Veterans question care decision by VA Mountain Home

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JOHNSON CITY (WJHL) – Fifty years after he first touched down in Vietnam serving his country in the U.S. Navy, Charlie Higdon of Greeneville, Tennessee is fighting a new enemy everyday.

“I can’t do stuff I used to be able to do,” Higdon said, seated in a chair inside his neurologists drug infusion clinic where he goes every week to get treatment for Myasthenia Gravis.

“I got diagnosed many years ago, but I probably had it way before then,” he said.

The foundation that raises awareness about MG calls it “a chronic autoimmune neuromuscular disorder that is characterized by fluctuating weakness of the voluntary muscle groups.”

“Who knows why I got it,” he said. “We had Agent Orange everywhere, and I’d bet that has something to do with it.”

For years, the VA’s response to Higdon’s condition was to place him under the care of a neurologist and to cover the cost of expensive drug infusion therapy, something he’s recently started receiving weekly as the disease has progressed.

“I don’t think I’d be in the shape I’m in now if it wasn’t for that,” said Higdon.

“I don’t think I’d be in the shape I’m in now if it wasn’t for that,” said Charlie Higdon of Greeneville, US Veteran.

Until last year, Hidgon and other vets needing neurology care went to the Mountain Home VA Medical Center where contract neurologists like Dr. Stephen Kimbrough operated a clinic and oversaw drug infusion therapy.

In February 2015, the VA chose not to renew the contract, even though VA Mountain Home says it did not have its own neurologist on staff.

In the following weeks, vets needing neurological care gradually found physicians in the community.  Many, like Hidgon, began going to Dr. Kimbrough’s Johnson City office at Tri-State Mountain Neurology.

To treat Myasthenia Gravis, Higdon has been coming to an infusion clinic at his neurologist’s office. The VA now wants him to come for infusions at the hospital, something Higdon says he does not prefer.

There, VA patients and those not in the VAsystem receive infusion therapy under the oversight of neurologists.

According to the VA, Charlie Higdon is one of about 20 veterans treated by Dr. Kimbrough for neurological-related drug infusions for conditions like MG and multiple sclerosis.

“It’s been great,” Higdon said. “They’re really good to me here. I don’t have trouble getting appointments, and they’re able to keep a close watch on how I’m doing.”

In Hidgon’s opinion, that closely monitored care has made a difference.

“About two months ago, things started getting worse, so now I’m coming for infusions every week.”

Then two weeks ago – one year after the transition to community care – the veterans getting infusion treatments got phone calls from the VA.

“She told me to stop going to my neurologist for drug infusion treatments,” Higdon said. “She told me I had to start going back to the VA for that.”

What about his neurological care, he wondered, since his physician no longer had a VA contract?

“The word I got was there would be a neurologist (at the VA),” Higdon said. “They were hiring a neurologist. But I found out they’re hiring a rheumatologist instead of a neurologist.”

A spokesman confirms VA Mountain Home just hired a staff rheumatologist, a specialist who treats people with a variety of autoimmune disorders. She said that physician is credentialed in the VA system and able to safely oversee infusion drug therapies for veterans who need neurological care.

“Anytime we can provide the service in-house, we do it here, and that’s just good care,” said VA spokesman Judy Fowler. “We would never allow any physician to operate outside the scope of their practice.”

“It’s a fairly routine procedure,” she said.

But what VA Mountain Home officials describe as a logical, low-impact decision was met with sharp reaction by the veteran patients and Dr, Kimbrough, a physician who, until last year, was hired by the VA to care for neurology patients for 35 years.

“No one (with the VA) even came to me to talk about it,” said Dr. Charles Kimbrough. “Never heard anything from anyone. Actually, the first person to say a word to us was our patients.”

Kimbrough said the VA’s decision to put his patients under the treatment oversight of a rheumatologist makes no sense. “They (rheumatologists) are not comfortable with our drugs at all,” he said. “Some of the medications can be quite dangerous, and unchecked can lead to other serious problems.  Just today, I had a patient in my clinic start to have a reaction to the infusion drug. We need to be involved.”

Kimbrough said he and his practice believe the VA’s decision compromises their ability to care properly for his patients. “If you’re taking care of a patient, you have to be on top of everything.” So he says they had no choice but to drop the approximately 20 veteran patients needing infusion therapy.

“I’m not sure what these people are going to do, and it concerns me greatly,” Kimbrough said.

Not surprisingly, Kimbrough’s patients – several of whom contacted News Channel 11 about this issue – aren’t happy with the final result of the VA’s change.

“I’m losing my neurologist, and I’m losing my comfort,” Higdon said as he wrapped up his final drug infusion treatment at his neurologist’s office. “Sometimes the VA acts like they don’t care about the veteran. They want to save a little money.”

Kimbrough agrees. “Like most things – I suspect it’s financial. The problem is – financial doesn’t look at what is going to happen to the patients.”

The VA wasn’t aware of Kimbrough’s decision to drop his veteran infusion patients until informed by News Channel 11. We asked why Kimbrough’s opinion as the patient’s caregiver apparently didn’t factor into the VA’s decision.   “He’s not our employee,” Fowler said.  “It would be the chief of staff who is a medical doctor himself.  He would make that call.”

Chief of Staff Dr. David Hecht says the quality of the veteran’s care is the VA’s primary concern. He called the decision by Kimbrough and his practice to discontinue care for the veterans “unfortunate” and said it was the VA’s intent to continue compensating Kimbrough’s practice for general neurological care even after the removal of infusion therapy.  “Any of those veterans who need a neurologist’s care will get it,” Hecht said.

As for Dr, Kimbrough’s claim that the decision likely was based on money, the VA confirms money did play at least some role.

 “At end of contract period, the services provided were evaluated and the cost was considered and it was felt it would be better to bring that workload back to the facility. The estimated cost of sending these patients into the community for infusions was approximately $1 million. The salary cost (including benefits) for a part-time rheumatologist to perform the infusions at our facility is less than $150,000 per year. “

– VA Spokesperson Judy Fowler

“So it would be irresponsible of us from a fiduciary standpoint if we didn’t bring it in house,” Fowler said. “We have someone here who can provide the care.”

As for the veterans who aren’t happy with the decision, Fowler asked for patience. “We want them to be happy with their care,” she said “They have to keep in mind that we have to do the right thing for the VA.”

Charlie Higdon left his neurologist’s office with plans to get his next infusion under the care of a VA rheumatologist. As for who will oversee the treatment of the disease that’s robbing him of his ability to control his own body? “No clue,” he said. You’re guess is as good as mine.”

“This is not caring for us as far as I’m concerned,” Higdon said.Copyright 2016 WJHL.  All rights reserved.

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