Veterans Affairs Spins Non-VA Emergency Bill Denials With Local Story
The Department of Veterans Affairs is in a full-court press on spinning veterans’ fears that VA will refuse to pay non-VA emergency bills claiming veterans prefer VA emergency care.
Case in point is a spin article from the Milwaukee Journal Sentinel, in Milwaukee, WI, which is a part of the USA Today Network of news publishers. The article highlights a partnership between a local fire department and Milwaukee VA Medical Center for emergency calls.
West Allis Fire Department sent notices and enrollment forms to 2,000 veterans. The goal of the form was for veterans to elect to be taken to VA instead of the nearest hospital in the event of an emergency. Around 500 veterans responded.
The characters in the story say local veterans bypass calling 911 because they believe the ambulance divert them away from the VA hospital. Rather than be diverted to a non-VA hospital, veterans often fight for emergency care from VA…
Let me say that again.
Veterans allegedly fight for ambulances to bring them to VA for emergency care rather than being diverted to civilian facilities for emergency care.
Does that sound right to you?
Past Diversion Practice
Since the 1980s, Milwaukee area hospitals engaged in the practice of diverting patients to emergency rooms that could handle new patients. Frequently, those ambulances would divert away from VA due to its inability to handle certain emergencies.
As the story goes, veterans were apparently reluctant to call 911, at least according to those being interviewed, due to a preference for VA emergency care.
“They had literally put their loved one in the back seat. Their loved one was dead. They needed CPR. We said, ‘Why didn’t you call 911?’ ” said Ben Thelen, Milwaukee VA Medical Center Emergency Department nurse manager.
“And the family’s response was, ‘Well, he said no matter what happens, even if I’m dead, take me to the VA. Don’t call 911. Just drive me there.’ They took that very literally. That was like the wake-up call.”
According to the article, that veteran arrived dead at the VA hospital.
VA Emergency Care Is Dangerous
The rest of the article is spent highlighting the reasons VA prefer VA care for emergencies over civilian care. Now, as an attorney who works on malpractice cases, I can tell you I would never want VA health care in an emergency or for any other invasive procedure.
I personally prefer seeing staff physicians over receiving care from residents or medical students. It’s a thing. Many veterans say it is quite difficult to see a staff physician at any VA emergency room.
Further, when comparing non-VA to VA care, veterans have more rights and better odds of suing a private care provider over a VA care provider for malpractice. It is something veterans should consider.
Non-VA Emergency Bill Denial Scheme Behind VA Preference
As for the spin article, the author buried the truth at the end of a compound sentence as to why veterans go to VA hospitals in an emergency even if it puts their lives at risk, “and they didn’t want to worry about possibly getting socked with hefty bills.”
Most veterans I know would avoid VA in an emergency, but they are petrified VA will engage in its well known fraudulent practice of denying non-VA emergency room bills.
RELATED: Press Gets Award For Exposing VA ER Billing Scheme
I exposed this scandal to AJ Lagoe at Kare 11 News two years ago after my own personal emergency that ended with my own bill being denied incorrectly. The matter ended up before the House Committee on Veterans Affairs and on the television of Americans nationwide.
That narrative is running last week and this week concerning a lawsuit related to non-VA emergency billing problems, so it seems no surprise VA is coming at this from all angles with its propaganda disguised as news.
RELATED: Lawsuit – VA Misleads Vets On Non-VA Emergency Care
All Veterans In The VA System
The rest of the article builds up to the new goal of this full-court press, “The goal is to eventually have all veterans in the VA system…”
Let me say that again, “all veterans in the VA system…”
Do we all want to be in the VA system? Shouldn’t someone ask us?
According to the article, the verdict is already in. Veterans would avoid ambulances and instead would drive themselves to the VA emergency room because they love VA care:
- Veterans “feel more comfortable at the Milwaukee VA”
- Veterans prefer VA because “they have a bond with their caregivers”
- Health care is less expensive at VA
- Veterans like VA because their records “are easily accessible”
I understand the first and third reason for some veterans. The second reason seems like spin since veterans will likely never receive care from their normal “caregiver” when seeking emergency care in any system. As for records, receiving records from VA is not any easier than a civilian facility.
Is The Program Dangerous?
On the surface, this article is about opting for VA care in an emergency even if it is further away than the nearest emergency room. This, in my mind, sounds like a horrible plan that puts emotional sentiment ahead of medical decisionmaking at the time of an emergency.
The program and the spin in the article seems at least tangentially aimed at increasing enrollment by pushing more veterans in the VA health system at a time when policymakers are pushing the same to prevent suicide.
Part Of Suicide Prevention Program
VA repeatedly notes 14 of the 20 veterans who commit suicide every day are not in the VA system as a call for more funding to do more outreach to veterans to push those veterans into the VA system.
Based on VA logic, suicide will go down if all veterans are “in the VA system…” Of course, the logic is obviously flawed, and anyone with a basic handle on math can figure it out.
Most veterans are not disabled and not in the VA system. Last I checked, America has 22 million veterans and 7 million of those are in the VA system. Around one-third receive VA health care.
If you look at the suicide numbers, around one-third of the suicides are by veterans in the VA system. That seems consistent with the overall numbers.
But the second fly in the ointment is that these 6 veterans that are in the system commit suicide anyway. So, what makes VA policymakers so sure that paying $50 million per year on suicide prevention advertisements and public relations will make a dent?
Perhaps the push has more to do with increased spending for the vendors providing the services to the government than preventing suicide?
Ready To Enroll?
The article ends by encouraging readers to “enroll in the program” by contacting “Ben Thelen” at the local Milwaukee VA. (414) 384-2000, ext. 43924.
Some of you interested in what is going on should call to see what Ben has to say and report back with your findings.
I realize this is not the most overt public relations I have highlighted recently, but it came out on the back of an article about the Staab lawsuit over the agency’s non-VA emergency room billing scheme and other unusual press about VA suicide prevention tactics that board on veterans stalking.
Ive paid ambulance bills….ER bills…..and still have medical bills on my credit report that the VA refuses to pay…I am 100% service connected, disabled, unemployable….I have chosen to borrow the money to see a civilian doctor to help me with my chronic pain and anxiety disorders. The last time I took myself to the VA emergency room for my severe panic attacks…they locked me up against my will on the statement that I was suicidal///they WANTED me to commit suicide….I will never again enter a VAMC….I PRAY EVERYDAY THAT SOMETHING WILL IMPROVE FOR US VETERANS….I PRAY FOR ALL OF US!!!
Dear Benjamin Krause,
“Veterans allegedly fight for ambulances to bring them to VA for emergency care rather than being diverted to civilian facilities for emergency care. Does that sound right to you?”
It sound like Wilkie, McDonald, and Shulkin are in the room with Peake and Principi called creative writing.
I went to VA for a broken leg, single, no dependents, no family at home, 2 operations, 1st one with implants that were used, infected, mrsa, 3 months in long term care ward contaminated with mrsa and I am screaming for help, 2nd operation to remove the implants and debride the mrsa affected tissue on hurricane harvey night in houston, 2 weeks after the operation, bones not healed, I walk out of VA for my own safety and 4 arrests later due to the animus by staff due to my chronic complaints a 3rd is needed to correct the misaligned bones. VA ER care is substandard. So is the surgical departments. They just do not wanna know. I met good dr’s and bad mean evil bastards. the evil bastards are in control and go out of their way to insure your care is a failure. The Good Dr’s are the only reason ur not dead.
Vietnam former Acting Cmd Sgt Major………rank don’t mean shit at VA or anywhere else anymore.
Also doesn’t count the people who had pain medication taken away so bought on the street becoming a burden on his family and ODs because he was an addict. I wish to God I never moved, great care for 20yrs and I get to see hell every day. That wasn’t bad enough, changed my records and called up the VA to report AOK, now fighting for benefits had for 20yrs. People are evil, was collecting IU for 7yrs and protected ratings with injuries impossible to get better. So they increased my mental health to 100% and reduced my orthopedic ratings had over 10 years and impossible to get better. A year later they sent a letter, my mental health was secondary to my orthopedic problems and now they are better my mental health has to be rated against the 20% left of orthopedic problems. So of course want to reduce mental health because can’t be 100% secondary for 20% rating. People are insane and never thought possible people would actually feel better if someone passed, they win their sick game when someone dies. The have “Teams” that watch veterans on every social media site and reading you life everyday. Doesn’t matter if use different names or cover up, they will use your friends and watch from there. These are the worst people ever heard of and I know only a sliver of that dump.
This comment made by Mr. Benjamin Krause, “So, what makes VA policymakers so sure that paying $50 million per year on suicide prevention advertisements and public relations will make a dent?
Perhaps the push has more to do with increased spending for the vendors providing the services to the government than preventing suicide?” Spot on!
As a result of being one-day from death due to PA care instead of the PCP, I had been admitted to Non-VA ER at least 5 times and have never had an issue with my non-VA ER visits being paid by VA. I guess I was one of the lucky veterans.
However I have had issues with the wait times which is another reason why I nearly died, and with not being able to use Veterans Choice option due to not being provided a referral to a non-VA provider. Dental and Mental Health care are even worse than the medical. For some VA physicians the VAMC is just an easy and lucrative means of livelihood. The physicians get a six-digit income for part-time work and keep their private practice while not giving a damn about veterans. Veterans are a captive audience by a corrupt medical care system and the physician’s could care less as they get paid the same regardless of how many veterans they are forced to see. Annnnnd apparently due to the AFGE , they have no fear of losing their jobs.
So where is the incentive for the VAMC personnel to GAF? Whooa, I’m exhausted, enough said.
Buffalo va has to be among one of the worst I dont even want to go, I already informed my doctors I rather suffer and die at home. And I went and got Medicare just to end up canceling it months later because they are just as incompetent. I requested my free welcome to Medicare visit to search for a decent local doc since the buffalo va is is approx 45 minute drive n full of morons, and the civilian clinic just ended up trying to scam me, keep making appointments for supposed records review but at my last visit doctor said I have to reschedule AGAIN so she has enough time to red my records and this would make it 3 visits in 6 full months to just read my records and hundreds of dollars for supposed new patient visits and detailed (bs) exams that are anything but detailed, more like waste of time + Medicare membership fees = thousands of dollars wasted on yet another government health scam. All I wanted was my welcome to Medicare visit because it was supposed to be free and I got bills for bull**** instead. So now back at the va I find out these idiots dont want to take the time out to read through my records either and they been prescribing me meds they just admitted I’m not supposed to take so wtf. My last va er visit was a joke, supposedly I broke some ribs from having a bad cough for weeks so they decide to give me some bogus meds that dont do anything for the pain and they want me to go back in to take more xrays for what though because they dont do anything for broken ribs and they dont prescribe any meds that help if anything they’ll prescribe the wrong meds so I’m getting nowhere. I’m 35 I was eating healthy and exercising before i got sick and they let me stay with infection too long now i have vision problems and my list of symptoms is just growing I’m in constant pain, lethargic, my infections have turned into a chronic problem and the best option I have is to just tough it out at home
if you need her help you can reach him on [email protected] com, for any thing on relationship or anything you can think of for she is very powerful and so real…..??
I ask all veterans that use the VA system to call any VA Facility that provides medical services and closely listen to the first announcement you hear on the introduction from the VA. “If this is a medical emergency hang-up and dial 911”. Certainly the Esteemed Lawyer that produces this site and articled Mr. Benjamin Krause, ESQ is aware and has pointed to this fact many times. The VA does not want to be legally responsible for any associated deaths because a veteran did not go to the nearest emergency medical facility. The VA wants you to go to the nearest emergency facility because it increases their chances to avoid any coast associated with that visit do to the policies established in their Non VA Emergent Care Policies.
Contrary to popular belief if you call 911 in most states you will be taken to the closest emergency room available by state law (Mr. Krause, ESQ can attest to this). However by Law this does not dissolve the VA of their Legal Responsibility as also pointed out by Mr. Krause. Under VA Law when a patient is presented to a Emergency Room the treating physician and the attending hospital is required to notify the VA of their veterans admittance, the current course of treatment and when it is expected that the patient is stable enough to be transferred to the VA. The law clearly states that the attending physician “Not the VA” determines when the Veteran Patient is stable enough to transfer. In the case of Mr. Krause he reported to a emergency room with suspected Heart Attack symptoms, and any prudent lay person would logically decide to go to the nearest emergency medical facility. Now remember what the VA states on all of their Telecommunication’s systems “If this is a Medical Emergency hang up and Dial 911” and when you do that be aware that most state laws forbid Emergency Responders to divert from the Closest Emergency Room unless directed by that facility that they cannot take the patient for a legal reason. When a facility cannot accommodate a patients injuries most state laws mandate the emergency personnel proceed to the next emergency room available. The VA would and will in most cases be the farthest facility, and the VA has a record of turning emergency cases away to the closest Civilian Trama Center. In fact in recent cases that have been reported by Mr. Krause the VA diverted Veterans to Civilian Trama Centers when they had the capability which resulted in the Veterans Death. Due to the continued VA manipulation of the Non-VA Emergent Care Law passed by Congress, Veterans will continue to be at risk for both health and financial stability unless the legal system, congress, and the President step in to end the crisis. It might only be resolved by the numerous class action suits being filed. It is obvious that the VA shows a willingness to violate the US Circuit Court of Appeals for Veterans Claims, until such time as the Federal Court of Appeals or the Supreme Court takes action, on Congress and the President stop the criminal activities of the VA.
How come don’t no Veteran how come Veteran Medical Care Doctor can’t email his Senators or Representative his belief how improve Veterans Health Care.
Blow away, will ya?
Star are you Veteran do you believe a Veteran Medical Center Doctor even they have the right email their own Senators and Representative their own belief how improve Veterans Health Care…….be a Veteran and not Pew Wee
When is the VA system REALLY going to work for the 21st Century Veteran?
Waiting long enough you ruthless mother fucking ass-kissers.
Trump needs to implement micro-managing into VA to reduce neglugence & to help eliminate waste.
VA is a Monster that creates its own Cesspool. That’s why it will always need cleanings (Audits).
Any statement regarding the v.a. reducing wait times is goddamm lie! I ‘ve been waiting 4 months for opthamology, 6 months for rheumotology just to mention a few. Theft of travel funds, failure to pay emergency treatment, failure to pay authorized community care. No doctors, no nurses, death lists, on and on. The v.a. is responsible for v.a. suicides along with the politicians that send us to fight and due in wars based on their lies!
Suicide va enrolled. It would be interesting if someone would be able to determine if these veterans who have committed suicide.
Were new in the beginning of their treatment for mental health issues. I believe this is a very trying time.
These veterans at the beginning are given some very strong drug’s. The body and mind experience a massive change, it’s seems to be a trial and error period.
Ok, we will try this or try that. Some of these drugs will make the veterans start hearing voices and other behaviors they do not understand and more than likely drove them over the edge.
What the hell is happening to me ! You are not you, bouncing off walls. Paranoid. Can’t stay awake.
Some have their medicine stopped cold Turkey. Again, the body rebels and the veterans again, says what the hell is going on, I can’t take this anymore.
No one is listening to me, they don’t care. Why are they doing this to me. What the hell did they give me.
Then you have those employees who will use these actions against the veterans, when they act up or out and call the va police and then kick the veterans out !
You have been reported as being disruptive and now you will be punished for acting up or out.
The va fed these cocktails and when they give the veterans a bad reaction, they the va blames the veterans and not the provider or the medications.
When this happens ! They are telling the veterans, tell someone who gives a shit, you Faker, you milinger.
We will teach you, to act up. Go ahead and kill yourself, one less ass hole to deal with.
Spot on…. @James gallegos
Very well said !
Don’t use VAMC’s, too easy to kill veterans there and get away with it. I honestly believe I will feel better and live longer the more I don’t use them. Use at your own risk…
I am a 100% Disabled Veteran, service connected. My back locked-up in November of 2018. I was going to the Prescott, AZ VA and they do not have an ambulance. So I called the local one and they transported me to the local hospital since the Prescott VA has neither an ambulance nor a fully staffed emergency room. I was billed over $1500.00 by the ambulance co. and the VA refused to pay. Eventually the ambulance co. just wrote this off or I would have had to pay.
I now refuse to go to the Prescott VA. They did an illegal Disruptive Patient Committee in secret against me without my knowledge or right to attend the meeting or defend myself. This was do because I called the White House VA Hot line Trump set-up for veterans. Now I have found out only a small number of people are involved in that so it is worthless. Trump screwed us again. They should close the VA Hospitals and send us to real doctors in the community.
I can understand the author’s concern about not having serious emergency care at the VA, but most veterans do not want to run up a bill to a civilian hospital for several reasons. In a true emergency, the closest emergency room is always the wise choice. One can be transferred after being stabilized. My experience with residents has been favorable and often better than with the staff, because often the staff at the VA are not on the cutting edge in which the residents are during most of their rotations. Yet, the staff does have the overwatch of residents and students. My main concern is a financial one. Because I now have Medicare, if I am not seen at a VA, it becomes responsible for my billing and leaves me owning a great deal more than if cared for at the VA.
The issue of most of the completed suicides being within the VA system is no surprise considering that those who complete suicide within the VA system usually require more complex care than their peers in civilian care. Also, they have a much more complex system to navigate within VA! However, the Mental Health Care I have received with the North Texas VA in Dallas has been world class level. I have been hospitalized by the VA for an attempted suicide and although the six week hospitalization in the North Little Rock VA, it was in Dallas where the majority of the outpatient care was in Dallas. NLR got me started on the right path, but Dallas got me straightened out after I almost “fell off the wagon.”
There are so many that need to know where to go to find out. I find most of the employees being very concerned about my personal well-being. It is getting around the others that is difficult.
Although I haven´t researched the VA M-21 to see if VA has implemented an actual policy for handling emergency care at a non-VA hospital, in recent years there has been a shift at the RO here. Prior to the shift, any Veteran who went to a non-VA emergency room for care ran up against the VA denying payment to the hospital for the service(s), which left the Veteran in a precarious situation, when s/he received a bill directly from the hospital. Many Veterans here hand-waved it away with the idea the VA would get around to paying it. Unfortunately, non-VA hospitals are notorious for pursuing billing issues promptly through collection, etc., which then left the Veteran in a situation reminding me of Gene Wilder, in Young Frankenstein, yelling ¨ITŚ ALIVE!
The cure to this dilemma is the VA RO Patient Advocate, and a copy of the Emergency Room Doctor´s medical note, which can be retrieved by the Veteran, or representative, from the hospital medical records office, usually in person. The VA policy has been, and still may be, a Veteran had to, or has to, contact the VA ON-CALL Advice Nurse in order to receive prior authorization for the non-VA hospital emergency room visit. However, considering most Veterans are not acutely aware of the responsibility of contacting the Advice Nurse in the moment of need for the emergency room visit, a post visit phone contact with the VA Regional Office Patient Advocate explaining the ER situation, coupled with a copy of the ER Doctor´s note – indicating the visit resulted in a need for emergency care (this is key) – which then can be forwarded to the Patient Advocate, will usually head off any credit reporting by the non-VA hospital, provided the Veteran does not ¨sit on his/her rights¨ as attorneys view it, and has been diligent in attempting to correct the situation.
Realizing the above is not a big fix to the problem, the approach over the years in application has resulted in favorable outcomes for Veterans here.
Y’all are not going to believe what occurred this morning at my small VHA healthcare clinic.
Originally, my PCP wanted to see me in March for a second follow-up of my hospital stay in late November.
In late December, a scheduler called and informed me March was not possible. Neither would February be possible. So, he made an appointment for this Thursday, Jan 31, 2019. And “lab” would be today or last week sometime.
Now, in the past week it gets interesting. All of a sudden, my wife received a phone call from a scheduler wanting to know why I’m scheduled for this Friday. She said, why ask me, ask the doctor!
Today, I go to lab. There’s no consult for lab work. So the lab tech tries to find out why!
Then, all of a sudden I’ve got VHA employees asking me “Why does the doctor want to see you?” My response is; *”Ask the doctor!”*
To make this a short story –
I now have an appointment set for May, 2019 with lab work to be done March 12, 2019! Why they didn’t keep my original PCP appointment in March is why I now would rather use private healthcare!
Yeh, you Doctor thought he was in private care. He wanted to see his appointment early by working late until his vacation schedule. But that would put him in the potential of running amuck of the computer bonus system for the Director. He would have patients scheduled for AM working through lunch and PM working late. But the computer schedule would have him seeing patients more than 15 minutes late in his override appointments. One of the bugs the computer guys have to work out. Some doctors want to spend more time with their patients and run behind. They get shoved out of the system when they would be willing to spend a couple of extra hours on duty but that would cut into the Director’s bonus.
So drop a slip in the Directors comment box and explain the situation. That PC could schedule overrides that also would override the bonus counting program and show visits as scheduled during lunch hour and after time clock out.
Screw those dancing monkeys, Crazy elf. That Dr. likely had something WAY more important to attend like an AFGE huddle to establish food banks at all VA’s for poor gov’t employees affected by gov’t shutdowns. (Just saw on news a VA employee interviewed claiming they almost went bankrupt, losing home, cars, et al….FUCK THEM…NEVER was their such coverage about Veterans killing themselves with no compensation pay and nobody cared, when we recently would be affected by shutdowns….WHY was that VA employee on news acting so destitute? I thought the Gov’t Welfare Works Program at the VA went uninterrupted. Maybe I was wrong or maybe just the contracted vending machine restocking folk were what affected those poor AFGE VA employees on news a bit ago???!!!
Damn! I missed the sigh of relief of all that industrial weight testing color changing furniture at the VA gave when there was 30+ days less of fat ass occupying them!!
In reality I don’t believe anyone (nurses or schedulers or anyone) actually talked with my PCP. Because, why would they continue to ask: “Why does she want to see you so soon!”
I believe this was nothing more than a “scheduling scam” so this small clinic can stay open!
I also believe there’s a strong push to privatize the VHA Healthcare System!
I wouldn’t sign up for VA ER here because it is an 81 mile drive and I like the local ER’s response to my previous visits. But in LA, DC, San Diego, Sheridan and some other places I’ve been, the VA ER is clearly superior to anything else in the area. Possibly DC Georgetown would be better if you were closer or NIH–Bethesda. So the form should be prioritized by location. In LA I’d rather spend an extra 5 minutes in the ambulance to get to the West LA VA than other place including UCLA or Cedar Sinai by their reputation. UCLA is only 1 minute difference.
So a rational pick needs to be made. Denver VA ER would not be a first choice over Colorado Medical Center but they are on the same campus and you’d have to not indicate you are a vet to get to the Colorado Medical Center ER since the opening of the new VA Medical Center. In another year or two there probably won’t be much difference at Denver.
No in the va system ?. How many would be enrolled, but were denied their deserved disability claims and therefore in the appeals process.
It’s been reported 300 thousand veterans died before receiving treatment and now over 400 thousand are in the same boat.
Is the va doing this on purpose, knowing veterans will die. Why were there over 700 thousand claims with errors.
Is it being done on purpose. Who is keeping track of veterans who die and have been refused treatment, because of their disability claims denied and or in appeals.
I’m still paying for a hospital stay, (Nov. 28 – 30, 2018), the VA is responsible for.
I may be ahead of myself, as my VA OIG investigation case is still in APPEALS window, but correspondence and my gut feeling says to add:
Just saying. Standby…. cuz I’m not stopping @ OIG.
Yeah, I should have added lots more as well!
Veterans who read this can you please tell me how come Veteran Medical Center Providers can’t email own Senators and Representative to share their beliefs how improve Veterans Health Care?
I am a former care provider and I did this and it ruined my VA career. I have been fucked with beyond all measure and they have essentially gotten away with it.
You all have no idea how bad the VA care is. I know some of you have had good results and like your care, but you are i the minority. VA care is in no way on par with modern care and service standards. When you go to any VA you are essentially a type of living cadaver for medical students and residents. The care is so bad at the VA I have put in my living will to never put me in care of the VA. If I am ever forced to to be put in the care of the VA I have elected to commit suicide instead.
RAND Corp. Reports: *Most* Veterans don’t mind the leeches at the VA or the leeches used as medicine in VA emergency rooms. *Most* Veterans don’t mind the shit conditions of world class third world medicine and the uncooked chicken really isn’t that bad with a side of operating room flies.
Lastly, *most* Veterans don’t mind spinning the gambling wheel and drinking from a VA drinking fountain near an ER where you may just get lucky and all this BS will end with the VA denying the Legionnaire’s Disease from pinching pennies to pad those performance bonuses….oh, and if all that doesn’t do the trick, the non- sterilized medical equipment will bring you back with sepsis in no time.
Rand Corp. Reports Veterans are FED-UP with the AFGE Infection at the VA!!!!!!!!!!!!!!!!!!!!!
VERY WELL STATED!!
Well stated, The Va is practicing as much as they can with PAs instead of real doctors, Jump into a cesspool if you need emergency care, if you have no other alternative than to go to VA emergency rooms And by the Way, FIRE THE INCOMPETENT VA OFFICIALS WHO PRODUCED THAT ARTICLE.
News for you. All clinics, including private ones, use PAs and NPs. You won’t escape them by going private especially those of us that can’t afford “Cadillac policies”
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