Josh Moon

Montgomery Advertiser

In an exam room at the Central Alabama Veterans Health Care Systems hospital in late May, Willie McCall, a decorated Army veteran who served in the Korean War, was dying.

His blood pressure had dropped to a dangerous low and his Chronic Obstructive Pulmonary Disease had left McCall, who was unconscious, gasping for air. The 85-year-old’s upper body mostly rested in the lap of his nephew, Fred Porterfield, who had been caring for his uncle for the better part of five years. McCall’s lower body and legs were in the lap of Dawn Knapp, Porterfield’s business partner at F&D Auto Repair and one of the many people who helped care for McCall in his final days.

McCall was lying on his two caretakers because the room contained no bed. He had been rolled into the room in a wheelchair for an exam, but during it, his blood pressure had dipped and he began to slide out of the chair. Although there was a doctor and a nurse in the room at the time, it was Fred and Dawn who said they caught McCall and tried to arrange his frail, 95-pound body into a more comfortable position on the floor, in their laps.

The doctor in the room at the time, Porterfield said, was Dr. Ramaseetha Gutta, and she determined that McCall needed emergency care to survive. She and the nurse left the room to call for an ambulance to take McCall from CAVHCS to Baptist East.

When the door to the exam room closed behind them, Porterfield and Knapp were on the floor, holding McCall, who had been awake and alert hours earlier, had eaten breakfast that morning and was, despite his dementia and other health issues, very much alive.

For 15 minutes, Porterfield estimates, the three sat in the room on the floor, McCall gasping for air. No one from the VA hospital entered the room. Dr. Gutta did not return to check on her patient. No nurse brought oxygen or other medication. No orderly brought a gurney.

“The next time that door opened, it was the paramedics coming to get him,” Porterfield said. “The people at the VA left him in there to die. They simply didn’t care. Didn’t check on him, didn’t do nothing. How can you not care more than that? That’s what I’ll never understand about all of this – how they just didn’t care.”

McCall did not die that day, or even that week. After nine days and a surgical procedure at Baptist East, McCall recovered enough to go home. A day after returning home, on June 6, he suffered a heart attack and died at Baptist South.

But that day at CAVHCS when they were left alone, Porterfield and Knapp say, is indicative of the sort of uncaring, bureaucratic, infuriating treatment they endured while dealing with a VA system that seemed far more focused on arbitrary regulations than on patient care and service.

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A history of frustration

McCall and his family’s issues with the VA stretch back into the 1950s, when he began applying for veteran’s benefits for injuries he suffered during the Korean War. Serving as an assistant gunner, McCall was on the battlefield during brutally cold weather while fighting the former Soviet Union, and as a result he suffered frostbite on his feet.

Documents retained by McCall show where he was treated by doctors on the battlefield for the injuries. It was those documents and the help of Alabama Rep. Martha Roby, R-Montgomery, that finally allowed McCall to claim his benefits and obtain treatment for his injuries – 56 years later.

In June 2014, headlines around the country announced that McCall had received more than $100,000 in money owed to him for years of denied treatment and that he was finally able to get the free medical care he deserved.

But that wasn’t the complete story. In reality, the $100,000 payment to McCall was merely a portion of the sum he was owed, Porterfield said. Documents he showed the Advertiser refer to McCall’s payment as “partial” and Porterfield said the family was told that more money would be coming when the VA calculated the total amount owed.

Four years later, that calculation continues.

“They’ve never sent us another dime,” Porterfield said. “When I write and ask, I guess they ignore the letters. I sort of got the feeling they were just waiting on him to die, trying to wait him out, you know.”

Porterfield said it wasn’t simply the lack of payment that left him with that feeling. There were a number of other issues, as well – from long delays on things as simple as McCall’s orders of orthopedic shoes for his damaged feet to infuriating denials for coverage of things McCall clearly needed, such as assisted care.

“Just pick a topic or an area and I guarantee you we have a story that will blow your mind,” Knapp said. “I think that while we were involved in it, it was hard to see how bad it was. But once Willie died and we took a step back, it’s something that just makes you angry and makes you wonder how many days or even years did this cost him.”

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'Worst of the worst'

CAVHCS officials are currently examining McCall’s case and attempting to uncover what went wrong and how it might be prevented in the future. In a statement to the Advertiser, a spokesperson said, “As we are unable to discuss specifics concerning Mr. McCall’s health care, the Chief of Staff and his highly qualified team is conducting a case review of the Veteran’s health care records to determine if there was a lapse in the Veteran’s health care.”

Roby and her office have also been looking into the problems. While she said she couldn’t get into specifics because of privacy concerns, Roby called McCall’s treatment “the worst of the worst” among many horrible stories recently of veterans’ care.

Following a VA event on Thursday in Montgomery, when asked about McCall’s case, Roby put her hands up, took a deep breath and said, “Wait just a second, because I’ve been thinking about what I want to say about this.”

After a pause, the congresswoman said, “(McCall’s case) represents the worst of the worst within the VA. When things like this happen – when things this seemingly egregious happen – I get very frustrated. Because when we identify bad actors in the VA who cause many of these issues, we can’t remove them.

“To be clear, 95 percent of the people who work in our (VA) are good people and their hearts are in the right place. But there is a culture of complacency and mismanagement there that has been allowed to fester, and (McCall’s case) is one of the results of that.”

Of the many examples of poor treatment that Porterfield and Knapp relayed to the Advertiser, the one that brought them the most grief, because of its time-consuming nature, was the numerous applications they submitted for aid and attendance for McCall.

Aid and attendance benefits provides a veteran an increase in pension if he requires the aid of another person to perform daily tasks, such as bathing, feeding, using the bathroom, etc. In June 2013, the VA ruled that McCall was eligible for those increased benefits due to his dementia and trouble walking.

However, when Porterfield, who, as McCall’s only relative, had power of attorney for his uncle, began applying on behalf of McCall to receive the benefits, the claim was denied. And it continued to be denied, despite a letter from Dr. Gutta stating such aid was required for McCall, and despite a VA employee filling out the request forms.

“I was spending $5,200 per month trying to take care of him and they’re telling me that he doesn’t need the aid,” said Porterfield, who would get up each morning at 5 to go sit with his uncle until another caretaker arrived at 9.

“When you try to respond, they don’t want to talk to you, they just want you to fill out the forms,” Porterfield said. “So they can mail them back, denied, and never really tell you why. I’ve spoken with so many people about this, tried to understand what was needed to prove this, tried to provide everything necessary, but it still wasn’t enough.”

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Missing signs

The problems didn’t end with a lack of compensation for aid for McCall. For months, Porterfield and Knapp would load McCall into a car and take him to Birmingham to get an ultrasound. They assumed the scan was to monitor McCall’s COPD – a condition doctors blamed on his years of smoking, a habit McCall picked up in the Army thanks to the free cigarettes, but one that VA doctors never prescribed him oxygen to treat.

In 2015, after two years of the trips to Birmingham, a private physician, who was examining McCall after Porterfield became concerned that the lack of care he was receiving at CAVHCS was the problem, told Porterfield and Knapp that the artery in McCall’s neck was almost completely blocked.

“It was cutting off circulation to his brain and here you have a patient with vascular dementia,” Knapp said. “They weren’t treating it. We were telling them that he was sleeping a lot and they would just write it off to the dementia, saying, ‘Well, you should be happy he’s sleeping and not up all night screaming.’”

It was that sort of dismissive attitude, Porterfield and Knapp say, that led to many of McCall’s late-stage issues, and ultimately, they believe, a painful death.

As his uncle’s health began to deteriorate rapidly in October, Porterfield said he became increasingly concerned about the quality of care and the attentiveness of the VA doctors. Knapp too, who has some training in elderly care, was noticing signs of odd issues. But each time they brought up the oddities or symptoms, they say the doctors and staff at the VA quickly dismissed them.

Swelling around McCall’s feet was written off as high salt intake, despite Knapp using little salt in the meals she prepared for him.

Problems producing a bowel movement brought a prescription for a stool softener.

Pain in McCall’s abdomen – pain so severe that he would scream when anyone attempted to lift him from his wheelchair – were also written off as a symptom of the bowel issues.

And everything, they say, could be explained by stating that McCall had dementia.

“Because he had dementia and was 85, they wrote him off and didn’t care,” Porterfield said. “I don’t say that lightly. I’ve thought about that. I’ve thought about their attitudes. You don’t dismiss people like that unless you gave up on them. I don’t know how long he had left, and he might have died at the same time, but he didn’t have to feel the pain that he did.”

In March, McCall’s face began to swell, and Porterfield and Knapp said he looked as if he had been punched repeatedly around his eyes. They had seen enough.

They reached out to a friend and asked for help getting into see a private doctor. It took a couple of weeks, but they say that doctor told them that many of McCall’s issues had been treatable – but they had been missed for far too long.

The stomach issues were being caused by a blocked gallbladder. The issues with McCall falling asleep were caused by the blockage in his neck. The swelling all over his body was because his kidneys were failing – a product of extremely high potassium levels.

“The doctor said all of it could have been caught with simple bloodwork, which they rarely did at the VA,” Knapp said. “We actually had them tell us once that they’d use the bloodwork from the last visit, not to worry about it.”

Knapp and others who cared for McCall said VA staff routinely failed to take his blood, weigh him properly and take his blood pressure, because his arm was so small “they didn’t have a cuff to fit him.”

Knapp said she began the process of catheterizing McCall twice per day. After a week, he had shed nearly 40 pounds.

“That poor man had that much water sitting on him,” Knapp said. “But here’s how resilient he was – every time we would solve one of these problems, he would bounce back a little more, be a little more like the Willie we knew.”

Eventually, McCall returned somewhat to his former self, started to eat again and interact with his caretakers. But in May, he began to have consistent issues falling asleep. Porterfield said his uncle would sometimes fall asleep while eating and appeared to be groggy, especially late in the morning after his breakfast. When that issue was mentioned during a doctor’s visit at the VA, it was written off as a common symptom of dementia.

But on May 26, when McCall fell asleep during the visit and his blood pressure was dangerously low, Knapp said Dr. Gutta began asking what McCall’s blood pressure was prior to Knapp administering his blood pressure medicine. Knapp, taken aback, said she had no idea and wasn’t aware that providing the medicine was up to her discretion.

“I’m not the doctor,” Knapp said. “Maybe the sleeping was tied to the dementia, maybe the blood pressure issue was something that just happens, but it had been going on for weeks and instead of listening to us and checking on it, they dismissed it, again.”

Prevention for others

At the root of it all, Porterfield and Knapp say their problem is the dismissive and uncaring atmosphere towards military veterans, especially in a system set up to care for military veterans. Often, they said, they felt like “a number on a chart instead of an actual patient,” and that their primary care doctor was often in a rush, seemingly overwhelmed by her patient obligations.

And she was not alone. The indifferent attitude, they said, has seemingly infected the entire system and exists even after an embarrassing scandal exposed egregious failures. To illustrate that point, they told the story of attempting to get dental care for McCall.

After several failed attempts and canceled appointments (on the dentist’s end; Porterfield said he never missed one of his uncle’s appointments), they were finally able to get into see a dentist to possibly determine why McCall wasn’t eating and seemed to be in pain on one side of his mouth.

The visit was cut short, Porterfield said, because McCall was “too weak to hold the X-ray machine up by himself so they couldn’t get X-rays of his mouth.” Knapp volunteered to wear a leaded vest and hold the machine, but CAVHCS staff said that was against regulations.

“All they did was the dentist went in there with a toothbrush and toothpaste and started trying to brush his teeth,” Porterfield said. “She looked in there, said, ‘Oh, he’s infected,’ and that was it. She said he needed to see an oral surgeon. Of course by that time, though, the problems with the kidneys was there and we didn’t have long enough to get him in to see the oral surgeon.”

Porterfield and Knapp said they’re not sure why there was such a failure in treating McCall, particularly since his case was so well publicized and so many people knew him. But whatever the reason, they know he wasn’t alone. They have heard the stories from other vets during long waits at appointments and Porterfield said he’s received letters from veterans relaying similar stories.

In each instance, he said, it’s simply a lack of compassion and an overwhelming amount of bureaucracy that stands in between the patient and quality health care. The bureaucracy, he expects, but the lack of compassion is troubling.

“These folks fought for their country and were injured,” Porterfield said. “I can’t understand why they run into so many problems just trying to get the care they were promised. They’re not after a handout. They just want to be cared for the way you said you would. It’s a shame that’s not the case.

“I thought about letting it all go when my uncle died, but I hope by telling this story and what we went through, maybe it will help prevent it for others. Our veterans deserve better than what we received. A lot better.”