jump through the hoops and that you've missed one ... then your congress person has no leverage). So ... if you've done all you're supposed to do and still don't get results, contact the congressperson. My apologies for ranging about this if you've already engaged them.
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