The U.S. leads the pack in the percentage of older adults who have trouble paying their medical bills.
WALLA WALLA -- This summer Dr. Carolyn Clancy, interim undersecretary for health for the U.S. Department of Veterans Affairs, sent a message to all hands systemwide.
"You are in control of a piece of providing Veterans health care or services -- that is your job," it stated. "Let's redouble our efforts to improve the Veteran's experience and let's do it now."
The email landed in the inbox of every VA employee in mid-July.
But it was too late for "Melanie," a U.S. Army veteran and former office worker at the Yakima Community Based Outpatient Clinic, who was fired in April after four months on the job.
Her termination came the day before a representative of the Office of Inspector General visited the facility.
Melanie has theories about why that happened, including that the VA does not welcome dissent. Not even, in her case, if comments are about systematic hindrances that hurt employee performance and service to veterans.
Several months earlier Clancy would exhort VA employees to take control of their jobs and "move forward with urgency," said Melanie, who is in her early 40s and requested anonymity for this story in fear of retribution from the VA and hurting future job prospects.
She said she was doing just as Clancy urged.
"I was on time every day, I stayed late every day and I have the emails to prove it," she said. "But I didn't have time to get the job done in those hours."
She added she didn't ask for overtime and accepted what little compensation time the VA handed out without complaint. "I just wanted to get the work done."
In a letter to her boss, Melanie said calls to the clinic never stopped and there was a constant flow of activity coming and going. If there was a slight letup, the time was spent catching up on flagged orders and other to-dos.
Not long after her job began, Melanie realized she had not received adequate training for the software used for billing insurance companies. And neither could she access the program on her computer.
"I requested further assistance in training and I never got a reply," she said.
In copies of a letter and emails to her VA superiors furnished to the Union-Bulletin, Melanie had reminded officials she had received a "glowing performance appraisal" just weeks before failing an audit of her performance in billing veterans' insurers.
"I was in disbelief because I asked the senior (clerical worker) several times for assistance in getting this set up and was basically ignored and told 'later,'" she wrote.
At one point the situation was so overwhelming, Melanie had what she described as an emotional breakdown. Told to go home and not to worry, she stayed home the next day to calm down, she said.
But when she was honest about why she called in sick, her boss told her it was a misuse of leave.
While her experience of working at the VA is just a hint of the troubled health system, her own experience as a former soldier and then years later as a VA patient speaks volumes about why she was determined to do her best for the agency.
After serving in the U.S. Army four years as a microwave systems operator, Melanie was honorably discharged without a blemish on her record, she said. She then became a nurse. Then she developed an alcohol addiction.
"I destroyed my own career," she said. "The state suspended my (nursing) license, as well they should have. I lost my house."
But getting pregnant with her daughter changed Melanie's world, she said, and all was on the upswing until Melanie suffered a herniated disk.
The pain in her back meant she couldn't work for the following 30 months; it also resulted in her getting hooked on pain medications.
But the substance use disorder program she participated in at the Jonathan M. Wainwright Memorial Veterans Affairs Medical Center in Walla Walla saved her life, she said.
"I saw going to work for the VA as a way to help others," Melanie said. "I was so excited to get this job. Even though I wasn't a nurse anymore, I didn't care."
Her new job at the Yakima clinic, which is administered by the Walla Walla VA, would put her in a healthy environment that would also allow her to begin steps toward reclaiming her nursing license, Melanie said.
However, she apparently ran afoul of Walla Walla's policies. Doctors in Yakima refused to put patients on an extra waiting list for medical appointments as officials in Walla Walla ordered, Melanie said.
"But we were trained to keep an extended waiting list and there were times we got 'nasty grams' from Walla Walla." Melanie said. "I told Walla Walla 'We won't use the list. We've been told to schedule them.'"
Melanie and others in the Yakima office tried calling Walla Walla VA directly to work issues out, to no avail.
"The communication was so poor," she said. "Everything had to be by email and (her boss) would never respond. The chains of command are so far away. And those supervisors were never coming to our building at all."
Since doctoring of appointment schedules and other problems with services at the Department of Veterans Affairs have gained national attention this year, administrators have entered change mode.
That includes the supervisory process, said Brian Westfield, director of Jonathan M. Wainwright Memorial Veterans Affairs Medical Center.
Staff working off the Walla Walla campus in clinics in Eastern Washington, Northeast Oregon and Central Idaho will report to a manager or director of medicine at their own location. Those heads will then report to an associate chief of staff in Walla Walla, Westfield said.
It's "an attempt to reduce the number of people giving direction," he explained. "So it's all up one chain of command."
Westfield said he expects the procedural change to roll out by late fall.
Again, too late for Melanie.
When she was fired by her Walla Walla supervisors, they physically escorted her out of the Yakima clinic "like a criminal," Melanie recalled. "In front of a room full of veterans."
Now, she added, she must return to the same VA clinic to get her own health care.
"Every time I think about what happened, it really upsets me," Melanie said. "I've never been fired for performance before. It was really a slap in the face for how hard I was working."
Sheila Hagar can be reached at firstname.lastname@example.org or 526-8322.
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