Long Wait List at Missoula VA Clinic Provokes Changes, New Managment Explains

Veterans Administration clinics are under scrutiny across the country after the discovery of an attempted cover-up of deaths due to long wait lists in Arizona. Long wait lines for service are something Missoula vets say they have had to deal with too.

Tyler Preston fought in Afghanistan, but says he struggled to get care at the Missoula VA clinic after requesting help with blinding headaches that were hindering his college studies.

"I went in to make an appointment to see if I could figure out some other way of treating these headaches because it was distracting me in my classes," Preston said. "I went in to make an appointment, they said 'Can we have your phone number? We'll give you a call and we'll schedule an appointment.' I said 'Okay' and gave them my phone number. A week and a half later I got a call from the VA and they tried to schedule me for an appointment, but the earliest appointment was a month out. I had no other options but to take that appointment, so I took the appointment and I suffered through the rest of the semester."

Preston said he eventually got to speak to his doctor for only 15 minutes and received no help, however, things changed in recent months after a new manager, Nurse Practitioner Ronald Shepherd, assigned Preston with a new doctor and changed the way cases were handled at the clinic.

Shepherd took over management responsibilities in October of 2013 and said that annual visits and acute care problems were suffering delays when he came to the staff.

"We try to get people in annually for their visits, and what we were noticing was that these were getting further and further out," Shepherd said. "Some of the more acute issues, especially with the younger veterans who don't have as many chronic issues, were harder to get in and were having to wait longer."

In response, Shepherd focused clinic services on chronic conditions in the morning and acute care in the afternoons. There was also a goal of ensuring that each medical professional was being used to their full abilities, instead of focusing all of the clients on doctors.

"We're constantly trying to improve the process of using all members of the team to their highest level of licensure," Shepheard said. "Meaning that if it's an issue that can be brought in and an RN taken care of, then a person doesn't need to wait to see their doctor or nurse practitioner. We get them in, we get them seen by the RN, and the RN takes care of it."

Preston says that Shepherd also made another significant change.

"When you go to the front window, they had an inch and a half thick bulletproof plate glass separating you and the receptionist," Preston said. "One of the very first things that Mr. Shepherd did was take out that glass. I mean, what better way to say 'Hey, welcome, we're here to help you at the VA clinic, but we don't trust you enough to have an interaction face to face.'"

Shepherd said the glass was put up in the past after an incident involving a threatening client, but that the glass was causing more harm than good. Not only was it causing vets to feel as if they were being treated at arms length, those with bad hearing had troubles communicating with clinic staff.

"I'm a veteran myself," Shepherd said. "I would feel the same way. If you're treated that way, you're more likely to act that way. There needs to be trust on both sides."

Managing the wait-list at a VA clinic can be very difficult, especially at a clinic like Missoula's which handles somewhere around 6,000 patients from Montana and Idaho. Both states are known for having a disproportionately high number of vets.

Despite its flaws, Shepherd had high praise for the VA system, which he says saved his life just last month when he had to undergo a complicated neurosurgery.

"I wouldn't be alive today if it weren't for the VA," Shepherd said. "They used their sharing agreement with the University of Utah for me to see one of the number one neurosurgeons in the country. I had brain surgery about four weeks ago and I'm already back here at work. I'd say that that doesn't always get the publicity it should."