[mills3186]

The health care systems are generally overburdened, the mid-level practitioners in that specialty (PA's and NP's) are there to do an initial evaluation and triage as needed. After reviewing x-rays and determining if any additional tests are needed, they would refer you right away to one of the orthopods they work with. The orthopedic surgeons are generally not consulted if surgery is not needed since their time is too valuable for non-surgical cases. If the PA has any question or concerns about the x-rays, they would discuss with the Doc. The Ortho PA's I worked with in the past were extremely knowledgeable and talented.

[Northwoods]

Originally Posted by geofitz13

My wife fell and broke both ankles while in South Carolina on 8/17. We went to a local Urgent Care where they took xrays and splinted her. They advised to see an ortho as soon as possible. They gave us the written report as well as a disc containing the xrays.
8/19 we call our provider, and are told we could see a PA late in the afternoon. (At this point, she is in excruciating pain, meds not helping.) I told them that we had xrays in hand, along with physicians's report, and we needed to see ortho. They refused, said the PA needed to see her to evaluate. We then called ortho directly. I again told them we had xrays and report, and the condition my wife was in. They said they could fit her in in OCTOBER. Two broken ankles and they think she should wait two months. We then called an ambulance to have her taken to the Villages Hospital. We were advised to go to Ocala, as Villages hospital was not capable of treating this type of injury. So off to Ocala we went. She was re-xrayed, resplinted, and was told to see their ortho ASAP. We saw him about two hours later. Examined, resplinted (because VHS would not allow him to put her in boots, wants their own supplier) and sent on her way. Fortunately, no surgery was needed, but it was explained that if she had not been treated promptly, she could have further injured herself.
Is it reasonable for VHS ortho to defer treatment for two freshly broken ankles for TWO MONTHS?? The docs at Ocala certainly didn't think so.
We both have the same PC in VHS, and I have an appointment scheduled for tomorrow afternoon. She is going to get an earful. As will the people in the VHS office in Sumter Landing. Again, two broken ankles, don't bother treating for two months?? I think this is borderline malpractice.

I've never had a healthcare encounter where I didn't first have an evaluation by a PA, nurse, etc. If I go to the emergency room I am first evaluated by a nurse. When I see my doctor, the CMA evaluates me first.
There are so many people who think they know exactly what is wrong with them, that are SO wrong about what is wrong with them.
I have no doubt that you knew exactly what needed to be done. There is a very good chance that the PA would understood your situation and would have expedited and referred you to the right specialist. They might have even had a better plan of attack than what you wanted.

[geofitz13]

Well, I presented the situation to two people at VHS (I see no need to give names) and they agreed with me. They seemed genuinely concerned that their own procedures appear to not have been followed. They are looking into it further, and I expect to hear something in the next day or two. Keep in mind the sequence. First, the injury. Second, tried to present the xrays and physician report to VHS and were told we would see "Tony". I am assuming this was a PA or NA, we were never told. Third, contacted ortho, and were told they do not do first or second days visits, she would have to wait until October. Fourth, were told by VHS to call an ambulance and go to the hospital. At no time were we offered and alternatives or explanations. It was literally take it or leave it. If they had followed their own procedures as outlined by the two people I talked to today, we would not even be having this discussion. If we were told it would be a few days, that is one thing. Two months is unacceptable under any circumstances. If we were given any options or any explanations, that would be different.
**Edit** The two people I spoke to were managers with VHS who are responsible for dealing with situations like this. Not just someone I ran into....

[graciegirl]

Originally Posted by geofitz13

Well, I presented the situation to two people at VHS (I see no need to give names) and they agreed with me. They seemed genuinely concerned that their own procedures appear to not have been followed. They are looking into it further, and I expect to hear something in the next day or two. Keep in mind the sequence. First, the injury. Second, tried to present the xrays and physician report to VHS and were told we would see "Tony". I am assuming this was a PA or NA, we were never told. Third, contacted ortho, and were told they do not do first or second days visits, she would have to wait until October. Fourth, were told by VHS to call an ambulance and go to the hospital. At no time were we offered and alternatives or explanations. It was literally take it or leave it. If they had followed their own procedures as outlined by the two people I talked to today, we would not even be having this discussion. If we were told it would be a few days, that is one thing. Two months is unacceptable under any circumstances. If we were given any options or any explanations, that would be different.
**Edit** The two people I spoke to were managers with VHS who are responsible for dealing with situations like this. Not just someone I ran into....

You were told by VHS to call an ambulance and go to the hospital, or did you listen to this on the tape telling you what number to push? "If this is an emergency".

Frequently, when you seek an appointment without a referral or validation from a referring physician, this is what happens here in Florida when you try to see a specialist.

If you call VHS before business hours or after business hours you may get an answering service who will not be able to answer with the skill of the people who are really employed by VHS.

We have been impressed with the skill and sensitivity of all people who work at Creekside Care center. I don't know if it differs in other centers.

[charmed59]

Sometimes the gate keepers at Creekside do make getting timely appointments impossible. In every case, when I finally did get into see the nurse practitioner they were surprised I didn’t get an appointment within a day or two.

Part of the issue VHS is having is changing computer systems multiple times in the last two years. My mother has had terrible issues that ended up with her in the hospital twice because they lost requests for referrals and test results.

Sometimes the system is just overwhelmed. At hospital checkout the instructions said to get in to see her specialist within 3 days, the first available appointment for the specialist was 2 weeks, and this was in the summer. The office staff schedules to many non-emergency appointments per week, not allowing room for urgent appointments. I would be more than happy to have my yearly checkup scheduled 8 months out as long as in an urgent situation I could get in to see the doctor in a few days.

Right now I’m under 65, so I have good insurance that allows me to bypass VHS in an emergency. When I had orthopedic issues, and I couldn’t get in to see the PA or doctors for a week, I called my husband’s orthopedic doctors and got in the next day, and was well on my way to recovery by the time I could even get in to see my VHS Creekside nurse practitioner.

In the last few weeks both my mother and I were able to get timely appointments at Creekside, and the nurse mentioned that one of the doctors and a PA that were out on various leaves are all back now. Also they have found all the missing records, and are verifying prescriptions to ensure they all are correct. Perhaps the issues my family has had the last six months is getting better.

[geofitz13]

We were told by a scheduler that we should call 911. When I spoke to one of the supervisors yesterday, he told me that he was there when that happened. The procedure that should have occurred did not, and he was disappointed that it was not. Had he, at the time, or had the scheduler, at the time, followed the procedure that was later explained to me, then the whole incident would not have happened. My question was answered by the two supervisors. I am, according to them, not being unreasonable. Now, if they can remedy the situation so this won't happen to the next person, all will be good.

[rustyp]

Back to the original question - am I being unreasonable ? Many posters here believe you were by not following the advice first given to you to see the PA. A few others here love to bash TV health system. It's obvious you feel you were not being unreasonable. Your story has evolved into progressive disclosure the longer it stays alive. IT is coming up on re up time for TV health. Why not switch if you are so unhappy? What is the motive of continuing this debacle independent of which side of the fence anyone is on?

[Northwoods]

Originally Posted by geofitz13

We were told by a scheduler that we should call 911. When I spoke to one of the supervisors yesterday, he told me that he was there when that happened. The procedure that should have occurred did not, and he was disappointed that it was not. Had he, at the time, or had the scheduler, at the time, followed the procedure that was later explained to me, then the whole incident would not have happened. My question was answered by the two supervisors. I am, according to them, not being unreasonable. Now, if they can remedy the situation so this won't happen to the next person, all will be good.

That's good to hear. You were frustrated... you didn't feel the situation was handled correctly. But you talked to supervisors at TVH and they saw a breakdown in protocol and hopefully they are finding the issue and will make sure it doesn't happen in the future. They listened to you and admitted the system didn't work.
TO me? The fact that they listened to you, admitted a breakdown in protocol and looking to fix the issue is a big deal.
I guess you have to decide if this explanation works for you or if you want to find another healthcare provider.

[geofitz13]

[QUOTE=They listened to you and admitted the system didn't work.
TO me? The fact that they listened to you, admitted a breakdown in protocol and looking to fix the issue is a big deal.
I guess you have to decide if this explanation works for you or if you want to find another healthcare provider.[/QUOTE]

I agree wholeheartedly. It was a big deal that they listened. It would be nice if this didn't happen again, to someone else. In the meantime, as I think I have stated before, I couldn't be happier with the ROUTINE care that I and my wife have received by VHS. This is what would make it difficult to make a change. But at our ages, it is easy to expect that emergencies can occur, and if that part is deficient, it is a problem. I am trying to remain positive, given the response of the managers at VHS.

[thelegges]

Originally Posted by graciegirl

Yes it does but it is our experience that the people at the Creekside facility are very good and very thorough and very caring as well. Here in Florida a Physicians Assistant is held to be more important than in other places I have lived, and you know what? They are very smart indeed. I believe he or she could have facilitated your wife's journey to get the treatment of the orthopedic specialist and have made it far easier for all things to be put in place. Also keep in mind The Villages Hospital is NOT part of The Village Health System.

You asked. I do think that sometimes following procedure is the way to go, especially in scientific endeavors.

The first PA program was in the mid 60s. Physicians started hiring for their practice late 90s early 2000, when insurance companies allowed visit and surgeries to be billed.
No matter what state you live in PAs have always be highly regarded. Most were hired in hospitals. Physicians had to pay them out of their practice if they were used privately, thus it was a luxury.
Now it a necessity, not a luxury, to have a PA or a FA in office and surgery, they have become more prominent in the community.
Like a first responder PAs or FAs can get medical issue expedited to the best medical care needed.

[OrangeBlossomBaby]

Originally Posted by thelegges

The first PA program was in the mid 60s. Physicians started hiring for their practice late 90s early 2000, when insurance companies allowed visit and surgeries to be billed.
No matter what state you live in PAs have always be highly regarded. Most were hired in hospitals. Physicians had to pay them out of their practice if they were used privately, thus it was a luxury.
Now it a necessity, not a luxury, to have a PA or a FA in office and surgery, they have become more prominent in the community.
Like a first responder PAs or FAs can get medical issue expedited to the best medical care needed.

Yeah PAs are immediately under doctors on the medical care food chain, with Nurse Practitioners being a close second. Usually I'll see "whoever is available" at a group practice where I'm a patient. Of all the non-office-staff there, there's only been one PA who I didn't like at all. The rest gave excellent care, understood my medical needs, and encouraged me to be pro-active in my health.

I've seen over a dozen PAs throughout the years and only one of them left me with a negative impression of her. I can say the same for the doctors I've had throughout the years. Just one that I didn't like.

The OP had an unfavorable experienced, talked it out with the omnibudsmen (I'm assuming that's what they were, or how they were functioning), and got it resolved.

Glad for the update OP and hopefully you'll get the care you and your wife should get, going forward!

[justjim]

OP, I understand your wife was in excruciating pain (your words) and when our love ones are in pain we want “action” immediately. It appears that VHS has certain protocols which you did not follow. Who knows, given the same circumstances, we might have done the same as you and attempted to seek help elsewhere. It appears the two month timeline was just enough to send you over the edge so to speak. Sometimes, with good intentions, we make a quick decision at the wrong time. Unreasonable, maybe, but also understandable. Very happy that everything worked out in the long run. Full disclosure - neither my wife or I are currently in the VHS health system.

[DAVES]

Originally Posted by geofitz13

My wife fell and broke both ankles while in South Carolina on 8/17. We went to a local Urgent Care where they took xrays and splinted her. They advised to see an ortho as soon as possible. They gave us the written report as well as a disc containing the xrays.
8/19 we call our provider, and are told we could see a PA late in the afternoon. (At this point, she is in excruciating pain, meds not helping.) I told them that we had xrays in hand, along with physicians's report, and we needed to see ortho. They refused, said the PA needed to see her to evaluate. We then called ortho directly. I again told them we had xrays and report, and the condition my wife was in. They said they could fit her in in OCTOBER. Two broken ankles and they think she should wait two months. We then called an ambulance to have her taken to the Villages Hospital. We were advised to go to Ocala, as Villages hospital was not capable of treating this type of injury. So off to Ocala we went. She was re-xrayed, resplinted, and was told to see their ortho ASAP. We saw him about two hours later. Examined, resplinted (because VHS would not allow him to put her in boots, wants their own supplier) and sent on her way. Fortunately, no surgery was needed, but it was explained that if she had not been treated promptly, she could have further injured herself.
Is it reasonable for VHS ortho to defer treatment for two freshly broken ankles for TWO MONTHS?? The docs at Ocala certainly didn't think so.
We both have the same PC in VHS, and I have an appointment scheduled for tomorrow afternoon. She is going to get an earful. As will the people in the VHS office in Sumter Landing. Again, two broken ankles, don't bother treating for two months?? I think this is borderline malpractice.

Sadly, gone are the days when your doctor made house calls and knew you as a human being. Today, the most important medical question is, what insurance do you have?

When, you call the doctor's office, you do not speak to the doctor. The person you speak to is mostly like a travel agent.
Her computer tells her opened seats on Tuesday. That booking agent, your first contact with an office is actually a very important staff member. She has little or no medical training.
She can get hit with several calls at once and some calls are frankly unreasonable

We hear, we are told that you get better care from private healthcare rather than using a hospital emergency room. Frankly, it depends what for.

[Topspinmo]

Originally Posted by geofitz13

"Break their cronyism"??? Are you joking?? She is their PATIENT, they have a legal responsiblilty to provide services. Ortho made it clear that they do not do same day or next day visits. It was made quite clear that a physician had already recommended seeing ortho as soon as possible. The folks in Ocala were pretty clear in that she could have exacerbated the injury if we had waited for the time suggested by Villages ortho.
I'm only trying to see if our expectations of service are unreasonable. I think I may be looking at something other than the Villages Health System when we renew next year.

Makes some of us glad we got kicked out VHS.

[Aw Man]

Originally Posted by Topspinmo

Makes some of us glad we got kicked out VHS.

I'm happy that you are glad, but for the benefit of others that may be currently considering the Village Health System, please note that my wife and I have been in a Medicare Advantage Plan with VHS for the past 5 years and have been very pleased with our doctors and all services provided, in all respects.
We have had several medical issues and emergency care issues and have never experienced the problems described elsewhere in this post thread or in other post threads like it.