Readers of Tom Philpott's Military Update column sound off.

Beneficiaries Angry Over Delays Getting On-Base Care

As one of those repeatedly surveyed by TRICARE, I can attest to the accuracy of comments made in the article concerning access to care. When I first arrived with my family in the Washington, D.C. area in 2001, I found it nearly impossible to get someone to answer the TRICARE appointment line. When they did, it often took days, even weeks, to get an appointment.

I was told the local area policy was not to refer anyone outside the military system unless an appointment could not be had within 30 days. Conversely, clinics refused to book appointments more than a month in advance even for recurring issues. I was told to keep calling each successive day until I found an opening. If we complained of an acute need or called after duty hours, we were told to go to the emergency room at Andrews.

The first time I tried to book an appointment with my daughter's assigned pediatrician I was told the doctor had left active duty a year earlier. As a result my daughter did not see a pediatrician for over a year. My wife was assigned to the Gold Team but denied access to every doctor on it because their caseloads were full. Instead she was assigned to a physician assistant despite her rather extensive medical problems. In the end this turned out not to matter much because she rarely saw the same physician twice. She saw the doctor, PA, or nurse that had the first available open appointment. She couldn't see a specialist without a referral from a primary care physician, which meant making two appointments.

The final insult occurred when I was about to retire in 2007. My wife went to see her doctor at Bethesda about chronic lower abdominal pain. The doctor wanted to refer her to a surgeon because she suspected a possible hernia. She was overruled by her superior who never physically examined my wife and who said it most likely was a groin pull. As a result she was not allowed a follow-up. Six months later we were living in rural Montana where TRICARE Prime is not available. Although it cost more in out-of-pocket expenses, it proved to be something of a blessing in disguise. Since she was now seeing a private physician in Helena, there was no bureaucratic delay in getting to see a surgeon and having an ultrasound performed. It showed an inguinal/femoral hernia. Her surgeon performed corrective surgery the next week at a day surgery.

Good luck receiving such prompt care at a military hospital or clinic.

Had I been able to learn the name of the doctor at Bethesda who denied her care, I would have asked that charges be brought against him because her condition had become potentially life threatening due to the delay. We are much happier now not having to deal the total BS that seems to permeate TRICARE Prime.

WILLIAM M. KOHNKE
Colonel, USAF-Ret
Elliston, Mont.

I read with great interest your column entitled "TRICARE deputy gives system 'C+ or B-'." I understand why beneficiaries are choosing to use network providers rather than military providers. Unfortunately, overseas you do not even have that option.

I have had several dangerous situations with the military medical system. Two ended with complaints to Congress, although neither was solved to my satisfaction.

Since being overseas, my daughter has been through hell with the military providers: first with horrendous care by a pediatric behavioral medicine provider and then she had to endure incorrect surgery!

Yes, the procedure that was supposed to have been performed was not. After meeting with the hospital staff and patient safety representative, she was given a referral to a civilian provider where they performed the correct procedure.

Most recently, my daughter was misdiagnosed at the Fort Benning ER and was given an antibiotic that sent her back to the ER unable to breathe because she had mononucleosis, not tonsillitis.

I could go on with other stories about the care the rest of my family has received, but the bottom line is the same: military care is unreliable, inconsistent and, at best, slipshod.

NATALIE E.
Ramstein Air Force Base, Germany

Camp Lejeune Naval Hospital is the hardest place to get an appointment of anywhere we have been in last 20 years. We returned this summer after being gone three years. I am in the Exceptional Family Member Program, living in base housing and was enrolled to a family practice provider who was in the process of checking out. Then I was told that, yes, I was in Family Practice but I did not have a primary care manager.

After several trips to and phone calls with the TRICARE office, I was sent to the "panel co-coordinator" and assigned a new PCM. When I try to get an appointment I am told there is at least a seven-week wait.

I am overdue for several tests and studies that I have been told for 10+ years I should have done on a regular basis. I am past due for repeat tests and biopsies that were either misread or mishandled at our previous duty station, and need to get replacement medication for one I had to stop taking before our move here due to side effects.

The sad thing about my situation is my husband is a Navy Medical Officer - a family practice physician, currently assigned to a Green Side billet. A major complaint you hear from the hospital is over the number of people who show up in the ER for non-emergent issues. How else do dependents get to see a doctor?

I was smart enough to get refills on most of my meds before moving, and am able to manage pain on my own. But I can't do MRIs, CT scans, blood work or biopsies on my own. I do not rely on my husband to manage my healthcare, nor do I go to the ER. I am waiting patiently for this to get resolved. I have faith in the system my husband's career has been centered around, but it is getting more difficult to think things will ever be right again.

With the increasing numbers of Marines coming to Camp Lejeune doesn't it make sense to increase the number of providers? Some people are being given the option to go to doctors out in town but they are experiencing the same wait times there. It's time the Navy goes back to taking care of its own. Your article mentioned a grade of B- or C+ for medical system's performance. It's a failing grade at Camp Lejeune.

KAREN LARCOMBE
Via e-mail

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