Secret Recording Program Nationwide At VA Medical Care Centers

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VA Medical Care Centers

Benjamin KrauseUnder the auspices of health care quality improvement, VA medical care centers across the nation are now secretly recording veterans’ appointments with their doctors.

The practice started at two Illinois VA facilities connected with VISN 12, Edward Hines VA Medical Center and Jessie Brown Medical Center and is part of a quality improvement initiative at the facilities where veterans volunteer to record the doctors. How is that for a change of pace?

Doctors at these two VA medical care facilities agreed to secret recordings of patient appointments to evaluate oral statements made by veterans. The veteran is aware of the recording and brings the secret device into the room at random to avoid detection by the consenting doctors.

The recordings’ purpose is to help VA evaluate how the doctor evaluates patient statements. At the onset of the program, VA believed doctors were missing diagnosis by failing to properly listen to the veteran. VA further believed this failure resulted in missed diagnosis opportunities and excessive spending on unnecessary health care.

Does this sound like a great idea or a scheme to erode medical privacy under the guise of something else? In this instance, the recording program is benevolent in nature and is improving care according to head of the program, Dr. Saul Weiner.

In a publication by American Medical News, VA doctors at these facilities agreed to be secretly recorded during their examination with veterans during the research phase of the program. The veteran brings in a recorder without informing the doctor – this is fully sanctioned by VA and legal. Since the doctors previously consented to the recordings, the program may not violate Illinois dual party recording laws. All parties to a recording must consent prior to the recording in states like Illinois whereas single party states like Minnesota only require consent from one party, which could be the person surreptitiously recording the conversation.

The recording program was designed to teach VA how to better catch red flags from oral statements made by veterans during examinations. Here is an explanation of the flags from America Medical News:

So-called red flags such as missed appointments, drug noncompliance, missed screenings and sudden spikes in previously controlled diabetes and hypertension went unexplored in more than 60% of patient visits to physicians, said the study, published April 16 in Annals of Internal Medicine.

These red flags often indicate that factors such as job loss, change in insurance status and trouble with transportation are impeding care, said Saul Weiner, MD, professor of medicine at the University of Illinois College of Medicine in Chicago.

“There are algorithms for how to manage certain chronic conditions, but that is not going to help you when in fact the underlying problem is that the physician missed a cue about something else that is happening with the patient,” Dr. Weiner said.

VA and its Health Services Research & Development division considered the program a success. Now, VA has implemented this secret recording scheme across VA with the claim that the recordings are only designed to catch these red flags.

My more skeptical self says these recordings are going to be used for a great deal more than just spotting flags. But, VA claims the recordings are outside the reach of the courts because they are supposedly used for quality improvement. Further, the recordings are supposedly encrypted and identity neutral meaning the only party that is identifiable is the doctor.

How are they ensuring the statements are confidential? Does the veteran waive privacy to help VA in this form of research? Have any of you participated in the scheme?

UPDATE 3/9/15: Following a call with Dr. Weiner, it sounds like this program is only secret in the sense that the doctor does not know each instance he or she is recorded until after the evaluation is conducted. It is not secret in the same way VA secretly recorded one veteran family at a Florida VA hospital. According to Dr. Weiner, the program is not malicious in nature and is done with the intent of holding doctors accountable, not veterans. However, other VA employees and doctors not affiliated with the incognito recording program are shocked its secretive nature and seek to undue its progress.

Source: https://www.amednews.com/article/20130508/profession/130509991/8/

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70 Comments

  1. I smell a BIG rat here with this. The whole thing just stinks to me. Knowing what I already know about the VA, this thing could be set up for abuse toward the rights of veterans (what little rights we actually have). As adversarial as I know the VA to be, what’s going to keep them from saying the wrong things to veterans and asking veterans the wrong questions in order to illicit any response from the veteran that can be a detriment to him. In other words this whole thing could get out of hand to where the VA can use this without the knowledge of the veteran and become widespread particularly with C&P examinations.

  2. I think that this could be used against the Vets as well. Your appointment is supposed to be private and what you say to your Dr. is between you and him/her. I can see this used against the Vet if the Vet was taking a narcotic pain med and the Vet mentions that the Vet took a dose that was not within the prescription. I.E. took it early or late and therefore took too many. This could be used to say that the Vet is a “druggie” and the VA now has the proof. If the Vet makes a statement that he/she is feeling pretty down at their psychologist, then that could be used against the Vet as being “suicidal” and they could be put on hold for a certain amount of time and could do nothing. This would be in their record permanently even if they are not suicidal at all. I know if I mention anything about being even slightly down that my psych. Dr. perks up and I have to take the next five minutes to convince him that I am not a danger to myself or anyone. I have never been suicidal, or thought about it, so this is a huge red flag to me.
    I can see so many ways this can used against the Vet and with the VA’s record; I for one do not want this. What is to say that it is not happening right now and the VA has so much on us that this would be their way to get back at us? I think most of us don’t trust the VA enough to do this. The only way I could see it working is if the Vet brings in their own recording device when they want to and records the Dr. (or whoever they are talking to) and the Vet gets to keep the recorded conversation. Keep the recording out of the VA’s hands.

  3. Good HEADS UP, I had no knowledge of such GOING-ONS and furthermore, have no INTENTIONS of participating in such FARCES. THIS IS THE VERY REASON THAT WE CAN NOT GET PROPER CARE FROM OUR VA SYSTEM.
    IF WE HAVE TO BECOME WHAT WE ARE FIGHTING AGAINST TO WIN THE FIGHT, THEN WE HAVE ALREADY LOST. TRADING an UNKNOWN ENEMY for a KNOWN ENEMY will NOT solve our DIFFERENCES. We must DEAL with one another with RESPECT / HONESTY.

  4. Heck I do this all the time. Single party notification state is wonderful.
    If they miss something because I state it, I later have proof that it was brought to their attention and they blew it.
    Recorded an hour long Comp and Pen exam for PTSD.
    95% of the time the only questions asked were about non military.
    He almost ended the exam without ever getting to any of the stressors I had listed. As it was we touched on only a single one.

    Bet I wont use this in a NOD or Appeal if they deny me?

  5. To one respect I agree with the idea but in all others I am against it. My last VA doctor was an idiot! I could not understand a word she said and she didn’t seem to listen to a word I said. The only thing she cared about is the fact that I smoked, not the fact that my foot was the size of a football, black and burned for months after a chemical accident. She needed a nurse just so I could understand her.
    If it wasn’t for a smart nurse, in FB, I would have lost my foot. After being sent home, I posted my foot and a wonderful nurse came to my rescue and told me how to start treating it so the acid would stop burning. This is because my doctor had NO CLUE!. We do need accountability for the doctors but we don’t need more prying eyes watching our every move.

  6. “…..went unexplored in more than 60% of patient visits to physicians.” It would probably be an equally depressing statistic of “unexplored” complaints specific to the individual veteran.

    Then there is the fact these doctors were aware that they would be randomly recorded. If you are a doctor working for the VA you are supposed to be following VA guidelines and regulations. Maybe if someone told me I would be critiqued through anonymous recordings of my examinations, I would be darn sure I touched all the bases with each patient while this program was on going.

    So why didn’t they? It is simple answer which has been repeated here in this forum and throughout the veteran sites on the web; They don’t care and there is nothing you can do to them. In other words, there is no accountability.

    What employer could you work for where you do not complete all the tasks of your position 60% of the time and keep your job?

  7. More and more veterans to record VA doctors examinations to compare the veterans medical records is a great idea. Yes, also, recording video and audio of all matters, could immediately provide copy for the Veteran.

  8. Hell…They record us for damned sure. Just 3 days ago at my local CBOC a group of about 20 of us Vets were in the lab waiting room to be called in for labs. Our CBOC has horrible parking and all the streets around it are flagged as tow-away zones. So we were all talking amongst ourselves about how sad it is to park 5 blocks away and have to walk to the clinic. About 5 minutes into our discussion, appears out of nowhere a VA cop and she stands in the doorway, all big and bad with her uniform, badge and gun, and begins lecturing all of us about “frustrations” involving parking and how she has to park and walk as well and so on. When she was done and the old timers had given her all their grief. I asked a simple question. “How did you know we were discussing the parking issue?” She stumbled and said well everyone always talks about it and then walks off. Look….I’m no dummy and I see the camera hidden in the fake tree there in the waiting room so I know we are being watched but NOW I know we are being listened too as well. Just a reminder, mind your P’s and Q’s at any VA facility lest you get labeled a “troublemaker” and will never see the inside of one again ever.

  9. Personally, I think this is a good idea. I began recording my C&P’s after a nurse magically announced I was cured of my high BP and a psychologist said my PTSD was getting better after I repeatedly told her I was experiencing anxiety attacks and sleeping less because of adrenalin producing dreams of fire fights. Very few staff members actually listen to what you say, i.e. weight, BP readings, etc. the only thing they are doing is typing data and what they want into that damn computer.

    And after the VA tried to reduce compensation because of the above BS, yes I record my appointments. It’s obviously adversarial I just want to keep things on a level playing field and keep those involved honest.

    • Typing things in to their damn computer…like your responses to all the latest health fads the VA keeps pushing. They very carefully record your responses to smoking cessation, weight loss programs, chocolate as a PTSD cure etc, but when it comes time to actually listen to a veteran describe their symptoms, they cannot accurately note them.
      I believe that is because a VA official will see data tabulated over how many are participating in weight loss programs, and don’t give a damn over a veteran describing pain.

  10. I think we NEED someone or something in our corner. It’s a shame it has to be a mechanical device. And Dennis is correct. It could easily backfire. How about the VA start being professional and keeping their vows to their patients??

    I’ll wait now for the laughter to die down.

  11. This story brings some clarity to another example, of similar recordings in court rooms, police body cams, and how we are living in a complete Orwellian nightmare of cams and voice recorders, facial recognition software, everywhere in what used to be the USA, but is now the risen (NGE) Gestapo Empire: to wit, the convenient death of the judge hearing the false arrest case against my wife, as in, he was immediately murdered because he was ready to dismiss the latest attack, false arrest, by the VA on my family. Long story later, film at 11.

  12. I believe you are reading this incorrectly. The patient are recording the appointments with the doctors’ consent.

    “The physicians involved consented to being recorded for the study, and part of the study’s design was that the doctors did not know which particular patients would be taping them.”

    You might want to read the article a bit more closely.

    • And I’m going to guess since everyone involved agreed to do this, then they have probably signed consent forms. Not sure whose privacy it erodes when everyone knows about it.

      • there is no fucking way I would give up my right to privacy through HIPPA with an excuse like, “we are attempting to improve the quality of service to veterans.” if you agree to the recording you are giving up your individual right to privacy! don’t be so fucking stupid, the VA will screw you and chew you and then spit you out…and laugh at you as you leave, infact, if you leave the VA and they are laughing as you leave….they already fucked you!

      • I’ve personally never had any bad experiences with VA…I’m very sorry if you have. Experiences vary from person to person and place to place, so I consider myself fortunate. I’m glad the author went back and actually did his homework on this story:

        UPDATE 3/9/15: Following a call with Dr. Weiner, it sounds like this program is only secret in the sense that the doctor does not know each instance he or she is recorded until after the evaluation is conducted. It is not secret in the same way VA secretly recorded one veteran family at a Florida VA hospital. According to Dr. Weiner, the program is not malicious in nature and is done with the intent of holding doctors accountable, not veterans.

  13. Veterans beware! I for one am done with the VA healthcare system. I’ve noticed, after every xray, mri, etc. they get the info, never tell me anything and I’m outta of the loop.

    • I’ve had a few of those incidences aswell, last year got an MRI of my skull, the MRI tech totally freaked out after she injected a die into my hand and started to do a scan. I noticed her on the phone in the room the stand in freaking out on the phone and then she noticed I noticed and started telling me I was having a reaction to the die or whatever. They never wrote it in my record at all. Nothing was reported on the MRI…So Veterans beware, they don’t want to help you anymore than previously all the noise level in the last 2 years.

  14. I had actually questioned this with my friends last year. One can tell by the questions and the way the VA employees act or response, they are always attempting to get a VETERANS to make statements that can be used against the VETERANS benefits! I asked my VASH Caseworker last year if I was being recorded and she said no but I think she actually lied. I try to go into the VA process as if they are recording me now. Call me fucked up and paranoid but I’ve seen enough VA bullshit to totally justify my beliefs!

    • Oswaldo, I too go into my appointments with the attitude that they may be recording them. I also make sure to state things that I want the VA to know about. If there is anything that is not right, I bring it up. If something is said that I think it could be twisted and used against me, I try to answer it in a way that it cannot be used against me. I also make sure to get my records from the ROI no more than a week after something I have a question about is done so it will be fresh in my mind and I can compare what was done and/or said and what is in my records. I also make my own notes to be put in my records so I can have my point of view about what happened. I guess I don’t look at it as being f*cked up or paranoid, I look at it as being very cautious and that I don’t trust them for one second.
      Also I think that we are in the same thing in regarding the VASH thing and I know how you feel about that. I too am very upset with my “treatment” in this program. You are not alone in that either. Stay aware of what they are doing and don’t let them get over on you.

  15. This is definitely a two edged sword. It bears possibilities for good and bad. If we look at the track record for VA treatment and take the time to record conversations with medical staff – I recorded several visits in a journal with the help of my wife. She is always present during my appointments. If one does so it is very easy to see the questions are purposeful and very one-sided. I was asked, for example, “If we cut off your foot and give you a prosthetic do you think you will be able to walk?” This was during a C&P evaluation. How does one answer that type of question?
    Ok, we all know that most of the VA folks ask specific questions designed to either invalidate our examination or try to make liars out of us. It happened in the military as well and it happened at civilian hospitals too. In one instance I had fallen onto a slab of cement and (it felt like I had) cracked my hip. I laid in the room for 45 minutes because the doctor wanted to make sure I wasn’t faking. This was at a civilian hospital. The he told me that many people came in pretending to be injured just to get drugs. Again, it would seem that medical treatment anywhere today is a double-edged sword.
    The healthcare system is set up with certain procedures to weed out the cranks and fakers. It places certain standardized obstacles for this purpose into the treatment process. I understand this, I worked in a medical center myself. Some is to protect the doctor, some to protect the investors in the hospital, and some to comply with federal laws. Believe me it is not easy being a doctor in some of the medical facilities today. In many cases, and this pertains to the VA medical teams, they are inhibited from making certain statements or saying something that is completely definitive and pointed – such as “it is clear that there is nerve damage to such and such area” or “obviously you accident in the military was the cause of the problems you have now”.
    Anyway, in many ways we are beating a dead horse. Like several have said, it’s better to keep your wits when being seen at the VA. Complete honesty, although very admirable, can be counterproductive. For over 10 years I was just that, completely honest. While some doctors and staff truly appreciated the honesty, many also exploited that honesty and drew invalid conclusions or wrote things in my record that would certainly prevent me form getting certain benefits should I apply for them at some future date. I also discovered that when asked pointed questions, which seem fairly innocent at the time, it is best to hedge a bit – not lie but sometimes too much information can be detrimental. Mainly this is because sarcasm and humor does not translate well in a typed summary not does it make it into the doctors notes. Indeed it is very difficult at time to write something and it mean the same thing to everyone. And then there are those special choices in vocabulary that get recorded – such as words like “claimed” which have negative connotations. Just think of the difference between stated and claimed.
    Anyway, one last time, keep your wits when at a VA appointment whether for a C&P or any appointment. You see, anyone with access to one of the computers can look at your records – all of them, including dental and psychological records. Yes, the brand new physical therapy trainee can view ALL of your records… Be honest but be aware and prudent in your statements. Your life does not have to be an open book…

    • drleyrose, What if a vet moves from a VA in one state to another VA in another state and the new VA refuses to look at the vet’s medical records from the last VA (10 yrs. of records) and as a result, the meds that the vet have been taking are cut-off and the vet has to start over and prove to the new VA that the vet has the disability that the vet is claiming even though the vet was discharged because of this disability and had recently received an increase for the same disability that the new VA states the vet does not have and they can find no reason for the vet to be taking these meds.
      This happened to me. I tried to show the new VA my important records from the other VA and the new VA refused to look at it as well.
      Because of this, I became homeless because I could not get a job. This is affecting me to this day. The VA has screwed me over and they don’t care. I should have recorded my appointments when I came to this new VA and I would have the proof to have something done to them. They have ruined my life.

    • yeah, no shit sherlock! Like most veterans with VA dealings and time under our belts, we already know this and this is what we are trying to fight because 98% of us veterans don’t have bullshit claims, are not seeking a pitty pot and are not drugg addicts looking for drugs…we are seeking our benefits, we earned through the blood, sweat and tears of our military service.

  16. va deathcare with death panels to killl vets for the bonous $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

  17. I can not count the number of complaints that I have heard from Vets that say their doctor does not listen to them; writes down notes that do NOT reflect what the veteran actually said; who makes comments that are anti-veteran, anti-Compensation and that just outright lie to the patients

    I think that ALL C&P exams should be videotaped.

    That way, if actual range of motion tests were not done, the veteran can prove it. If the doctor claims the veteran said something that they didn’t, there will be absolute proof on the video.

    If you have a doctor that can not speak, or can not understand English well, once again, that would show up on the video.

    This would also stop vets that claim that THEY told the doctor something, when they actually did not. This kind of system would help to protect EVERYONE.

    A copy of the video could easily be duplicated, on the spot, and given to the veteran. What better evidence could anyone have?

    There is WAY too much bull manure in the system

    • Lyndon, Very good point. I think that both parties involved should get a copy of the tape. This way the VA could not “lose” the tape and therefore get away with denying the claim. This would give the vet a better chance of holding the VA accountable and would lead to a better transparency for that part of the VA. I like it!

      • Figure8fan, my comment is in reply to yours above on Weiners research grant. As one who was involved in reviewing research projects for possible funding, I can say that cost is at the higher end for minimal return. I say minimal because the VA could easily fix this without spending almost a million by listening to vets. This reminds me of a Colonel pushing a certain medical research project, only to be fired when I found and reported he had consulted on the exact same project with the same investigator a few years prior, but never disclosed the conflict. It also reminds me of the numerous VA funded research projects in the 90s on PTSD where they seemed to alternate who the lead investigator was, then pass their research around the table to their buddies and call it peer review. It has been damn frustrating seeing so much money wasted on worthless research.

    • Video taping, etc.. will do no good when you have absolutely no one to give it to, to contest it? Not the Pt. Advocate. VA director, Who at Regional office, OIG, Congressman. We have no one to hear us but the media when enough Vets are harmed. Otherwise we are on our own. VA can and will do anything they wish with absolutely no oversight.
      When are we going to demand a change!? Get the VA out of our healthcare and prevent the death and severe mental anguish they cause us all.

    • There are many VA encounters where I wished I had a video or audio tape. The difference in the treatment notes and what was written in my records often left me wondering who they were writing about. The real problem I have with this program, is in order for this to comply with current laws, the veteran also had to sign a privacy release for sharing information. Since there are so many exceptions in the VA privacy disclosure statement, they might not need it.* However, at the very least, the veteran would have to sign a program participation document.

      Once produced, how many people will see or hear it? What will be the level of employees that have access? How will it be secured from unauthorized access?

      In the case of these stealth participants whose interaction will be shared with the provider, how will they be treated from-here-on-out? Will there be covert retaliation? Will the doctor tell others on your supposed “health care team?” Are the doctors voluntarily really allowing random recordings? What kind of pressure was brought to bear on them to agree?

      *Unlike your private doctor, the VA can release your private information, to such people as congressional committees, many state agencies – prescription information, disease control information, abuse centers are just a few of the many ways the VA can be releasing your information. They also can release your information to law enforcement agencies “when applicable legal requirements are met.” That does not mean they need a court order in all circumstances. To read the entire policy (8 pages): https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3048

  18. I like it but I’m not sure how it could work. When I 1st went to the VA for an evaluation the 1st question I was asked was did I have a recording device & if I did that I must remove or disable it before they could proceed. Next they asked if I owned a gun, where it was & was it loaded. This was also followed by the “if you don’t answer, you won’t be treated.” I know that’s not part of what was asked but I feel it’s very important. You could also add some recording devices for family members who often come with the veteran & also give some to those of us who are ministers & frequently visit with those who are hospitalized.

    • It would be just to video tape or have a recording of all VA appointments. That way you would have a verbal records of the bigotry, prejudice and two faced none care doctors and other employee’s! FTVA! They record us! Dr. Rana and Remilar at Martinez, California VA Medical Clinic and other last in their class doctor’s at the VA do too I would imagine. None of them I have seen over the last 47 year’s have honestly given me good care. I have to correct that one or two have plus, one or two PA’s and Technician’s, that would make about 10% of the medical people along with a few other’s I have seen over those 47 year’s!
      .

      • They will not let you take a recording or a video… I tried with husbands case. I would take notes while they were talking but then they did not want me in room.

  19. Don’t get excited guys! It’s just some Illinois Tea Baggers seeing how far they can stick it in. That shit won’t float anywhere else, stupid bastards. They are messing with sacred contractual Care Taker – Client relationships. That one is going to get stuffed down their throats, again, stupid bastards.

    • And would you care to cite your source of “some Illinois tea baggers?” This is a nation wide program if you read the article.

  20. Iv been recording these clowns for years ?!?!

    Am I not supposed to ?

    Did I do something wrong ?
    Am I being wrong again va?

    Sorry va I’m wrong

  21. This is a very touchy subject. Many of you have very important comments and many of you I feel are right in your thoughts. I can see the concerns and benefits but if someone records it and the veteran agrees and the veteran has a mental problem, they should not be asked to agree as their state of mind at the actual time they may not know what they are signing. Now at one visit just a few days ago, I wished that the doctor had been recorded as his statements about future treatment for a condition I have with my teeth. I was told there is no further care needed, when asked what about the hole left in my mouth, I was told “there are partials but it cost so much and so much work, you did not have any problems eating before did you. Reply no well no further treatment needed. I stated word for word back to them and they said yes no further treatment needed.

    I advised them via v.a. regulations that I qualify for a partial and would like something done as I had read if this was not done the rest of my teeth could shift and cause more problems. They did not like me repeating what the doctor had told me and told me that he did not say this. If it had been recorded I would have had my proof. Now its their word against my word, who are they going to believe. I know its not me. I think if they are going to record veterans this should be approved by congress and guidelines made, rules regulations, procedures. On the benefits and down falls on how it can effect veterans care.

    They should ask all veterans what they think in a survey. If it is being done now halt it now and put on hold until they determine it to be constitutional and no rights are violated.

    • this have been going on for ages…5 months ago or longer i reported to the patient advocate about why my doctor report was missing from my file from 1997..they had been hidden(missing) because of the info it contained…the patient advocate got back to me a month later and had located the doctors involved at that time and gave me a verbal report as to what they had said and i asked for it in writing and opened up A CAN OF WORMS..the FIO said they would have to have a meeting because no one had requested stuff like this before in writing..another month went by and finally i got a WRITTEN report and it WAS WORD FOR WORD and U WOULD KNOW IT CAME FROM A RECORDING…if i had not been recording the info from what the patient advocate said that they said i would not have known about the recording…YES BRING THE RECORDINGS ON IT WILL STOP THE HE/SHE SAY…

  22. I am the physician who has been coordinating the project you are writing about. I am author of the studies that Mr. Krause quotes, and also the person interviewed in the AMA news article which is from May of 2013 (see link above). I would like to tell you about what we are doing.

    There is a lot of research showing that physicians and other health care providers often overlook the personal challenges patients face while trying to manage their own health care. For example a Veteran with diabetes who starts to work the night shift may no longer be able to take his insulin and other medications on the usual schedule. It is critical for doctors to find out about these challenges and to help Veterans adapt to them at every visit. If they don’t, then Veterans will not receive care that is beneficial to them.

    The only way to know if physicians are asking about the challenges Veterans face and then helping them address them, is by audio recording the visit. And the only way to do that ethically is to give the Veteran control of that process. We invite Veterans to volunteer to audio record their visit. We tell them that our quality improvement team will listen to the visit and then provide feedback to the health care team on whether they are addressing Veterans’ individual needs and circumstances when planning their care. We also tell them that this is entirely voluntary. Not everyone is comfortable recording their visit for a quality improvement program. So that is a personal decision. We give them a number to call if they ever have questions.

    The project has been really helpful in terms of our providing doctors, nurses, pharmacists and front desk clerks with feedback on how they can do a better job helping meet Veterans’ needs. Also, there are situations where we do hear them doing a great job, and we commend them for that and reinforce excellent care.

    What do we consider excellent personalized care? Take as an example the one above about a Veteran with diabetes who has to work the night shift. The first thing that happened when he could not take his insulin at the usual times is that his sugars got out of control. They were often too high. A physician who doesn’t figure out what is really the problem will incorrectly think that he or she just needs to prescribe a higher dosage of insulin. On the other hand, if he or she asks the Veteran about what has changed in their life that might explain why their diabetes has gone out of control, they will learn about the Veteran’s new work situation. The correct care will involve talking with the Veteran about how to change when to take their medicine and eat meals so that they can control their diabetes.

    With this audio recording project we have found that Veterans face many different kinds of challenges in their lives related to work, family, disability, finances etc…and that getting them the right care depends on addressing those challenges in every care plan. This project has enabled us to give physicians and care teams continuous feedback on how to do this better.

    To answer the concerns mentioned in this blog: first, only Veterans audio record their care. There is never a situation in which anyone else does. So, there is no situation in which Veterans are unaware they are being recorded, since they are always the one doing the recording. Second, all the staff know that some Veterans will be recording their visits. Also, on a regular basis, we provide staff with many examples from the audio recordings. The names of Veterans and staff are removed, because it is only the examples themselves that are important to discuss.

    The staff that listens to the audio recordings are not health care providers or administrators. They have been trained to listen for clues that Veterans have particular challenges and then to see if the health care team is addressing them. Those clues are the “red flags” that are referred to above. The audio recordings are not accessible to anyone else in the VA system or outside and are encrypted. Also there are no identifiers. Instead of using the Veteran’s name, we assign a number that tells us which health care team took care of the patient. That way we can give feedback to the right health care providers. These identifiers are stored separately and also are not accessible to anyone except the quality improvement team. All this is important because it means that the data can never be used for any other purpose other than to provide feedback on quality. Finally, quality improvement data is legally protected from discovery in court. So, the data will never end up in court. – and wouldn’t be much use anyway because the identifiable information is removed.

    This project is not national. It is currently just at two VA facilities. A major health care journal that is run by The Joint Commission (which accredits all US healthcare facilities) and that focuses on quality improvement will be publishing a report of this project in June.

    We have gone to great lengths to do this right, consulting with an ethics team, legal counsel, privacy officers and quality improvement experts. We are always looking for ways to improve and welcome feedback. I can be reached at [email protected].

    • Dr Weiner, I am a social worker at Hines. I understand the value of research and by all means want excellent care for our veterans and support ways we can do better. Couple of questions I have: Why didn’t Hines leadership know about this? How does this effect the patient provider relationship? There will be a veterans townhall meeting at Hines on Tuesday. I suggest you attend to really hear how veterans feel about these recordings. Veterans plan on bringing this issue up. We need transparency.

      • Mr Clarno,

        Thank you for reaching out to me. Please note that this is not a research project but a quality improvement project. The difference is that this project is not designed to study Veterans or their care. It is designed entirely to improve their care. Regarding your questions and the town hall meeting: I am based at Jesse Brown VAMC but would like to attend if I can. I’ll email you at your VA account to learn more about the meeting you refer to. I hope we can talk before the meeting so I can better understand the issues you are referring to. The VISN leadership funds the project and knows it well. The it’s been active for over two years. The head of medical services and of primary care at Hines have been real champions of the project. I realize not everyone knows about everything, which can sometimes lead to confusion when issues arise. I am eager to work with you to sort out any issues including concerns any Veterans have. I’ll email your VA account.

    • DON’T TRUST THE VA OR THE DOCTORS, THEY ARE NOT YOUR FRIENDS….

      I’m sorry but under the HIPPA Laws aren’t they violating our rights if in fact they are secretly tapping Veterans. If they are can we do a “Class Action Lawsuit”???? What should be happening is that Veterans should allowed to secretly video tape those “Asswholes” who give us “Subpar-Healthcare”…What need to do is “Stop Bitching and Do a March on Washington” and let the Media Outlets and out Elected Officials no how we feel as Veterans.

      I am so afraid of all the VAMC’s that I carry a card in my wallet, “In Case of Emergency”, “Do Not Take Me To Any VA Hospital, I Would Rather Die”…Hell I don’t need a lot of veterans to march with me, but I can sure use your support… I signed my USMC Contract by myself but I gained a lot of faithful friends! It only take one Veteran and many will follow, Who the hell care about these veterans groups who say they will support us but basically only care about their membership levels…If don’t speak up now, we will only keep commenting on this blog because we are mad…Let’s Be About It, Not Talk About It!!!!

      If you show me that your ready, I will do my best to make away, 1 Veteran Marching could lead to possibly Thousands of Veterans Marching….I never let any negativity stop me from moving forward….I would like everyone’s support to make this happen…What the worst the VA can do too me is place me on the watch list, I’m probably on the watch list already…So I’m LMAO and ready to rock n roll….I tell Veterans all the time, I served my Country 100% Physically Able but came out 100% Disabled…

      Danny Toliver, USMC 100% Disabled Veteran
      (215) 264-819
      [email protected]

      PS: I WAS DENIED MY PTSD MEDICATION FROM VAMC BECAUSE I WOULD NOT AGREE TO TAPED BY MY PSYCHIATRIST AT VAMC COATESVILLE IN 2013…

    • Doctor, you are very good at spouting the VA propaganda.

      When VA “doctors” start to accurately start to put in the medical record what they claim occurred during the visit, then I will accept your long winded explanation of why this is such a great program. Maybe a better study would be how is it the private sector seems to do so well without big brother looking over a doctors shoulder?

      By the way, the IG reports tell you exactly how they are doing asking screening questions now. In IG report, one after the other, in examining vet’s EHR they find veterans not being screened. Heck, back when you folks were on your smoking kick, In my medical records it states by the doctors notes that she counseled me on cigarette cessation. The only problem was that I haven’t smoked for 20 years and the date the record was created, I was 300 miles away. Do you think I admire that doctor’s integrity or the others who have lied?

      How about just finding competent medical personnel? That is what will make VA care acceptable.

      • Dan, I had a PCP in Sept. 2014 put in my record that I smoked more than the NEVER smoked since then. I asked about it and was told that it is a requirement for them to put something in my record related to smoking. I was very upset about this and demanded that it be removed, an addendum put in, or something. It is still like this to this day, nothing to correct it and no one will do anything about it. I was told that it was not that big of a problem. I think I will start recording my appointments even if I am not allowed to do so. We don’t know if they are recording us so I feel that it is fair game.

    • Saul here, probably ALSO condones lobotomies as a NEW and FRESH treatment for PTSD….it’s no coincidence that you made the mistake of posting here…you could not resist could you? Are you EVEN a Veteran? I imagine you are just checking-in with your LAB RATS on a Veteran Advocacy Site, right?
      You must think we Veterans are really stupid!
      So the VA has George Orwell’s “1984” as now part of their regulation doc’s? Or is the VA simply taking a page from Nazi Germany and how they experimented on their own?
      DO NOT FEED THE TROLLS!

      • If you google this guy you will find so many thing on him. I have put in a couple of links and a PDF that is so full of things that this guy has done. He has 24 pages of “things” he has done. Look at the second link, it has to do with recording Dr’s done by patients and sound very similar to what is put on this blog. I am not sure if he is for the patient. I think he is more concerned about him and after reading the articles and looking at the PDF, it appears that way. This is just my opinion.

        https://www.ihrp.uic.edu/researcher/saul-j-weiner-md

        https://www.usmedicine.com/agencies/department-of-veterans-affairs/outcomes-improved-when-va-physicians-took-veterans-individual-challenges-into-consideration/

        https://www.uic.edu/depts/oaa/search/vppp_candidates/Weiner%20CV.pdf

      • What “Saul” here has actually now confirmed is that the VA MONITORS THIS BLOG…ACTIVELY. I do not want to be someone with their head in the sand but A LOT of times the very subjects posted on this site has actually been determined by my civilian cognitive therapist as NOT GREAT for my severe anxiety and PTSD…however, I realize that informing and even inciting anger is about the only way to start an organized revolution of change to anything and give you kudos Ben, for keeping on keeping on in this chin-deep-$hit the VA reliably keeps dishing out at our expense.

        How is this program even legal? “Saul” claims they have consulted every ethical and legal avenue…BUT I am BETTING they only consulted IN-HOUSE with their own tripe.

      • I found this in the second link that I posted on here earlier. It states that the study was done in the Durham, NC, VAMC and the University of Illinois at Chicago (UIC) as shown below. This would indicate that this is may be more wide spread. By stating another VAMC, it looks as if it is being done and maybe it is being done at the present at many of the VAMC’s across the nation.
        Another note on this is who funded the research. The VA funded this and from what I can find to connect the funding and the research title, it is this one.

        “Intervening to Prevent Contextual Errors in Medical Decision Making” (EDU 08-430). Principal Investigator: Saul Weiner, MD.
        Support 38%.
        Direct Costs: $874,034.
        Source of Funding: Veterans Administration, HSR&D.
        Dates: 2009-2012

        The study conducted by researchers from the Jesse Brown and Edward Hines Jr. VAMCs in the Chicago area, the Durham, NC, VAMC and the University of Illinois at Chicago (UIC), was the largest ever to be conducted using real patients to collect data about their doctors’ behavior using concealed audio recorders. The VA-funded study appeared this spring in the Annals of Internal Medicine

        legal things I am still looking for.

    • Interesting comment. Would these recordings also be allowed to be used by a veteran against the VA? What action would the VA take against a practioner that is found on a recording to be grossly incompetent?
      My privacy was violated when the VA took my personal information, gave it to a VA contractor so they could find and bill my private health insurance for surgery on a service connected injury. The VA claimed I signed a document allowing this, so I sent them a FOIA requesting that. Their response was they could not find that document, but they we’re sure it existed because their employees are thorough.
      In addition, I just received a letter from the VAMC privacy officer with a printout of my recent medical appointment with a few redactions. I wanted the entire record removed because the Nurse Primary Care provider falsified so much of the record. With the minimal redactions, it makes her look competent rather than indicating how incompetent she really is. Her license to practice in this state has no infractions because the VA refuses to hold her accountable.
      As a result of all this, the Chief of Staff called me and wants me to act as his “secret shopper”. I meet with him in a week to discuss that. I wonder if he will offer this secret recording ability.

    • This is a touchy situation i wish they recorded my visits then i could have proved they lied about me. Even if they recorded it does nothing to stop them from writing in the chart that you said or did something you never did. How long do they keep the recording and does the veterans have access to the recording. And is it legal.

  23. BAD NEWS FOR VETERANS!
    Anyone ELSE find it as *shear coincidence* that one of the chief people in charge of this program SUDDENLY just starts POSTING HERE???!
    No coincidence!
    These are HIPPA violations on a GRAND SCALE. This person whom posted below that’s supposedly in charge of this NEW RECORDING PROGRAM does not *get it* that it’s a VIOLATION of PRIVACY!
    With that said though, I recall when I actually used to use the VA for a very short time and upon being questioned/intake by an old female nurse with the DOOR WIDE OPEN, I said I was not comfortable talking about certain chronic health issues with the door wide open and know what she said? “You have absolutely NO PRIVACY at the VA…and she proceeded with a maniacal LAUGH”!! This was back in 2007 or 2008 and not a thing has changed.
    How about instead of a secret taping and video taping of we Veterans, have interpreters for the Dr.’s so Veterans can actually understand WTF they are saying?! That same interpreter would then be able to relay to Dr. what the Veteran says.
    OR…how about not hiring last in their class foreign Dr.’s that the VA WAIVES their entire residency requirement….and I am talking MEDICAL RESIDENCY….not USA citizenship residency?
    This recording and video taping of Veterans is NOT for so-called “improvements”, I guarantee it.
    No, it will indeed be used AGAINST we Vets. I can see it now, when a Dr. comes into the room or even the medical Tech and they ask you how you are doing and if you say, “Fine” as a common conversational reply, I can see the VA using THAT word to take away Veteran’s benefits and even more.
    No, this is horrible that they are even doing this. I CARE NOT TO BE SOME EXPERIMENT AND LAB RAT FOR THE VA.
    Again, I thank God I have Medicare and the choice to NOT use the damn VA, where you are guaranteed of only one thing…incompetence!

      • That’s well and good but the VA ASLO uses such behavior by Veterans complaining about their health/mental issues sometimes or often to label them as “Malingerers”, as have read it all too often from Veteran’s accounts on hadit.com…so it really depends on which idiot you see at the VA and the degree of incompetence that idiot currently is at….they are awarded, after all, with bonuses for being incompetent, right?
        I just never cease to be surprised at the low levels the VA aspires to.

        Here’s how to resolve VA incompetence: Require every member of Congress and Gov’t to use the VAHC’s….will see rats jumping ship en masse so thick you will be able to walk on the very water…or the rat’s bodies.

  24. 03/07/2015

    Dear Benjamin Krause,

    I was stunned when I saw this article–almost a double take—very similar to my new book called “The VA Empire”—-I thought it would be a good idea to get as many of the VA Hospitals on the front cover so people can point and refer to them and interact immediately without even opening the book. Your article does that—very good.

    This Book is for those who wish for a quick read –like the non responsive ones——Basic Facts and Figures, Issues brought up by the Mofo.com Lawsuit in 2007—just maybe they may help.

    Times are a changing and so are the tactics.

    The VA will enter into the digital age.

    Where are the cameras when you need them?

    Sincerely,

    Don Karg

  25. March 7, 2015 at 3:39 pm Dr. Saul stated on here that “this is not a research project but a quality improvement project”. He also claims that “this project is not designed to study Veterans or their care. It is designed entirely to improve their care”. The difference is a play on words. How can you improve something if you do not study and/or research it? If you look at this link it shows that Dr. Saul is a researcher, and according to this link from the UIC, https://www.ihrp.uic.edu/researcher/saul-j-weiner-md, states the following:
    Dr. Weiner, an internist and pediatrician, has a primary research interest in exploring and identifying ways to improve how physicians individualize treatment decisions. He has developed the concept of “contextual errors” to describe medical errors that result from failures to identify or take into account factors in patients’ lives and circumstances that are relevant to their care. He works with actors who present in physician practices as incognito standardized patients to collect comparative data on physician decision making under various conditions.
    Reading this, one should also take note that in the last sentence it states “He works with actors who…” the whole article is interesting.
    A PDF states his accomplishments and nothing in it states if he is a veteran or not. It has many other things that he has done but not a word on being a vet. This is the link for the PDF: https://www.uic.edu/depts/oaa/search/vppp_candidates/Weiner%20CV.pdf. I am not sure what happened to my other post in which I had posted these links.

  26. While dealing with a Doctor at the Albuquerque VA who had lied about what I said, on my second appointment with him I carried my own Sony digital recorder to make sure he couldn’t lie again, and get away with it. He became upset and opened door to the room open and started complaining to anyone who could hear him in the hall. He is very unprofessional and acts like a child. He was later dismissed from this VA. Due to the way this VA flip flops with care and is prone to hyperbole when accusing Veterans who complain about treatment it is not conducive to good health. I underwent 9 hours of shoulder surgery, 2 separate types in fact, and was punched in the same shoulder a few hours after surgery. A Nurse Flak Rankham made two attempts to insert an IV and left the second bent tubing in my arm. I received no Pain treatment in Post-Op after being cut open in 8 different places, got punched in front of another Vietnam Vet and patient. Staff failed to put on the abductor brace to hold my arm across my chest. 3 days later a friend noticed it at my home and attached it giving me quite a bit of relief. The VA demanded $2,500.00 from the insurance of the man who struck my motorcycle, even though they left me in pain and disabled in the shoulder. They staged an Ethics Committee Meeting, a Board of Investigation, but finally had a real Ethics Meeting. They refused to return my money, refused to charge the Aid who punched me in the shoulder even though it was witnessed, and refused me therapy for the shoulder. The Patient Advocate, Dwight, did get Fired for lying and harassment of a Patient. The Regional Counsel who staged the first Ethics Meeting was transferred, and the Director Norme E Browne was caught stealing from the Va Healthcare System and was Fired. He had been directing the nonsense going on against me. The new Director sent me an Apology letter saying it was all the first Director’s fault I was Tortured and abused while being denied surgery for 10 months. She spelled my name wrong, yet on the threatening letters the VA sent me they did manage to spell my name right. The VA Parking Police refused 3 times to charge the Aid who did punch me, but they are in the same Union. The last Officer I tried to get to do something, a Lieutenant, also said he would get even with me if he found out I was making it up. Several weeks after I contacted him he committed suicide in the VA down at the Records Office in the basement where I had been filing all my FOIAs. The VA sent an ex-Cop to my house that morning asking about where I had been earlier, when he shot himself. They assumed I did it, which is a great insult to a Veteran, but they found out it was a suicide, They never apologized for sending the Cop to my home.

    • Dennis your story leaves me with hope that there is justice. what did you do to get them to listen to you. I am in the same boat. and need help. I am sorry that you had to go through what you did go through. You are the 1st success story I read where the V.A. expressed they were wrong and corrected it. it’s easier for someone to admit a mistake and say I am sorry this happened to you, instead of trying different ways to hurt you. It took a strong person to admit a wrong and set the record straight. God Bless

  27. many of us veterans have been to many different VA’s in different states for lets say the past 40 years. i would say it is more common than not that what is written in the medical records by different doctors, in different VAs, different states, is pretty much the same deflection tactics. almost proof that the VA medical employees are trained by VA (legal & management) to do this behavior. minimize any medical complaint. anything in past history, no matter how non-sensical, is linked to “the-cause”, never-mind medical evidence. never-mind that documented injury in the military.

    since when has complaints and constructive criticism ever been listened to at VA from veterans and their caretakers over the YEARS?

    sure some doctors say respectful things to veterans to gain their trust, say they will write what is necessary in their records to help them out, pat them on the shoulder, thank them for their service. yet, then go look at what was written in medical record. that doctor can’t write anything out of the “VA-ordinary-rules” anymore than a veteran can make a complaint that is going to actually be heard. has VA listened to national media? Congress? veteran caretakers? veterans orgs..over the years? if so, we wouldn’t be at this stage with VA today if that were true.

    and now all of a sudden veterans are to believe VA really has veterans’ back with these audio recordings? VA never has before with he-she-says incidents. VA turns its nose up to Congress, to national media, to darn near anyone, much less a little ol audio recording. VA has been recording us for years just like some veterans have been recording office visits. some of them are on youtube. didn’t change squat did it? did VA listen to those audio clips made by those veterans and help the veteran? i don’t think so.

    just saying. and its that part, the part of the deep dark culture of VA that i think will get a team of nefarious psych & legal types to listen to the tapes, extrapolate & twist data to build their model of new nefarious tactics to trick & trip the veterans.

    you don’t need an audio recording, VA & vets have tried that. veterans seriously need a national stand.

  28. my comments are apparently too long to post. 2 paragraphs on this subject and the author of this site doesn’t list a email to write them. I am not a member of google plus your 1st child, facecrook, or twatter and never would be one after reading their horrendous privacy policy.

    Is this a real site to help vets or just one that the VA uses to gain insight to veteran complaints?

    If you are here to help veterans, I would highly suggest you move from a free email service and give us a real address to contact you.

    • If you notice this article is over two months old. You should slow your roll, brother. Ben is a totally disabled vet, a lawyer and he limits his practice to VR&E issues. He posts interesting developments in the VA and a lot of guys here are just letting off steam. If you want free advice get it from hadit.com, or vets.yuku.com.

      • If you noticed, the soldier didn’t disparage the author, his content or convey the time the article was conceived of much less written down to be the focal point of his reply. The entire reply was asking for a standard email for replying instead of being forced to use facebook or twitter.

        If you want free advice,. lol. How about staying on point and helping veterans instead of telling them to slow their roll? That soldier earned his roll, and probably needs help and is frustrated with the lack of it. I for one as a fellow soldier see my brother trying to connect with other brother soldiers and finding what most of us find,… A bunch of hot air,.. no action.

        I love everything being posted here, and enjoy my fellow veterans replies. Keep up the great work. Soldiers and vets read your content, and face the same problems generation-ally.

    • Soldier, this site is indeed a very good site and Ben has helped many, many veterans. If you would look at the upper left part of this site you would see a hand and above the pinky finger there is an envelope. That is the e-mail symbol to contact Ben. It does work as many of us vets can attest to. Sometimes this site has a delay in posting comments. I have had my comments not show up for several hours. It is no big deal, just check back later.
      Hope this helps,
      f8f

  29. Must read! NSA did this for commercial calls, emails, text and it’s illegal. We as Veterans wore a uniform and now we are subject to being recorded with approval by the Veteran. What about our private counseling sessions with counselors or patient advocates?

    In the civilian world you need a court order to access recordings or tapings. If we say something wrong where is our right to legal counsel?

    Frank

    https://www.disabledveterans.org/2015/03/06/secret-recording-program-nationwide-va-medical-care-centers/

  30. I like the idea, and hope it goes viral. One doctor say this, one doctor say that. Some try to know things better than the Veteran do, but the doctor was not there during an event. Doctors try to fake heal Veterans because of symptoms that do not occur at the moment giving doctors a big Pat on the back, while later the Veteran is at home suffering! Doctors also appear to be friendly in cases, but railroad Veterans out of their claims and compensation. All of my doctors have been white, and one Indian.It appeas that they are more pleased to great and talk to their kind( white people). I’m black by the way. Yeah, and most all white people can kiss my ass!

  31. ‘In GOD we Trust’, all others shall be recorded by the veteran just encase. The VA has been awarded sovereign status just as a independent nation. We the veteran alone can do nothing to change this, but together we can. We know the VA will not support the veteran as we don’t pay their ranks, the US Congress does. Once we learn how to effect their pay we can effect their policies against us. Once we can effect the new military signups, we can effect the way Congress treats us. We the veteran need clear concise to the point Websites that educate the young to avoid military service until Congress revokes sovereign immunity for VA employees. If they are doing the right thing, they do not ever need sovereign immunity and will give us the same or better service then the civilian medical community.

    Record every interaction you have with the VA, and keep those records secret. They will help you in Federal court despite anyone telling you contrary advice. Check your ‘State’ laws on secret recording, or one party recording, and consult your local attorney.

    Document every interaction with VA employees and keep detailed dated notes.

    Request all your VA files including the instant message system and secret internal note recording system the VA refuses to disclose. They will refuse saying the notes and emails may contain more then your records and they can’t go through them all. Your continuous FOIA requests that are not fulfilled will be ammo against tyranny.

    Thank you Ben!

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