Tom Wilemon

twilemon@tennessean.com

The same gut instinct that helped Robert Morgan survive war in the jungles of Vietnam spurred him to stand up and plead for quicker medical care at a public meeting.

“I’ll die, and the reason I’ll die is because I don’t receive timely care,” he said to the director of the VA hospital in Nashville on Sept. 22.

The Goodlettsville man said he probably had cancer that had metastasized.

He was right.

On Oct. 7, he learned he had pancreatic cancer that had spread to his liver. He spent last weekend in that hospital on an IV after days of vomiting. Today, he is scheduled for his first appointment with an oncologist.

Morgan said the cancer should have been diagnosed earlier because he had several risk factors — diabetes, exposure to Agent Orange and a flare-up of pancreatitis two years ago.

The Nashville hospital is the flagship of the U.S. Department of Veterans Affairs’ Tennessee Valley Healthcare System. The average time to see a primary care physician there is double the national average, according to a recent report released by the U.S. Office of Inspector General. Satellite clinics in Dover, Clarksville, Murfreesboro and Hopkinsville have the same lags. And all of its clinics, including the ones that Morgan relied upon, lacked training on patient aligned care teams.

That’s a team that is supposed to provide “proactive” and “disease prevention” care, according to the VA’s own definition. Juan Morales, director of Tennessee Valley Healthcare System, agreed with the report’s findings and submitted a plan to complete corrective action by March 1.

Morgan spoke at a town hall meeting that was called after another government audit revealed that the hospital had some of the longest wait times in the nation for patients to see specialists.

Morgan said he never missed a doctor’s appointment, yet the cancer went undetected for too long.

“I don’t mean to point fingers at the doctors,“ Morgan said. “I’m sure they are overworked and are just doing as good as they can. I am trying not to be bitter.”

‘Deny til they die’

One doctor wrote him a letter on the day of his diagnosis. It was a letter to try to get another Veterans Affairs division to expedite an appeal Morgan made in 2009 of a decision to deny him full disability for post-traumatic stress disorder.

The letter states Morgan’s “prognosis for survival with this condition will depend upon tissue type, but it is likely to be poor. Please help expedite any pending VA claims on Mr. Morgan’s behalf.”

He walked into a VA service office in Nashville with the letter that day and also filed an Agent Orange claim.

“I still haven’t heard anything about my appeals claim, but within 24 hours I had a printed denial in my hand delivered by mail declining my claim for Agent Orange contamination,” Morgan said.

He’d like to get the appeals claim approved retroactively because an extra $1,000 a month would add up to something he could leave to his wife. Currently, he’s deemed 30 percent disabled due to PTSD.

Morgan was on a reconnaissance platoon with the U.S. Army, 2nd Battalion, 7th Cavalry.

“I received two Bronze Stars within three days of each other, both of them for heroism under fire,” he said. “I received an air medal. You have to make 25 combat insertions into hostile territory to be awarded that medal. I received an Army commendation medal. I received the Vietnam Cross of Gallantry. I was just a grunt. A foot soldier. Cannon fodder.”

Morgan said he’s asked a member of the staff of U.S. Rep. Jim Cooper, D-Tenn., for help because he does not think the VA will make a decision on his appeal before he dies.

“That’s the way they do veterans,” he said. “Veterans talk about it. We got an expression for it. It’s ‘deny til they die.’ ”

Reach Tom Wilemon at 615-726-5961 and on Twitter @TomWilemon.

What the OIG report says

Tennessee Valley Healthcare System needs to make several improvements, according to a report from the Department of Veterans Affairs Office of Inspector General.

Alcohol abuse: Managers need to ensure that patients with excessive alcohol use receive brief treatment or get evaluated by a specialist within two weeks of screening.

Patient service: Staff from clinics need training on how to interview patients and coach them.

Drug reaction: Staff needed to track patients receiving newly prescribed fluoroquinolone and better inform patients about the possibility of reactions and side effects.

Maury County: Outpatient clinic not compliant with the Americans with Disabilities Act. Staff did not have access to electronic version of hazardous materials information. Process to ensure tracking of hazardous materials needs improvement. Panic alarm system needed evaluation. Signage needed for location of fire extinguishers. Medications needed to be secured to be accessible only by staff who dispense or administer them. Personally identifiable information needed better protection when laboratory specimens were being transported. Information technology security closet needed better safety and security standards.