The national Department of Veterans Affairs has dropped its star ranking system under which VA hospitals across the country were given one to five stars.

That news was among the information shared by Roseburg VA staff at a town hall Wednesday evening.

The Roseburg Veterans Affairs Medical Center had alternated between one and two stars under the system.

Sarah Teeter, veteran experience officer for the Roseburg VA, said the VA found the star rating was misleading. Many thought it was giving them information about how their local VA hospitals compared with non-VA hospitals, she said.

“It was determined that it often went to misinterpretation, that people were comparing it to a rating on Yelp or like how people look on Amazon and it says this vendor’s a five-star vendor. So people were interpreting that as being good or bad,” she said.

Teeter said the star ranking was only intended to compare different VA facilities with each other.

In January, the stars will be gone, she said. Instead, the VA is providing information about how each VA performs compared with other local medical facilities and other VAs.

The reporting includes details such as access, comparative rates of MRSA infection and whether doctors ask patients about their stress levels.

The Roseburg VA downgraded its emergency department to a five day a week urgent care in August.

Associate Director Ryan Baker said the VA hopes to hire the support staff necessary to expand the urgent care to seven days a week. But he said without those staff members, patients will be safer going to private urgent cares on the weekend for now.

The only in-network urgent care in Douglas County that’s open on the weekend is the Umpqua Health Newton Creek on Northeast Stephens Street.

Heidi Thompson, from the Office of Community Care, said the VA will begin taking over authorizing and scheduling care veterans receive from outside providers in January.

Veterans had been required to contact TriWest, the company coordinating the care, and have them schedule appointments for outside care. Thompson said the VA is working on eventually making it possible for veterans to call outside providers directly to schedule appointments.

“We’re looking at different options to be able to kind of eliminate the middle man as much as possible,” Thompson said.

TriWest will continue to work on building the network of private providers in the VA’s network, she said.

Veterans have been making 350 ER visits at community hospitals per week, Thompson said. Veterans at previous town halls had voiced concerns about whether their bills would be paid if they went to those ERs. Thompson said the VA has approved paying the bill for 98% of those visits.

She said it’s easier to get reimbursement now than it was in the past. The requirements are that the hospital be in the VA’s network, that the VA be notified within 72 hours and that a prudent layperson would have believed the patient’s symptoms were an emergency.

In response to veteran questions about what the prudent layperson standard means, she said if you feel you’re experiencing an emergency you probably are. She used the example of her husband who had a health scare in which he was slurring his words. They thought he was having a stroke, but it turned out to be a migraine. That’s a layperson’s idea of an emergency, and that would be covered, she said.

Chief of Staff Marlene Hassenfratz said new primary care providers have been hired and the VA is working on attracting more providers. Women Veterans Program Manager Jessica Burnett said new women’s health care providers have also been hired.

Hassenfratz said the VA is also enhancing its medical education department so it can train smart, eager young physicians at the VA with the hope that they will choose to stay in Southern Oregon.

In response to concerns raised at a previous town hall, Hassenfratz said the VA will coordinate with community providers to provide lung cancer testing for veterans at risk.

She also responded to a veteran asking about increasing chiropractic and acupuncture services by saying she wants to expand the VA’s whole health program.

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Senior Reporter

Carisa Cegavske is the senior reporter for The News-Review. She can be reached at ccegavske@nrtoday.com or 541-957-4213. Follow her on Twitter @carisa_cegavske

(7) comments

chicagomike

I was informed that the three remaining topics I promised to write about and post here are going to be better addressed in a letter to the editor or guest column. I will do that.

The fact that Director Allen has promised to offer lung cancer screening to Veterans based on their smoking history is a step in the right direction.

I will continue to address with the director other recommended medical screenings which the Roseburg VA has failed to provide to Veterans and the fact based changes that need to be made.

Dr. Hasserfratz did mention at the Brookings town hall, she would look into offering low dose CT lung cancer screening Veterans based on their exposure to known respiratory carcinogens during their military service.

Below is an excerpt from a letter to the editor, published in the News Review last January, prior to Director Allen’s arrival at Roseburg:

“I have been given permission to share the story of Vietnam U.S. Army veteran Steve Hodge.

He passed away on October 5, 2018, spending his final days at the River House on the Roseburg VA Campus.

It wasn’t until after being diagnosed with renal cancer that Steve was diagnosed with lung cancer, which was listed as the cause of his death. Steve had quit smoking for 40 years prior to being diagnosed with lung cancer.

The fact that the VA has not offered lung cancer screening to veterans exposed to Agent Orange is unconscionable.”

Steve Hodge’s Cremains are located in a memorial wall at the Roseburg National Cemetery. The Agent Orange Lung Cancer could have been detected early using Low Dose CT and saved his life. - Mike

chicagomike

Roseburg VA Radiology Part "D" - The Upright MRI performed in the sitting/standing positions. If your doctor wants to send you for an MRI for back/neck problems, etc. Ask your doctor to see the view of your spine in which you experience your problem -- sitting, standing, bending, or lying down. I am providing this link to the FONAR UPRIGHT MRI: https://www.fonar.com/patient/

I am going to briefly tell my VA story and why it almost took an act of Congress to have the upright MRI performed through the Roseburg VA after Roseburg's initial denial. Dr. Hasserfratz recognizes the value of the performing the Upright MRI (also referred to as a loaded MRI) and I will share here, my VA journey and how it has paved the way for other Veterans who will benefit. The upright MRI is grossly underutilized throughout the VA health care system.

After meeting with my VA PCP in 2015 and examining the plastic model of my spine I was able to think about what we had discussed while driving home to Brookings from the Grants Pass VA Clinic. I sent a secure message to my PCP stating that all of the VA MRI studies performed of my spine since 2009 in Illinois and at the Roseburg and Portland VAMCs had been performed while I was laying down, which is the position that provides relief from the sciatica, radiculopathy, neuropathy, neurogenic claudication, degenerative arthritis, all of which the VA had diagnosed me with.

My PCP sent my secure message to Portland VAMC and on 12/18/15, Dr. Andrew Bieber responded "agree with obtaining a standing or compressive MRI imaging to determine if patient pathology related to position".

Neither Portland or White City VAs or Triwest knew where to send me for the compressive study of my spine. While I was able to locate plenty of the upright MRI facilities back east, there was not one of these MRI scanners located in the state of Oregon. Idaho had one, there were 2 in southern CA, and the Center for Diagnostic Imaging (CDI) in Renton, WA had the upright MRI which after informing the VA, is where they sent me. The upright MRI of my spine showed the neural foramina stenosis, nerve root encroachment, and tarlov cysts on my sacral spine.

Back to Dr. Bieber's 12/18/15 message, he wrote: "if imaging MRI shows pathology then re-refer to neurosurgery for clinical visit." I was told by my Grants Pass VA PCP on January 19, 2016, after reviewing the CDI radiologist report from the upright MRI performed the day before that he would put me in for a neurosurgical consult at the Portland VA but it would take a while. I would later be informed that Portland was too booked up to see me so I tried to see a non VA neurosurgeon through choice. I was told that newer studies were needed. I had switched to the Roseburg VA healthcare system and due to not being able to utilize the Brookings VA clinic due to the chronic problem of inadequate staffing (which still exists today), I was given the option of going to Roseburg for primary care.

My Non-VA Pain doctor who had been providing spinal injections and nerve ablation for years, requested new upright MRIs of my spine. The request for new upright MRIs was denied. I received a voicemail fro someone named Ramona at the Roseburg VA stating that "there's no definitive advantage doing an upright MRI versus conventional" and that my Doctors request for new studies had been denied. I would later find out that it was Roseburg VA Chief of Radiology Dr. Wang who issued that denial, which is documented in my medical records. After a letter writing campaign to Congressman DeFazio, Doug Paxton and a phone call from Assistant Chief of Radiology Timothy Duncan at Portland VAMC in response to DeFazio's query, Dr. Duncan, like Dr Bieber, stated that the upright MRI (compressive study) was appropriate. At the Grand Opening/ribbon cutting of the new Brookings VA Clinic on 9/11/17 (a new clinic which was and still is unable to meet the needs of community Veterans), I provided a letter to then A/Director Barbara Galbreth documenting the efforts made to repeat the upright MRI study. 4 days later Triwest called to schedule the new upright MRI studies of my Cervical, Lumbar and Sacral spine. Dr. Wang would later reverse his position and recognized the value of of upright compressive studies of the spine. An interesting note here is that the Roseburg VA did not pay for these Oct.11, 2017 studies. They were ordered by a VA doctor in Eagle River Alaska so that the expense would not be attributed to the Roseburg VA.

My story has already benefitted another Veteran who receives his Care at the Eureka, CA VA Clinic. His PCP was also unaware of the upright MRI when he requested it. She ordered an upright MRI of his spine. There is now a facility in the SanFranciso Bay Area where Veterans can go for an upright MRI Study.

Dr. HasserFratz understands the value of the upright MRI. Veterans need to be made aware of this option. I even suggested in a 8/16/17 letter to Paxton to share this info with Veterans. Maybe Dr. Hasserfratz will share this info? -Mike

chicagomike

Roseburg VA Radiology Part "C" - On October 12, 2016 The OIG issued a report of it's inspection of the RVAHCS Radiology/teleradiolgy. From the report: "We substantiated that the system lacked a peer review process for radiology. The system's radiology service level peer review program was not an integrated part of the system's overall peer review program for quality management. This could hinder the system's ability to detect misinterpretations of radiologic studies, if they occurred."

It is important to note here that Director Allen did provide me with the following information on 8/21/19. "The Roseburg GE MRI was put into service in 2008. MRI can have up to 10 years life cycle per VACO recommendation." Roseburg's MRI is now 12 years old. The following information comes from multiple sources including Dr. Wang. It is important to note that my email and personal request of Dr. Hasserfratz for the serial number of Roseburg's GE 1.5T HDX MRI Scanner have gone unanswered. The Serial number would enable me to better address/verify with GE the following information. The GE 1.5T HDX MRI scanner reportedly had problems with the CXK4 Magnet being responsible for producing blurry imaging. To address this, GE apparently made changes to the magnet as well as software modifications and the GE 1.5T HDXT went into production. Software was apparently made available to improve images produced by the HDX to partially upgrade the HDX to an HDXT but the original CXK4 Magnet would remain. The GE 1.5T HDX is available for purchase on the secondary market and can be purchased for cheap but is not desirable.

In a radiology email town hall with Whitmer, I reported what CMC's radiologist tech informed when I asked why Roseburg's images appeared dark and blurry. The Tech informed me that this could be a software problem. The Tech also informed that CMC's Machine programs the MRI using height and weight to set parameters to achieve water and fat separation from the images. I asked Whitmer in a radiology email town hall if Roseburg's MRI had this capability? Whitmer did not respond to the email. I again asked this question to Whitmer during one of the 5 of the 6 meetings he requested with me on 8/20/18 and again publicly asked the same question that night at the Brookings town hall meeting which he replied he would look into. At my October 19, 2018 meeting with Whitmer and the patient advocate, I was finally given response to this question 5 months after I asked it. The Patient Advocate informed that Roseburg's MRI was too old to set parameters using height and weight to achieve water and fat separation from it's images. This response was documented in a follow-up email.

On October 30, 2018 Joel Corcoran from Senator Merkley's office called me prior to a scheduled congressional call in with the Roseburg VA that day. Joel asked me to email him a list of questions which I did. These were also sent to Whitmer. Some of the questions asked were: 1. With regards to the OIG inspection finding-"Has a peer review process been put in place? and have misinterpretation images been detected?"

2. "Why are non-VA radiology images (including those ordered by the VA) not entered into the Roseburg Veterans radiology records? And would this be helpful if direct comparisons could be made to Roseburg's own studies like my shoulder MRIs to detect the misinterpretations which have been made?"

3. "As a result of my 12/27/17 radiology letter, non-VA radiology studies are now listed in my Roseburg VA Radiology Records. About these non-VA studies my VA records indicates that: images have been downloaded into the AGFA PACS system". Has Roseburg made these notations in all Roseburg Veterans records as related to non-VA radiology studies?"

Neither Mr. Corcoran or Whitmer provided answers to these or other questions asked in the 10/30/18 email or follow-up email requesting answers.

Her are the identified problems which were discussed with Dr. Hasserfratz when we met on 12/18 to discuss Roseburg's radiology problems prior to the town hall.

Roseburg Radiology dept. does not accept outside radiology reports for scan into the Veterans radiology records. The radiology clerk instructed me to provide these reports to my nurse, which I did and these are scanned into a record keeping system (different from the Veterans VISTA medical records). Roseburg Radiology will, if able to, scan the outside radiology study images but these will not appear in the Veterans radiology records but be put in the PACS system. Why the three different radiology record systems? Dr. Hasserfratz understands the problem and shared that VA providers are frustrated by this flawed record keeping system. The fact that 2 of my PCPs (I've had 7 PCPs since 2017) have indicated that not all of my radiology studies are available in my radiology records and this is documented in my medical records highlights this problem. Some of my radiology studies performed at other VA Facilities in Illinois and White City, have now been included in my Roseburg VA Radiology Records only because I raised the issue in my twelve page12/27/17 letter sent to Paxton and Congressman DeFazio.

Dr. Hasserfratz informed that the problems with the 3 separate Roseburg radiology record keeping systems (actually more than 3 if you include other VA facilities) would be solved when the new Cerner VA/DOD medical records system came online. I disagree as I seriously doubt it will address the problems I've raised here and these problems will continue because it would dependent on the due diligence of the VA to instruct and pay it's employees to ensure all previous VA and outside radiology studies of all Veterans be entered into the new system.

The larger problem which has an adverse affect on Roseburg VA Veterans is that when Veterans are sent into the community for care, only the flawed Roseburg radiology studies are sent to the provider.

Dr. Hasserfratz's solution to the problems in Roseburg is to have Roseburg's new Acting Chief of Radiology perform an "unbiased" review of mine and another Veteran's flawed MRI studies. I informed that if the Acting Chief did not conclude what my doctors, who are the end users of my Roseburg VA MRI Images have concluded, that I will pay for my own unbiased radiologist to review these images.

Director Allen has informed he will not make the request to replace the MRI scanner. It is unlikely that any investment will be made to refurbish the GE 1.5 T HDX machine if that's even possible. Perhaps the best possible solution is to remove Roseburg's MRI from service and send Veterans into the community to have MRIs performed on newer equipment.

I will submit Roseburg Radiology Part "D" dedicated to the Upright sitting/standing MRI which is grossly underutilized by the VA.

chicagomike

Roseburg Radiology part "B"- Radiology x-rays,MRI and CT scans are used to treat, diagnose and in some cases, compensate Veterans for service connected conditions. The VA has failed myself and other Veterans with regards the above statement.

On 11/20/19, myself and 2 Vietnam Veterans, VVA Chapter 757 board members, met with Director Allen. Numerous problems were discussed. One of these Veterans, whom I'll call John, shared the following with Director Allen: On 10/20/18 John had an MRI performed at Curry Medical Center (CMC) that showed a cyst on his brain. On 10/21/18 this MRI was repeated at the Roseburg VA. The cyst was apparently not seen and was not reported by the Roseburg Radiologist. Six months later, John had the MRI repeated at Providence Medical Center that showed the cyst on his brain was still there. John also shared that the Roseburg VA orthopedic doctor offered to shoot his shoulder up with Cortisone. John went outside the VA and used his medicare to have extensive Rotator Cuff Surgery.

It is important to emphasize here that Veterans medical records and Radiology records do not follow the Veteran from other VA Facilities. Incomplete medical records and problems list are a huge problem for Veterans. I will focus on Radiology Records and the failure of the Roseburg VA to use prior radiology studies for comparison.

On 5/30/17 I had Roseburg VA MRIs performed of my right shoulder and my right knee. During our 1 1/2 + hour conversation on 12/26/17 I informed Dr. Wang of the 9/26/09 MRI performed at Hines VA Hospital in Illinois. I asked Dr. Wang why a 1/12/16 Xray was used for comparison to Roseburg's 5/30/17 MRI and not the Hines MRI. Dr. Wang informed he was not aware of the Hines study and he looked it up. Using the Hines MRI for comparison Dr. Wang admitted that he made numerous (substantial) mistakes in his report of the 5/30/17 Roseburg MRI. Dr. Wang made numerous correction addendums to his 5/30/17 report to more accurately reflect the the complex tearing of the medial meniscus, the ACL was not torn as wells other significant discrepancies.

There are x-ray studies of my knee performed at the VA in Illinois that use 4 or more views of my right knee compared with 2 views performed here. Using x-rays, my arthritic knee improves at the VA in Oregon.

The 5/08/17 CMC MRI reports all of the torn tendons in my Right shoulder and the complex tearing of the labrum. The 5/30/17 Roseburg MRI incorrectly reports two of the torn tendons as tendonopathy. Dr. Wang does notice the disruption of the bicep tendon and reports that the Labrum was not well visualized due to some motion artifact but the remainder of the Labrum is grossly intact.

Dr. Wang and I concurred that the motion artifact was due to the flexible receiver coil loosely wrapped around my shoulder. Roseburg's MRI Scanner is a small bore machine, the Flexible receiver coil was rubbing on the inside of the tube as I was moved between scanning segments and the release of the tension on that cuff during the scan was the likely cause of the motion artifact. Dr. Wang and I also agreed that it is the radiologist technicians job to recognize motion artifact when it occurs and repeat that section of the scan. The Roseburg technician did not do that and that is why the complex tearing of the labrum was missed. The CMC MRI Scanner uses a receiver coil that is fixed to the table to prevent inducing motion artifact into the scan.

Dr. Wang also informed that some patients have a difficult time being scanned using Roseburg's Small Bore MRI. Dr. Wang informed that the wide bore scanners make the patient more comfortable and produce better scans.

During our 4/24/18 comparison of the two Roseburg right shoulder MRI images to the CMC MRI images Roseburg's were dark and blurry, CMC's were bright and clear. Dr. Wang admitted that Roseburg's images were not the best and did not show everything. He said the newer Phillips MRI scanner in Eugene produced higher quality images but maintained that Roseburg's MRI does have some diagnostic value but he wanted a new MRI scanner, and stated he can always send Veterans to Eugene when he needs to have clearer images. What was discussed in person, on the telephone, etc. was all documented in letters and emails with Whitmer, Shanon Goodwin, and other email recipients at that time.

After Whitmer changed his mind or VISN 20 changed Whitmer's mind about replacing Roseburg's MRI, he stated that that the motion artifact that occurred on 5/30/17 during Roseburg's MRI of my right shoulder was due to having 2 MRI scans performed on the same day. Allen would later regurgitate this same BS in an unsigned, not dated statement bearing no VA letterhead, to support his (VISNs) financial decision for not replacing the Roseburg MRI scanner. There are some severe flaws in this statement:

1. Roseburg has scheduled me twice in 2017 to have more than one MRI performed on the same day. So had Hines VA and Center for Diagnostic Imaging.

2. How could performing an MRI scan of my knee have induced motion artifact in my shoulder MRI scan that was done before the knee scan?

On the same day in June, 2017 Roseburg scheduled and performed MRIs of my right and left hips-pelvis and my cervical spine. I have yet to have new hips/pelvis MRIs on a newer machine to compare to Roseburg VA's. The CDI MRI performed in October, 2017 report when compared to Roseburg's shows the nerve root encroachment, spinal cord abutment and all of the stenosis. Roseburg's MRI report does not.

I will have to continue Roseburg radiology in Part "C". I still need to address known problems with Roseburg's GE 1.5t HDX MRI scanner, why the images are dark and blurry, and what Dr. Hasserfratz is going to do.- Mike

chicagomike

#1.RoseburgVA Radiology Part "A"- I first met Director Allen at the June town hall meeting in Brookings. The issue I raised was that former Director Whitmer had promised in emails and at two town hall meetings that he would make the High Tech- High Cost replacement request for a new MRI Scanner for Roseburg. Whitmer even sent me a link to a West Palm Beach FL VA story where as Deputy Director, Whitmer was involved with replacing the old MRI Scanner (like Roseburg's) that produced poor quality images. Whitmer Left without making the Replacement request.

Allen's response to my query was that he would never make a promise to do something and not follow through. in my discussion with Allen after the meeting, he informed he would not be making the request to replace Roseburg's MRI. It is unlikely that Roseburg VA will make the investment that Mercy did to update it's MRI.

According to a Mercy employee, Mercy Hospital spent $750,000.00 refurbishing their 10 year old inpatient MRI. Mercy also operates an outpatient Imaging facility with a newer 3 Tesla, wide bore MRI which produces High Quality Images.

My first knowledge of the problems with Roseburg's MRI Scanner was brought my attention by a non-VA doctor. A previous lumbar MRI performed at Hines VA showed the arthritis in my spine. Arthritis disappeared from the Roseburg MRI lumbar study and then returned on a non- VA MRI performed after the Roseburg Study. None of the VA's MRIs showed the neural foramina stenosis/nerve root encroachment in my lumbar spine. I first brought this to the attention of Paxton when I spoke about it at the 8/16/17 town hall and presented then A/Director Dana Brice with a letter.

Roseburg MRI's of of my right shoulder: In 2013 the Roseburg Radiologist reported that my bicep tendon was visualized in bicipital groove and my rotator cuff was torn. My bicep tendon could not have been seated in it's groove as it was shredded and surgically detached and re-attached below the joint 10 years earlier. The MRI performed in 2017 on Curry Medical Centers (CMC) 2 year old MRI Scanner showed the the rotator cuff was not torn and the clear disruption of the Bicep tendon.

On May 8, 2017 My non-VA Doctor ordered the right shoulder MRI that was performed at Curry Medical Center. On May 10, 2017 I brought the images to Roseburg Radiology and they were unable to load the images. On 5/10/17, immediately after seeing my new Roseburg PCP for the first time (who reported in my VA medical records that there was nothing wrong with my shoulder or my knee), I immediately went to Roseburg's ER. The ER Doctor immediately noticed the deformities in my right shoulder and knee, sent me for X-rays, ordered MRIs and orthopedic consults. These Roseburg MRIs were performed on 5/30/17. I would later be alerted to the differences between these MRIs which led to an hour and a half phone conversation with Chief Radiologist with Dr. Wang, followed by a 12 page letter and 2 additional meetings with Dr. Wang in which MRI image comparisons were made. Dr. Wang admitted he and other radiologists made mistakes due in part to Roseburg's poor image quality, Dr. Wang wanted a new MRI scanner and even invited me to the ribbon cutting ceremony for the new MRI if my efforts were successful.

Tomorrow in Roseburg Radiology Part "B" I will address more of the problems I discussed with Dr. Wang, the problems with VA Radiology's 3 separate record keeping systems as well as my 12/18/2019 meeting with Dr. Hasserfratz and what she is doing to address radiology problems in Roseburg.

Mike

chicagomike

I am going to post 4 comments here which will address 1. Roseburg Radiology Departments 12 year old MRI Scanner which produces flawed images and radiology reports, 2. Low Dose CT Lung Cancer Screening for Veterans smoking history and military exposures to known respiratory carcinogens, 3. How going to the urgent care or VA clinic if a Veteran is experiencing a silent heart attack could cause an unnecessary delay in treatment that could have a deadly outcome. 4. How Veterans are still on the hook for emergency room bills when the VA uses the definition of a prudent layperson to deny payment.

Director Allen and Chief of Staff Dr. Hasserfratz, to their credit have given me the opportunity to address Numerous problems with RVAHCS which Whitmer and Paxton did not and even lied to and mislead Veterans and a US Senator and Congressman. Lung Cancer Screening is the positive result of Director Allen's and Dr. Hasserfratz's discussions and email dialogues. - Mike

nr77

Article might sound good for public relations but fails to address that

OCC office may take months to process the bills, and in the meantime Veterans credit ratings are damaged. Same goes for approving pre authorizations. Google Brandon Donovan for an example of how OCC has treated too many Veterans. OCC management is inefficient and dysfunctional.

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