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Prosthetics Perils

Reprinted from PN/Paraplegia News May 2013

Because of a change in the VA prosthetics process, veterans are facing a tougher time getting medical equipment.

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When the Department of Veterans Affairs (VA) Prosthetic and Sensory Aids Service decided to overhaul the prosthetics process, leaders at Paralyzed Veterans of America (PVA) knew this could spell trouble for its members.

Veterans who were already used to enduring long waits for customized wheelchairs, patient lifts and other high-dollar prosthetics equipment now had to deal with even more red tape and time in an already painstaking process.

The New Way

Under this new process, a request for prosthetics equipment costing over “micro-purchase authority” ($3,000 or more) has to leave the local VA prosthetics for approval from centralized offices run by the VA Office of Acquisition and Logistics.

The $3,000 limit was established by laws governing contracting authority on the government’s behalf. That means those purchasing agents who didn’t hold a “warrant” cannot transact above the set limit.

Why is this important to PVA members? Because most durable medical items used by veterans with severe disabilities cost well over $3,000. The items must be approved by contract representatives who never have to interact with veterans. The representatives have no clinical expertise yet may question, modify, or delay requests for prescribed equipment.

If the process works as intended, a consult or prescription submitted by a clinician goes to the local prosthetics purchase agent. If the cost exceeds $3,000, the request goes to the network contracting representative for review.

The contracting representative solicits bids from vendors, and the chosen vendor produces and delivers the product. The clinically relevant aspects of the order don’t get questioned or modified by administrators. The chosen vendor is capable of meeting the time and specification requirements of the bid.


The veteran receives the equipment and can get on with life. That is what is supposed to happen. But here is what actually happened in the following cases:

Generating Paperwork

A PVA member with terminal, service-connected ALS (Lou Gehrig’s disease) and his elderly wife were prescribed a whole house generator in order to keep his ventilator working in the event of a power outage.

VA prosthetics delayed the request by referring it to a major medical equipment committee, which required the veteran to produce four years of records from the electric company and his spouse’s health records to substantiate the claim.

The local PVA service officer sought the intervention of the Veterans Integrated Service Network (VISN) director, after which the request was immediately approved. The same veteran was later prescribed an artificial ventilator but died ten days after the equipment order was submitted.

Records show the prosthetics chief sat on the request for a week, deciding whether she should rent or buy the equipment. When questioned, she answered there are no established time frames for procurement and delivery of such devices in instances of terminal illness.

Put on Hold

Another PVA member with terminal ALS was prescribed a percussion vest and ventilator machine, both needed to sustain artificially the veteran’s respiratory system.

The local prosthetics office received the consult for the vest on Dec. 3, 2012, but didn’t forward it to the network contracting office for nearly two months.

After the local PVA service officer got involved and pointed out the egregious delay to VISN leadership, the network contracting office placed the order the next day, and the vendor shipped the vest to the veteran by overnight delivery.

Similarly, the request for the ventilator took two weeks to reach contracting, which didn’t occur until the PVA service officer again raised the issue and notified the contracting office. The contracting office notified prosthetics that the ventilator cost less than $3,000, thus could have been purchased locally.

Power Problem

A PVA member with quadriplegia had a consult submitted for a power chair on Aug. 15, 2012, by his physical therapist.

VA medical notes show the order sat idle for about four weeks before being sent to the VISN contracting office. The responsible contract representative sought three vendor bids, then inexplicably closed the order after receiving none.

The PVA service officer contacted the VISN Prosthetics Representative (VPR) to find out why the order had not been fulfilled, only to find it had been dropped. The VPR attributed the process breakdown to miscommunication between local VA prosthetics and network contracting, after which she directed her staff to bypass the system to procure the wheelchair locally.

Two more orders were discovered to have sat for three to four weeks before submission to contracting.

We Told You So

These three stories increasingly typify reports PVA has received from the field that illustrate the reality of a VA prosthetics process in disrepair.

Orders found inexplicably languishing on an administrator’s desk; unnecessary referrals to approval committees for items that are routinely issued in other VISNs; prosthetics staff applying outdated or unenforceable standards to delay or deny requests. These are the symptoms of a system that needs greater quality assurance and more attentive leadership.

Although larger procurements like powered wheelchairs and porch lifts are a small percentage of the total workload for VA, they represent the most critical equipment needed by the majority of PVA’s members — veterans with paralysis, neurodegenerative diseases, and other severe afflictions who literally need prosthetics to live.

Delays in these procurements prove costly to the government, in terms of unnecessarily extended hospital stays while awaiting equipment, and to veterans, in terms of lost independence and quality of life.

Disheartening is the fact that PVA leaders predicted this would happen and voiced these concerns to VA leadership well before the changes to the prosthetics process were implemented in 2011.

Moreover, now that the top job in the VA prosthetics hierarchy, which is currently vacant, has been downgraded a level thus bearing far less authority, it’s hard to imagine how VA can fix these problems in the
near future.

It appears veterans can no longer count on VA to fix these problems on its own. And neither will PVA.

For more information or help with a prosthetics items or equipment, visit pva.org or contact a local PVA national service officer. 

 

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