Tuesday, April 09, 2013

Jack Kegley's Experience At Seattle's VA Raises Questions About Patient Care

Jack Kegley USMC is a 100% disabled Veteran (Vietnam) currently receiving treatment at the Seattle VA.

With the use of treatment such as MIST therapy, skin grafts, negative pressure therapy and specialized boots to offload the wound, his wound shrunk to the size of a pencil lead and was continuing to heal. Then the VA decided to give up on him. Why?

In 2007 Jack sought treatment of a diabetic ulcer about the size of a quarter, on his right big toe. Elderly diabetics are frequently at risk for injuries of this sort and, if not properly treated, they can grow to the size of a nickel or quarter and compromise the patient's health generally.  For two years he was treated weekly at the dermatology clinic where a nurse practitioner would debride the foot (that is, scrap off any dead tissue), wrap it in a bandage and send him on his way. This did not result in healing.

Typical "Crow Boot"
In 2009, a new approach was tried: instead of treating Jack as an ulcer with a patient to be managed, he was treated as a patient with an ulcer to be healed.. The more aggressive and holistic approach went after not just the dead tissue of the toe, but the entire patient's nutrition (vitamins and minerals), blood sugar, bio mechanics of walking and so forth. This included the use of a Celleration Corporation “MIST Treatment” (which is also approved at other VA facilities and at Madigan Hospital). Plans were made for a "crow Boot" made to offload the foot even further and perhaps a skin graft to close the wound completely. The ulcer began to shrink and reached the size of a pencil lead.

However toward the end of 2012 that treatment was terminated. The Mist Treatment device was taken away and the previous, ineffectual treatment of scraping the wound was resumed. What does this mean to Jack?

He wrote to the VA several times:
"Let me start this conversation by stating that I am pleased with the level of care that has been provided to me, under most circumstances, by those I have worked with at the VA Seattle and that the following is not reflective of the entire staff and facility.

I am now back at the position I was a year ago with no indications to what type of progress they expect to make, how they expect to offload the weight on my toes (I now have wounds of both large toes) or give me any indication as to the future plans.  They are even talking about taking the scooter away at some point in the future.  I will not tolerate going backwards, I will get out of the VA system and seek private care before I let this return to a point it was a year ago.
Now that they have cancelled the crow boot which was suppose to offload my right foot, and made other changes that do not give me confidence, there are no indications as to when they expect to do anything other than debride the foot.
It has now been 8 weeks since Podiatry took over care of the wound, I am no better than I was when they started, my second toe is healing as expected (but no indication as to why the foot blistered in the first place) and secondary wound has occurred on the side of the original injury.  When I was receiving the Mist treatments, infections were non existent ( I am now under antibiotic care for an additional 6 week to fight a new infection) and an explanation was never given as to why I only received 3 of 27 mist treatments authorized by fee services and why the treatments were cancelled. No plans have been discussed as to future offloading of the wounds or future treatments other than a weekly debridement.  That treatment has now been denied for the future with no explanation to me as to why.
As a Marine I learned the difficult we did right away and that the impossible took a little longer.  I will not stop this type of correspondence until my status returns to a satisfactory state or this issue is resolved.
John M Kegley
Lest you think that MIST Technology is some strange, new-age things, see the Bibliography of studies proving its effectiveness. It's not as cheap in the short run as debridement but, on the other hand, it was fixing the problem. The crow boot is not exotic either.
The VA system is not a privilege or a nice-to-have; it is a right that was earned by service to our nation. It is not a place to mess around; it is a place to implement effective treatment. Why was the treatment that was working ended and the treatment that was not working resumed?
Why the change?
Who benefited from stopping the treatment that worked?
So far, Jack has written several times to the VA and not received any response giving him a satisfactory response as to why the Seattle VA Hospital decided it didn't like MIST treatments and the crow boot. What will it take to get these questions answered and effective treatment resumed?


Washington State Legal Assistance to Military Personnel (LAMP)

The lawyers of Washington State help with Legal Assistance to Military Personnel through a variety of programs.

For Our Warrior Community

The Washington State Bar Association's Online Lawyer Directory has a way to locate lawyers who have picked Military Law as a practice area.
  • Go to http://www.mywsba.org/default.aspx?tabid=177
  • In the scroll box labelled "Area of Practice" pick "Military"
  • You may pick further criteria, e.g. city, although that will limit results
  • Click "Search"
  • You will get a list of lawyers; click on their names to get contact information.
Servicemembers, veterans and their families, just as any other citizen, may find information on pro bono (free) and low bono programs in Washington State, see "How to Find Legal Help". You can also find a lot of self-help materials at http://www.washingtonlawhelp.org/
Active duty service members may wish to go first to Armed Forces Legal Assistance's online database to "locate active duty legal activities offering general legal services within the continental United States". A query for the state of Washington lists the following:

Fairchild AFB (Air Force)
1 E. Bong St. Suite 103 [Bldg 2285]
Spokane, WA 99011
Phone: 509-247-2838 DSN 657-2838
Joint Base Lewis-McChord (Army)
Legal Assistance Office
Mailstop 69 Box 339500
Tacoma, WA 98433
Phone: 253-477-1873/1875 
McChord AFB (Air Force)
62 AW/JA
100 Joe Jackson Blvd
Tacoma, WA 98438
Phone: 253-982-5513 DSN 382-5513
NSB Bangor (Navy)
NLSO NW Branch Office Bangor
1001 Tautog Circle
Silverdale, WA 98315
Phone: 360-396-6003 744-6003
USCG Seattle (Coast Guard)
Commander 13th Coast Guard District
915 Second Ave.
Seattle WA
Seattle, WA 98174
Phone: 206-220-7110
NAVSTA Everett (Navy)
NLSO NW Branch Office Everett
2000 W Marine View Drive
Everett, WA 98207
Phone: 425-304-4551 727-4551
NAS Whidbey Island (Navy)
NLSO NW Branch Office Whidbey Island
3530 N. Langley Blvd.
Oak Harbor, WA 98278
Phone: 360-257-2126 820-2126
Naval Shipyard Puget Sound (Navy)
NLSO Northwest
365 South Barclay BLdg 433 Bremerton, WA 98314
Bremerton, WA 98314
Phone: 360-476-2156 439-2156

The Findlaw website has a city-by-city list of lawyers interested in representing active-duty military personnel, military reservists, and veterans here.
The Northwest Justice Project has resources for poor people needing help with civil (not criminal) legal matters. Its Veterans Project can help with things such as child support adjustments, vacating criminal convictions, driver's license suspensions, and more. See the video below ! You can also check out its list of resources relating to veterans.

For Attorneys

Washington State Bar Association has an active Legal Assistance to Military Personnel (LAMP) Section. For contact information, a calendar of upcoming trainings and other events, and more, see http://www.wsba.org/Legal-Community/Sections/Legal-Assistance-to-Military-Personnel.

Anyone with more information on these or other programs, please add in a comment below. The purpose is service!

See also

Monday, April 08, 2013

Search Washington State Law Sites Easily

Many important topics include information that spans multiple sites. For example, information on lawyers in Washington States is spread across one State Bar, multiple County Bars, various specialty organizations and the state courts.
You don't want to use plain ol' Google, because that tends to mix results from Washington State with Washington D.C. and Washington University in St. Louis. Instead, you figure out which sites you want to search all at once, build a Google Custom Search, and there you go:

4freeCLE: The Free CLE Newsletter! April 7, 2013

4freeCLE: The Free CLE Newsletter!
April 7, 2013
In This Issue
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Does Your State Offer Free CLE For Pro Bono?

Several states offer free CLE credit in exchange for pro bono service, e.g.MinnesotaWashington. Researching this is time-consuming, so if you want to do your colleagues a solid, check out your state and send the results to the editor. I'll be happy to give you credit in the publicity!

Director: Donald McWhinnie
Starring: Leo McKern
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From the comfort of your home, office or pasture, these webcast seminars makes it easy to keep your skills and knowledge up-to-date!
Find more webcasts at 4freeCLE's Web-Based CLE.
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Many of these in-person programs can earn you credit in multiple states. When in doubt, check with the credit-granting authority in your state.
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Washington State: How To Earn Six MCLE Credits a Year Through Pro Bono ServiceYou can earn 6 credits with 6 hours of service, every year! 
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