By Mark Gutglueck
A local Navy veteran has gone public with complaints that staff members at the Loma Linda Veterans Administration Hospital have been both neglectful and unresponsive in rendering her needed medical care and assistance.
Phyllis J. Seleska, who is now 66, served in the U.S. Navy for more than twenty years, after enlisting at the age of 35 in 1986. She was a veteran of both Operation Desert Storm and Enduring Freedom, with multiple war zone deployments. Consequent to her service, she suffers from post traumatic stress disorder, and her rating has made her eligible for 100 percent of her physical and mental health issues being covered under the Veterans Health Care System for life.
More than fourteen months ago, on August 6. 2017, Seleska slipped on wet concrete at her home, injuring her arm and hand. Despite the pain and swelling, owing to the lateness of the hour on a Sunday night, she elected to wait until the following day to go to the hospital. She splinted her wrist in an effort to immobilize her hand and hold the swelling in check.
She went to the emergency room at the Jerry L. Pettis Veterans Medical Center the following morning. Upon attempting to check in, she was rebuked by the desk clerk for having splinted her wrist. Thereafter she encountered a several hour delay before she was taken in to the radiology department for an x-ray. When the splint was removed for the x-ray, swelling was immediate. Thereafter, she was returned to the emergency waiting room. Seleska’s entreaties for attention were rebuffed with statements from hospital staff that patients with chest pains and shortness of breath had to be given a higher priority and that she would “just have to wait.” Meanwhile her wrist continued to swell over the hours, growing increasingly painful.
Some 14 hours after she had arrived at the hospital, at 11:30 pm, she was seen and treated by Dr. Willard Gilbert. His first reaction, according to Seleska, was “Oh my God! Had someone shown me these x-rays, I would have had you off to orthopedics hours ago. You’ve done a number on your wrist; it’s broken in three places. That’s got to be unbelievably painful!” Seleska was immediately administered a pain shot and a soft splint was installed, with orders to report to orthopedics the next day.
Seleska checked into orthopedics on August 8, 2017, just prior to her 9 a.m. appointment time. Following a two hour wait, she was ushered into a treatment room where, she said, “two impressively large attendants” undertook to set her wrist, doing so without administering any pain medication. The setting procedure took place while she was lying on a table, taking place in two ten minute installments punctuated by a short break. Seleska described this as an “excruciatingly painful process,” followed by the installation of a cast splint. That ordeal over, Seleska next dealt with the hospital’s front desk personnel to book a follow-up appointment. While doing so she was chastised for the “very loud ruckus” she had raised while her wrist was being set.
On August 16, 2017 a follow up x-ray confirmed a good set, and three more rolls of cast material were put on over the cast splint, ranging from Seleska’s fingertips to her shoulder, with most of the 8 pounds, 4 ounce weight and bulk of the cast in the area around her elbow area.
Being outfitted with the cast caused her right shoulder to hurt, Seleska said, but she chalked that up to lugging the heavy cast around for six weeks. The cast came off on September 19, 2017, at which point she was advised her wrist would take another year to fully heal. She was offered no rehab.
During an appointment to the orthopedics unit of the Loma Linda VA Hospital on March 29, 2018, Seleska informed the doctor who saw her of the discomfort she was experiencing in her right shoulder among other health issues. She was told, she said, to, “Pick your priority. I’m only allowed to write just one referral at a time.” Seleska at that point could no longer lift her right arm over her head, and was experiencing significant weakness and pain in that arm. She was referred to orthopedics and physical therapy, but was delayed in getting an orthopedics appointment until May 16. Previously she had inquired about the Veteran Administration’s Choice Program, by which she could potentially obtain treatment by a specialist outside the Veteran Administration (VA) system, but was told that difficulty would ensue in getting information relating to her treatment into her permanent record if she obtained treatment outside of the hospital. At the May 16 appointment, she received a thorough examination, during which the examining physician made observation of what he believed was a likely rotator cuff tear with other issues. Magnetic resonance imaging [MRI] offered the best means by which to determine the precise nature of Seleska’s problem, the doctor said. Nevertheless, the doctor told Seleska that a “new management team” was in place and that he was not allowed to request MRIs because, Seleska said the doctor informed her, “I guess we’re asking for too many of them. They’re about $3,000 a piece, so even though I think it will probably not help, they’re making us send patients to physical therapy for six weeks, 12 visits, with daily non-steroidal anti-inflammatory drug treatment. Just go and do what you can and when you come back, we’ll take care of it.”
At a May 31 appointment with the physical therapy department at the Veterans Ambulatory Care Center, Seleska said she encountered a therapist who told her, “You’re over 55, and unless you are an athlete or paid to use your body in some way, you should just learn to live with it, deal with it and suck it up.” She was told she could not be seen. She responded, she said, with “But I’m here. Why can’t you see me?” The response, she said, was, “We can’t see you.”
According to Seleska, she faithfully drove twice a week from her home in North San Bernardino to Redlands, the location of the ProCare Physical Therapy clinic, to which she had been referred. There, she engaged in exercises that were intended to improve her range of motion but which did not have that outcome and instead exacerbated her condition.
On July 17, a doctor in the VA Hospital’s orthopedics department conducted a rigorous examination of Seleska’s shoulder which included rotating her shoulder beyond the existing “pain points… to see how far you can really go,” Seleska quoted the doctor as saying, with another deep poke on the deltoid tear. “I’d say you’re going to need surgery, you’ve got a tear and underlying symptoms,” Seleska said the doctor told her. “You definitely need an MRI.”
On August 2, 2018, Seleska was given an MRI. On September 5, she learned through her mental health provider results of recent blood work she had done. That blood work showed a drop in her kidneys’ estimated glomerular filtration rate, as well as an indication that her daily use of non-steroidal anti-inflamatory drugs had resulted in severe narrowing of her lower esophagus, which was causing her to have difficulty swallowing. According to Seleska, her mental health provider advised her that remaining under the care of the VA Hospital was inadvisable.
On September 6, 2018, Seleska waited over an hour-and-a-half beyond her orthopedic appointment time. A resident who saw her initially advised her that “everyone over the age of 55 has some kind of rotator cuff tear,” telling her he didn’t see that much wrong, saying “It’s just a very small tear.” When Seleska pointed out that notation on her MRI report indicated “attention needed,” and that she had been experiencing significant pain and range of motion limitations, the resident conferred with an experienced doctor who made a more thorough evaluation of the MRI. Some 20 minutes later, the resident returned with an entirely different outlook and prognosis, saying, Seleska said, “You need surgery! There’s a lot more wrong than just the tear, including a deltoid tear, likely bursitis, and other conditions.” Seleska was told that in order to be eligible for surgery, she had to submit to a lidocaine/steroid injection into her right shoulder and if, over the course of two weeks that gave some relief, she was to return to see about getting onto the surgical schedule.
Seleska questioned why the evaluation of the outcome of the lidocaine/steroid injection would require a two week delay given that the effectiveness of that protocol could be ascertained within 20 minutes of the injection, and she noted that based on her prior experience it would not be likely she could obtain a return appointment in two weeks, given the degree to which the hospital’s appointment schedule was so densely booked. The resident insisted that the lidocaine/steroid injection was mandatory before any discussion of surgery could take place and that a two week delay in the evaluation of the effectiveness was standard procedure in the VA Hospital. The resident told her, she said, “Don’t worry about” the return appointment, since he would “put it in your record” that she was to be seen some 14 days hence. When the resident sought to inject the solution he had prepared into her rotator cuff, Seleska stopped him, insisting that he first provide her with a topical pain attenuator, which he did.
When Seleska attempted to schedule her follow-up appointment for the evaluation of the effectiveness of the injection, she was told there were no appointment openings available in two weeks. She advised the appointment clerk that she should check with the resident who had just injected her with the steroid/lidocaine concoction to confirm that her appointment was needed two weeks later. The clerk maintained that she was not permitted to make direct contact with physicians. Seleska then sought access to a patient advocate, but the clerk demurred, though at last Seleska was able to secure an appointment two weeks out. Nevertheless, according to Seleska, her concern that care for her shoulder was going to be drawn out has since been confirmed.
On September 18 she was seen in the orthopedics division, more than an hour after her appointment time, by Brian Tabatha, a physician assistant. She reported that the injection had worked. In going over a battery of pre-surgical questions, Tabatha asked if Seleska smoked. Seleska acknowledged smoking cigars. Tabatha said that for the surgery to proceed Seleska would need to “test nicotine-free for 60 consecutive days before we can consider you for surgery.” This was, Tabatha said, “departmental policy.” Upon Seleska’s request to see the policy in writing and speak with a patient advocate, Tabatha left and returned with Dr. Hasan Syed, a shoulder specialist within the orthopedics division. In response to Seleska’s request to see the draft of the departmental policy relating to not initiating surgery while a patient is yet using tobacco, Dr. Syed told Seleska it was his “personal preference that surgery patients be at least 30 days nicotine free.” Syed emphasized, Seleska said, that “smoking attacks rotator cuffs. I cannot believe that you were not told about this and the direct dangers of smoking related to rotator cuff injuries and the overwhelming chance of infection. That’s why you’ve injured both shoulders!” Seleska countered that she smoked cigars but did not inhale. In response, Syed had Tabatha provide Seleska with two non-VA studies, both of which stated, “Smoking may increase the risk of rotator cuff tears, which could consequently increase the need for surgical interventions.”
Thereafter ensued a testy exchange between Syed and Seleska over a shoulder surgery she underwent in 1993 while she was smoking two packs of cigarettes daily. She readily recovered from that surgery, Seleska said, adding that she underwent a back surgery in 2005 after quitting cigarettes. “I recovered without infection or nicotine related issues,” Seleska insisted. She said she told Syed of that operation. She said Dr. Syed retorted, “Are you denying the dangers of smoking? All of your injuries have been caused as a direct result of smoking! You don’t dictate to me what protocol I use to treat patients!”
When Seleska requested a patient advocate thereafter, she was not provided with one, although Tabatha told her that the patient advocate office was on the first floor. Seleska went to the patient advocate’s office, but it was after 4:30 pm, at which time patient advocates are not available.
Seleska insists that Dr. Syed’s size-up of the causes for her previous injuries were in error, as her 1993 left shoulder injury came about as the result of an injury sustained during a time of war at Diego Garcia, an island in the Indian Ocean at which the United States has an extensive military presence, where she was lifting 225 pound APS-115 radar sets up and down the ladder of P-3 Orion aircraft. She said her later back surgery was necessitated by injuries sustained during deck operations immediately after the Navy’s September 11, 2001 first strike operations while she was aboard aircraft carrier USS Carl Vinson, and that the injury to her right shoulder was wholly due to her slip last year onto her concrete pool deck.
Seleska has not been able to get the surgery on her right shoulder, and she believes the Veterans Administration and its healthcare system have skipped out on the responsibility to provide her with needed medical treatment. She said, “I was walked out on by an over-the-top, extremely aggressive doctor, who left me with absolutely no plan for future health care for my shoulder. I was egregiously bullied by Dr. Syed, and since have suffered varying degrees of post traumatic stress that now require additional medication never before necessary. I acknowledge that tobacco is not healthy, but neither was more than 20 years of exposure to magnesium, beryllium, asbestos, high powered ship’s radar radiation, JP-5 jet fuel, hydraulic fluid, deafening decibels of noise and the daily requirement of hazardous materials handling and usage. Let’s also not forget the ‘no choice’ anthrax shot series I was subjected to, all while in service, on the job.”
Seleska said she believed that Dr. Syed had wrongfully deprived her of the surgery she should have access to because her continued use of tobacco violated his “personal moral compass.”
Seleska continued, “For over a year now, I’ve had limited use of my right arm and significant pain. This is just me, just one particular evolution within an 8 year span. How many veterans are denied procedures or treatment because they smoke or because of some other fabricated ‘policy?’” she asked. “How many veterans don’t return to this health care system due to unreasonable, unacceptable, unnecessary delays, being made to unduly endure pain and disability? How many veterans have had their surgeries or treatments cancelled at the last minute because they tested ‘positive’ on a nicotine test?”
The doctors she has encountered at the Jerry L. Pettis Veterans Hospital in Loma Linda have varying attitudes, Seleska said. “I’ve met them all, from doctors that tell me they believe that ‘a patient should not have to endure/be in pain for any reason,’ to ones who say, ‘Suck it up. You’re getting old, learn to live with it…deal.’” She said some providers told her that if she wanted any pain medication, she would have to submit to a urinalysis program. Yet other providers have simply provided her with the pain medication upon request, she said.
Seleska said, “This particular health care system is being run by a new ‘management team,’ with a ‘one size fits all’ treatment matrix. Doctors’ requests for patients’ treatments are routinely denied or the doctors are just not authorized. You have to ‘request this and that and then that’ before you can get to what you actually need. The pharmacy has authority to override doctors’ prescription requests. A case in point is I used to receive lidoderm (lidocaine patch 5%). It’s easy to open, easy to put on, but most importantly, it works. Currently, I can only get a topical anesthetic cream (lidocaine 4%), 30 grams at a time, with a child proof cap that I am unable to open. I’ve been diagnosed with carpel tunnel in both wrists, but was told they just weren’t serious enough for surgery. Now, both hands are swollen to the point that I am unable to make a fist with either hand without pain and have developed ‘trigger’ finger in my dominant hand. My provider searched her screen and said, ‘I would have to prescribe this, this, and then that before we can get to the patch. I have no control over that.’ So what good is this product to me if I can’t open it?”
On October 3, Seleska was informed by Orthopedics Case Manager Sherri Miranda, a registered nurse, that Dr. Syed and Dr. Barry Watkins conferred and decided her condition was “not serious enough for surgery and surgery was not medically necessary.” This decision was made, Seleska said, “after every other doctor stated that I need surgery.” Seleska said she was told by some Veterans Administration Hospital orthopedics department personnel that “the ‘no surgery’ decision was made due to my behavior.” She said that Miranda wanted to book a follow-up appointment for four to five months in the future to see if surgery may be required in another six months or so. Seleska said she advised Miranda that she was unwilling to return to the Loma Linda Veterans Hospital orthopedics facility because of the bullying she had experienced in her dealing with Dr. Syed. “I no longer feel the trust, safety and confidence needed to go to the orthopedics unit at this facility again,” Seleska said. “If they’ll lie about ‘departmental policy,’ I believe they’ll lie whether a nicotine test is positive or negative. I feel that I, like many other veterans who have Medicare/TriWest, are being purposefully denied care or thwarted, to the degree that veterans are being forced to seek alternative care elsewhere.” TriWest administers the Department of Veterans Affairs Patient-Centered Community Care and Veterans Choice programs.
“I will not tolerate being bullied again,” Seleska said. “A referral request has been submitted for a second opinion to the San Diego VA Hospital.”
According to Seleska, she made 46 trips to the Loma Linda Veterans Administration hospital, the Veterans Ambulatory Care Center, Pro Care Physical Therapy and other medical care providers to which she was referred, entailing 1,102 miles traveled in an effort to have her shoulder taken care of properly, to no avail.
She enumerated multiple points of dissatisfaction with the Jerry L. Pettis Veterans Administration Hospital in Loma Linda, including the repeated refusal of hospital personnel to provide her with a patient advocate.
“Any time a veteran utters the words ‘patient advocate,’ everyone goes into ‘duck and cover’ mode,” Seleska said. “Their first knee-jerk reaction is to immediately assume that you want to yell, cuss and complain or file a complaint. It never occurs to them that the veteran may sometimes simply need a break, someone to step into our shoes to help navigate their processes. Patient advocates are routinely denied or not available.”
Seleska further decried the insensitivity with which aging patients are treated, the unavailability of the hospital’s written policies for examination by its patients, the wholesale closure of the hospital’s Saturday clinics which makes it difficult for veterans who work or have child care concerns to be seen or get treatment, and the violation of the Health Insurance Portability Accountability Act, which she said entails veterans being made to confirm personal data by orally reciting sensitive identifying information for verification purposes as well as having to discuss their medical conditions and needs in usually full and open bay waiting rooms. She said it is her perception that women veterans are accorded a lower priority by the Loma Linda VA Hospital staff than are male veterans. Overriding all of that, Seleska said, is the neglect, lack of care and disrespect the hospital’s personnel have consistently evinced toward those they are employed to serve in general “The maddening back and forth of protocols, combined with the routine denial of treatment and procedures of not just me but many others has prompted me to discuss a growing desire to request a Congressional inquiry with multiple care givers, as well as with a vast number of veterans camped out for hours in waiting rooms,” Seleska said. “Other than my primary providers, I’ve been seen by a different provider nearly every visit, with ‘policies’ routinely pulled out of thin air. Watching my brothers and sisters in a state of mental anguish and pain, all I can do is hug them.”
Wade Habshey, the spokesman for the Jerry L. Pettis Veterans Administration Hospital, without referencing Seleska by name, said, “VA Loma Linda personnel are working with the veteran to resolve her concerns. We appreciate the veteran’s service to our nation. We commend her for coming forward with the information she has provided. She deserves the very best in health care and, as with all our veterans, to be treated with respect. We will continue to follow up with the veteran’s inquiry.”
Habshey said, “Given the review of the patient’s concerns and her right to privacy, we’re not able to comment further.”
A local Navy veteran has gone public with complaints that staff members at the Loma Linda Veterans Administration Hospital have been both neglectful and unresponsive in rendering her needed medical care and assistance.
Phyllis J. Seleska, who is now 66, served in the U.S. Navy for more than twenty years, after enlisting at the age of 35 in 1986. She was a veteran of both Operation Desert Storm and Enduring Freedom, with multiple war zone deployments. Consequent to her service, she suffers from post traumatic stress disorder, and her rating has made her eligible for 100 percent of her physical and mental health issues being covered under the Veterans Health Care System for life.
More than fourteen months ago, on August 6. 2017, Seleska slipped on wet concrete at her home, injuring her arm and hand. Despite the pain and swelling, owing to the lateness of the hour on a Sunday night, she elected to wait until the following day to go to the hospital. She splinted her wrist in an effort to immobilize her hand and hold the swelling in check.
She went to the emergency room at the Jerry L. Pettis Veterans Medical Center the following morning. Upon attempting to check in, she was rebuked by the desk clerk for having splinted her wrist. Thereafter she encountered a several hour delay before she was taken in to the radiology department for an x-ray. When the splint was removed for the x-ray, swelling was immediate. Thereafter, she was returned to the emergency waiting room. Seleska’s entreaties for attention were rebuffed with statements from hospital staff that patients with chest pains and shortness of breath had to be given a higher priority and that she would “just have to wait.” Meanwhile her wrist continued to swell over the hours, growing increasingly painful.
Some 14 hours after she had arrived at the hospital, at 11:30 pm, she was seen and treated by Dr. Willard Gilbert. His first reaction, according to Seleska, was “Oh my God! Had someone shown me these x-rays, I would have had you off to orthopedics hours ago. You’ve done a number on your wrist; it’s broken in three places. That’s got to be unbelievably painful!” Seleska was immediately administered a pain shot and a soft splint was installed, with orders to report to orthopedics the next day.
Seleska checked into orthopedics on August 8, 2017, just prior to her 9 a.m. appointment time. Following a two hour wait, she was ushered into a treatment room where, she said, “two impressively large attendants” undertook to set her wrist, doing so without administering any pain medication. The setting procedure took place while she was lying on a table, taking place in two ten minute installments punctuated by a short break. Seleska described this as an “excruciatingly painful process,” followed by the installation of a cast splint. That ordeal over, Seleska next dealt with the hospital’s front desk personnel to book a follow-up appointment. While doing so she was chastised for the “very loud ruckus” she had raised while her wrist was being set.
On August 16, 2017 a follow up x-ray confirmed a good set, and three more rolls of cast material were put on over the cast splint, ranging from Seleska’s fingertips to her shoulder, with most of the 8 pounds, 4 ounce weight and bulk of the cast in the area around her elbow area.
Being outfitted with the cast caused her right shoulder to hurt, Seleska said, but she chalked that up to lugging the heavy cast around for six weeks. The cast came off on September 19, 2017, at which point she was advised her wrist would take another year to fully heal. She was offered no rehab.
During an appointment to the orthopedics unit of the Loma Linda VA Hospital on March 29, 2018, Seleska informed the doctor who saw her of the discomfort she was experiencing in her right shoulder among other health issues. She was told, she said, to, “Pick your priority. I’m only allowed to write just one referral at a time.” Seleska at that point could no longer lift her right arm over her head, and was experiencing significant weakness and pain in that arm. She was referred to orthopedics and physical therapy, but was delayed in getting an orthopedics appointment until May 16. Previously she had inquired about the Veteran Administration’s Choice Program, by which she could potentially obtain treatment by a specialist outside the Veteran Administration (VA) system, but was told that difficulty would ensue in getting information relating to her treatment into her permanent record if she obtained treatment outside of the hospital. At the May 16 appointment, she received a thorough examination, during which the examining physician made observation of what he believed was a likely rotator cuff tear with other issues. Magnetic resonance imaging [MRI] offered the best means by which to determine the precise nature of Seleska’s problem, the doctor said. Nevertheless, the doctor told Seleska that a “new management team” was in place and that he was not allowed to request MRIs because, Seleska said the doctor informed her, “I guess we’re asking for too many of them. They’re about $3,000 a piece, so even though I think it will probably not help, they’re making us send patients to physical therapy for six weeks, 12 visits, with daily non-steroidal anti-inflammatory drug treatment. Just go and do what you can and when you come back, we’ll take care of it.”
At a May 31 appointment with the physical therapy department at the Veterans Ambulatory Care Center, Seleska said she encountered a therapist who told her, “You’re over 55, and unless you are an athlete or paid to use your body in some way, you should just learn to live with it, deal with it and suck it up.” She was told she could not be seen. She responded, she said, with “But I’m here. Why can’t you see me?” The response, she said, was, “We can’t see you.”
According to Seleska, she faithfully drove twice a week from her home in North San Bernardino to Redlands, the location of the ProCare Physical Therapy clinic, to which she had been referred. There, she engaged in exercises that were intended to improve her range of motion but which did not have that outcome and instead exacerbated her condition.
On July 17, a doctor in the VA Hospital’s orthopedics department conducted a rigorous examination of Seleska’s shoulder which included rotating her shoulder beyond the existing “pain points… to see how far you can really go,” Seleska quoted the doctor as saying, with another deep poke on the deltoid tear. “I’d say you’re going to need surgery, you’ve got a tear and underlying symptoms,” Seleska said the doctor told her. “You definitely need an MRI.”
On August 2, 2018, Seleska was given an MRI. On September 5, she learned through her mental health provider results of recent blood work she had done. That blood work showed a drop in her kidneys’ estimated glomerular filtration rate, as well as an indication that her daily use of non-steroidal anti-inflamatory drugs had resulted in severe narrowing of her lower esophagus, which was causing her to have difficulty swallowing. According to Seleska, her mental health provider advised her that remaining under the care of the VA Hospital was inadvisable.
On September 6, 2018, Seleska waited over an hour-and-a-half beyond her orthopedic appointment time. A resident who saw her initially advised her that “everyone over the age of 55 has some kind of rotator cuff tear,” telling her he didn’t see that much wrong, saying “It’s just a very small tear.” When Seleska pointed out that notation on her MRI report indicated “attention needed,” and that she had been experiencing significant pain and range of motion limitations, the resident conferred with an experienced doctor who made a more thorough evaluation of the MRI. Some 20 minutes later, the resident returned with an entirely different outlook and prognosis, saying, Seleska said, “You need surgery! There’s a lot more wrong than just the tear, including a deltoid tear, likely bursitis, and other conditions.” Seleska was told that in order to be eligible for surgery, she had to submit to a lidocaine/steroid injection into her right shoulder and if, over the course of two weeks that gave some relief, she was to return to see about getting onto the surgical schedule.
Seleska questioned why the evaluation of the outcome of the lidocaine/steroid injection would require a two week delay given that the effectiveness of that protocol could be ascertained within 20 minutes of the injection, and she noted that based on her prior experience it would not be likely she could obtain a return appointment in two weeks, given the degree to which the hospital’s appointment schedule was so densely booked. The resident insisted that the lidocaine/steroid injection was mandatory before any discussion of surgery could take place and that a two week delay in the evaluation of the effectiveness was standard procedure in the VA Hospital. The resident told her, she said, “Don’t worry about” the return appointment, since he would “put it in your record” that she was to be seen some 14 days hence. When the resident sought to inject the solution he had prepared into her rotator cuff, Seleska stopped him, insisting that he first provide her with a topical pain attenuator, which he did.
When Seleska attempted to schedule her follow-up appointment for the evaluation of the effectiveness of the injection, she was told there were no appointment openings available in two weeks. She advised the appointment clerk that she should check with the resident who had just injected her with the steroid/lidocaine concoction to confirm that her appointment was needed two weeks later. The clerk maintained that she was not permitted to make direct contact with physicians. Seleska then sought access to a patient advocate, but the clerk demurred, though at last Seleska was able to secure an appointment two weeks out. Nevertheless, according to Seleska, her concern that care for her shoulder was going to be drawn out has since been confirmed.
On September 18 she was seen in the orthopedics division, more than an hour after her appointment time, by Brian Tabatha, a physician assistant. She reported that the injection had worked. In going over a battery of pre-surgical questions, Tabatha asked if Seleska smoked. Seleska acknowledged smoking cigars. Tabatha said that for the surgery to proceed Seleska would need to “test nicotine-free for 60 consecutive days before we can consider you for surgery.” This was, Tabatha said, “departmental policy.” Upon Seleska’s request to see the policy in writing and speak with a patient advocate, Tabatha left and returned with Dr. Hasan Syed, a shoulder specialist within the orthopedics division. In response to Seleska’s request to see the draft of the departmental policy relating to not initiating surgery while a patient is yet using tobacco, Dr. Syed told Seleska it was his “personal preference that surgery patients be at least 30 days nicotine free.” Syed emphasized, Seleska said, that “smoking attacks rotator cuffs. I cannot believe that you were not told about this and the direct dangers of smoking related to rotator cuff injuries and the overwhelming chance of infection. That’s why you’ve injured both shoulders!” Seleska countered that she smoked cigars but did not inhale. In response, Syed had Tabatha provide Seleska with two non-VA studies, both of which stated, “Smoking may increase the risk of rotator cuff tears, which could consequently increase the need for surgical interventions.”
Thereafter ensued a testy exchange between Syed and Seleska over a shoulder surgery she underwent in 1993 while she was smoking two packs of cigarettes daily. She readily recovered from that surgery, Seleska said, adding that she underwent a back surgery in 2005 after quitting cigarettes. “I recovered without infection or nicotine related issues,” Seleska insisted. She said she told Syed of that operation. She said Dr. Syed retorted, “Are you denying the dangers of smoking? All of your injuries have been caused as a direct result of smoking! You don’t dictate to me what protocol I use to treat patients!”
When Seleska requested a patient advocate thereafter, she was not provided with one, although Tabatha told her that the patient advocate office was on the first floor. Seleska went to the patient advocate’s office, but it was after 4:30 pm, at which time patient advocates are not available.
Seleska insists that Dr. Syed’s size-up of the causes for her previous injuries were in error, as her 1993 left shoulder injury came about as the result of an injury sustained during a time of war at Diego Garcia, an island in the Indian Ocean at which the United States has an extensive military presence, where she was lifting 225 pound APS-115 radar sets up and down the ladder of P-3 Orion aircraft. She said her later back surgery was necessitated by injuries sustained during deck operations immediately after the Navy’s September 11, 2001 first strike operations while she was aboard aircraft carrier USS Carl Vinson, and that the injury to her right shoulder was wholly due to her slip last year onto her concrete pool deck.
Seleska has not been able to get the surgery on her right shoulder, and she believes the Veterans Administration and its healthcare system have skipped out on the responsibility to provide her with needed medical treatment. She said, “I was walked out on by an over-the-top, extremely aggressive doctor, who left me with absolutely no plan for future health care for my shoulder. I was egregiously bullied by Dr. Syed, and since have suffered varying degrees of post traumatic stress that now require additional medication never before necessary. I acknowledge that tobacco is not healthy, but neither was more than 20 years of exposure to magnesium, beryllium, asbestos, high powered ship’s radar radiation, JP-5 jet fuel, hydraulic fluid, deafening decibels of noise and the daily requirement of hazardous materials handling and usage. Let’s also not forget the ‘no choice’ anthrax shot series I was subjected to, all while in service, on the job.”
Seleska said she believed that Dr. Syed had wrongfully deprived her of the surgery she should have access to because her continued use of tobacco violated his “personal moral compass.”
Seleska continued, “For over a year now, I’ve had limited use of my right arm and significant pain. This is just me, just one particular evolution within an 8 year span. How many veterans are denied procedures or treatment because they smoke or because of some other fabricated ‘policy?’” she asked. “How many veterans don’t return to this health care system due to unreasonable, unacceptable, unnecessary delays, being made to unduly endure pain and disability? How many veterans have had their surgeries or treatments cancelled at the last minute because they tested ‘positive’ on a nicotine test?”
The doctors she has encountered at the Jerry L. Pettis Veterans Hospital in Loma Linda have varying attitudes, Seleska said. “I’ve met them all, from doctors that tell me they believe that ‘a patient should not have to endure/be in pain for any reason,’ to ones who say, ‘Suck it up. You’re getting old, learn to live with it…deal.’” She said some providers told her that if she wanted any pain medication, she would have to submit to a urinalysis program. Yet other providers have simply provided her with the pain medication upon request, she said.
Seleska said, “This particular health care system is being run by a new ‘management team,’ with a ‘one size fits all’ treatment matrix. Doctors’ requests for patients’ treatments are routinely denied or the doctors are just not authorized. You have to ‘request this and that and then that’ before you can get to what you actually need. The pharmacy has authority to override doctors’ prescription requests. A case in point is I used to receive lidoderm (lidocaine patch 5%). It’s easy to open, easy to put on, but most importantly, it works. Currently, I can only get a topical anesthetic cream (lidocaine 4%), 30 grams at a time, with a child proof cap that I am unable to open. I’ve been diagnosed with carpel tunnel in both wrists, but was told they just weren’t serious enough for surgery. Now, both hands are swollen to the point that I am unable to make a fist with either hand without pain and have developed ‘trigger’ finger in my dominant hand. My provider searched her screen and said, ‘I would have to prescribe this, this, and then that before we can get to the patch. I have no control over that.’ So what good is this product to me if I can’t open it?”
On October 3, Seleska was informed by Orthopedics Case Manager Sherri Miranda, a registered nurse, that Dr. Syed and Dr. Barry Watkins conferred and decided her condition was “not serious enough for surgery and surgery was not medically necessary.” This decision was made, Seleska said, “after every other doctor stated that I need surgery.” Seleska said she was told by some Veterans Administration Hospital orthopedics department personnel that “the ‘no surgery’ decision was made due to my behavior.” She said that Miranda wanted to book a follow-up appointment for four to five months in the future to see if surgery may be required in another six months or so. Seleska said she advised Miranda that she was unwilling to return to the Loma Linda Veterans Hospital orthopedics facility because of the bullying she had experienced in her dealing with Dr. Syed. “I no longer feel the trust, safety and confidence needed to go to the orthopedics unit at this facility again,” Seleska said. “If they’ll lie about ‘departmental policy,’ I believe they’ll lie whether a nicotine test is positive or negative. I feel that I, like many other veterans who have Medicare/TriWest, are being purposefully denied care or thwarted, to the degree that veterans are being forced to seek alternative care elsewhere.” TriWest administers the Department of Veterans Affairs Patient-Centered Community Care and Veterans Choice programs.
“I will not tolerate being bullied again,” Seleska said. “A referral request has been submitted for a second opinion to the San Diego VA Hospital.”
According to Seleska, she made 46 trips to the Loma Linda Veterans Administration hospital, the Veterans Ambulatory Care Center, Pro Care Physical Therapy and other medical care providers to which she was referred, entailing 1,102 miles traveled in an effort to have her shoulder taken care of properly, to no avail.
She enumerated multiple points of dissatisfaction with the Jerry L. Pettis Veterans Administration Hospital in Loma Linda, including the repeated refusal of hospital personnel to provide her with a patient advocate.
“Any time a veteran utters the words ‘patient advocate,’ everyone goes into ‘duck and cover’ mode,” Seleska said. “Their first knee-jerk reaction is to immediately assume that you want to yell, cuss and complain or file a complaint. It never occurs to them that the veteran may sometimes simply need a break, someone to step into our shoes to help navigate their processes. Patient advocates are routinely denied or not available.”
Seleska further decried the insensitivity with which aging patients are treated, the unavailability of the hospital’s written policies for examination by its patients, the wholesale closure of the hospital’s Saturday clinics which makes it difficult for veterans who work or have child care concerns to be seen or get treatment, and the violation of the Health Insurance Portability Accountability Act, which she said entails veterans being made to confirm personal data by orally reciting sensitive identifying information for verification purposes as well as having to discuss their medical conditions and needs in usually full and open bay waiting rooms. She said it is her perception that women veterans are accorded a lower priority by the Loma Linda VA Hospital staff than are male veterans. Overriding all of that, Seleska said, is the neglect, lack of care and disrespect the hospital’s personnel have consistently evinced toward those they are employed to serve in general “The maddening back and forth of protocols, combined with the routine denial of treatment and procedures of not just me but many others has prompted me to discuss a growing desire to request a Congressional inquiry with multiple care givers, as well as with a vast number of veterans camped out for hours in waiting rooms,” Seleska said. “Other than my primary providers, I’ve been seen by a different provider nearly every visit, with ‘policies’ routinely pulled out of thin air. Watching my brothers and sisters in a state of mental anguish and pain, all I can do is hug them.”
Wade Habshey, the spokesman for the Jerry L. Pettis Veterans Administration Hospital, without referencing Seleska by name, said, “VA Loma Linda personnel are working with the veteran to resolve her concerns. We appreciate the veteran’s service to our nation. We commend her for coming forward with the information she has provided. She deserves the very best in health care and, as with all our veterans, to be treated with respect. We will continue to follow up with the veteran’s inquiry.”
Habshey said, “Given the review of the patient’s concerns and her right to privacy, we’re not able to comment further.”