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VHS Is this reasonable?
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 generally believe you are better off going outside The Villages Health (both the primary care and speciality offices) for something "challenging". UofFlorida/Shands in Gainesville is another good option for ortho.
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I think I would have made an appointment with an Ortho before even calling my GP. Does your insurance require you to have a referral?
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Most of us would only give opinions and if we missed or you missed a tiny part of the narrative, it could be another situation entirely.
You did find help. She has been treated. I hope she is well soon. |
My guess is if you would have went to the PA as suggested in the beginning the ending at VHS would have been much different. Just like lawyers and judges they work with each other every day. Never assume they will break their cronyism for someone they only see once in a while.
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To answer your question: no, I don’t think you’re being unreasonable.
However, in my experience with a PA, I think you would have found her/him working closely with the ortho doctor in resolving the pain issues and any other concerns you had. This is one of several reasons I don’t care for Medicare Advantage/managed health systems. Two months is outrageous, and you should have had the option of finding an ortho who could fit you in. And I’m sorry both you and your wife went through this. |
What is VHS?
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We did try ortho directly. They are the ones who said two months. They said they don't do same or next day visits. Really left us no choice but to call for ambulance. The EMT's are the ones who told us to go to Ocala, saying that The Villages Hospital would just send her there anyway, as they we're "not equipped to care for this kind of injury." I asked them to repeat that, because I found it hard to believe.
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Villages Health System (Services?} |
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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. |
No you are not unreasonable but maybe the PA visit would have speed things up. They probably have more patients than they have staff to handle and the PA stop helps to make sure that only critical injuries jump ahead of the line. I think things will get worse as there will be many more patients than medical personal in the future.
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So you were advised by an EMT that did not have access of the fracture on the X-ray disk, that Villages Hospital would send her to Ocala? Because they could not treat this type of injury.
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So, to answer the question. No, you were not being unreasonable. Your wife was in pain and you were trying your best to help her. I seems to me that VHS was moving you along, just not as fast as you would like. Maybe because it was not life threatening (just a guess)? |
But you waited two days. Why not have things done in S.C
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Yikes!!
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Assuming everything you said is correct...we can only go by that. I've broken both of my ankles...not at the same time, but years apart. BOTH times we went to the ER, got x-rayed etc. BOTH times the ankles got splinted and I was told to go home and elevate and see the ortho some days later. The 1st ankle-break, thankfully wasn't bad enough to require surgery so it was put in a cast (as I said, a few days later) and 6 wks later I was "good to go". I was younger than. Fast forward about 15 yrs another fall and this time it was bad. We were out of town, went to the local ER which did much the same as the 1st time. We went home and called our clinic and got in. Was evaluated and told I'd need surgery and would need an ortho. So I did and had surgery that required a plate and some screws. NOT a great experience!! Not knowing the circumstances of your wife and the break etc. I'm not sure that the care centers did what they could with the info they had. We all expect excellent attention when something happens to us. I'm so sorry you all had to go through that. BUT now it's behind you. IF you need more information, then speak to someone who has power (meaning an office manager and/or an administrator) NOT to discuss on a social media site.
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Also pretty important, in general (not knowing your exact health care setup):
If YOU call a doctor that you don't know, to make an appointment, you will be seen when the doctor has the right amount of time to meet you and do a consultation. That might take a month. Or two. If your doctor calls a doctor for a referral, that doctor will make the appointment and usually slip you in as a more urgent visit within a few days. Same thing with dentistry: if I went to my endodontist and said "Hey Doc I'm going to need a root canal, my doctor down the road told me to set one up." The endo will give me next available. And that might not be for a few weeks. If my dentist calls and says "Hey Doc, Jazzie has a blah blah in her blah blah and needs to get in, when's the soonest?" The endo will have me drive right over and it'll get done within the hour. Whether you need a referral for medical insurance or not: if they ALLOW referrals, get one. You will always be seen faster. |
I broke my wrist on a friday, went to villages er, was splinted and given pain meds, got to see the ortho on monday and was operated on by end of week. I was fortunate.
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Unless you are already a patient of the ortho Dr, what you went through is pretty normal. You are going to get to see a PA and nothing more 90 % of the time. Just do it!! That is why they have a PA.
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Broke my wrist on a Sat night, wrapped it up and went to Paramount Urgent Care on Sunday 8AM. They X-rayed and wrapped and said to take Aleve. They forwarded x-rays and report to Dr. Cook at Advanced Ortho Inst. (who neighbors had used). Cook's office called me Monday and booked me for Tues AM. Excessive swelling prevented surgery til the next Tues. Had surgery at The Villages hospital. I have Blue Cross/Blue Shield and regular Medicare and don't need referrals. I was happy with my treatment and scheduling. Previously I had tried the VHS/Medicare Advantage system and got too many bills that I never got before with Blue Cross etc. as I have an autoimmune disease and see several specialists so went back to Blue Cross. I am so sorry you and your wife went through this and I cringed reading what happened to her. I do not think you are being unreasonable at all and hope the ortho that said 2 months wasn't Advanced Ortho but I would report to a medical board whoever the ortho practice was.
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Thank you all for your replies. It's been an eye opener. My original question was, am I being unreasonable. Had they said "we can see you Thursday" or "we can see you Friday", that would have been entirely acceptable to me. A few days would have been inconvenient, but not unreasonable (to me). But for ortho to state that it was okay for a period of a couple months before even looking at it, I found unreasonable. Perhaps I am wrong. Judging by the comments here, I guess we need to adjust our expectations for emergency health care. BTW, I have had absolutely no issues with routine care, in fact, I find they are exceptional is this regard. Again, I sincerely thank everyone for your input. This site is a great resource for learning about TV.
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Great Example
This is a great example as to why we should have a Plan in case of a medical emergency and it should not include any thing to do with Village Medicine. There are so many options available that practice good medicine. There is Gainesville, Ocala, Moffitt in Tampa, Mayo in Jacksonville (which we use)in the case of Urgent Care there is the facility at the approximate junction of 441 and 42 where you will always see a Dr and will be sent to Hospital if needed. They are like an ER at a hospital. We used local Dr's at one time and if we believed them my wife would not be with us. We ended up at Mayo who found a Stage 3 cancer which was missed by local DR's and they saved her. I know some have had real good results in The Villages but I liken that to playing roulette with your life Why do it???
with your life. :ohdear: |
You are not unreasonable. It seems that VHS should be able to find an ortho somewhere in their network to see your wife ASAP. Although we have Original Medicare and are not in the Villages Health System, we have visited two VHS orthopedics here (Ethier and Silberberg).
I am a veteran of orthopedic surgeries, one a knee replacement, the rest the result of falls. Last summer on a trip abroad I fell and broke my femur in England. Contrary to the skeptics/critics about the British health care system, surgery was performed the next day and hospital care for the total nine days was wonderful, although the food was awful and there was no air conditioning. The total cost of $11,000 from start to finish was a fraction of what it would have been here. Thankfully, we had good trip insurance. From England I called Dr. Ethier at VHS to schedule followup care but was told, in effect, that he doesn't follow work that others have done. Same with another practice I called which suggested seeing a trauma orthopedic doctor in Ocala. I ended up going to a PA in our internist's office to have the stitches removed. She also prescribed home nursing and physical therapy. Eventually I saw a PA in another orthopedic practice for X-rays and follow up. I never did see a doctor here. My first broken femur occurred almost 20 years ago under a waterfall in Venezuela. My husband's orthopedic doctor in Houston had no qualms about seeing me and correcting the surgery that was done in Venezuela. A sign of changing times perhaps. |
NO, you are NOT being "unreasonable."
Waiting more than a day or so for an Ortho to look at what might even be only 'potentially' (much less actual) 2 broken ankles at the same time...is completely outrageous. :ohdear: Then again, there will always be those that will defend anything that has 'Villages' in its name...so no surprise there.:oops: I have to give you kudos though, that your self-control at such incompetence allowed you to start this thread...without being behind bars. :thumbup: |
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You asked. I do think that sometimes following procedure is the way to go, especially in scientific endeavors. |
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.
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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. |
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.... |
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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. |
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. |
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.
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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?
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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=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. |
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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. |
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