Pro and Con of VA Community Connect

As a foot and ankle surgeon working in a largely populated diabetic community having a established relationship with at risk diabetic is essential for efficient and quick care.  I have been with the Veteran Affairs Community Connect for over 5 years and have created wonderful relationships and lifetime friends.  Once established, diabetics in my practice can be seen in 24-hours to reduce infections and amputations.  With the Community Connect Program referrals are good for 6 months and patients are aware when it expires.  Overall, with this program, we as a practice have saved many limbs and reduced the number of hospitalizations.  However, this case presentation shows that the biggest CON of this program is access to local care.

The 64-year-old diabetic patient with Charcot deformity and complete neuropathy had a established relationship with me for the past 2 years, undergoing preventative care, and also as needed, diabetic ulcer care.  Patient was seen for an ulceration on the bottom of his right foot and has been improving over a two week period, however, patient was seen at his two week follow-up, which showed the ulceration getting worse.

At that point, I was concerned about progressive osteomyelitis as the wound was probing deeper to bone. Advised patient to go to the emergency room, however, patient had VA that required patient to be seen at the local VA hospital, as he had no other insurance.  At that time, detailed instruction was given upon admission on my recommendation.  Patient went the same day to the VA and was given oral antibiotics and sent home.  At that time, several days past by, then the foot got worse, s patient went again to the VA Hospital where he was admitted and placed on numerous antibiotics.  There were some issues with the operating room and surgery was not scheduled for another 7 days, requiring the patient to be admitted on IV antibiotics during the duration.

The patient returned to my clinic 2 months later with the partial amputation of the 5th digit to metatarsal and with an open ulceration of the foot.  Patient also DC home care, as he was feeling inadequate and is now having family members do the daily dressing changes. Situations with ulcerations progressing do happen frequently and podiatric practice, however, the benefit is to have the patient be sent to the local hospital where patient is seen and treated that same day for adequate consultation, IV antibiotics, MRI and possible limb salvage procedure. Could we of saved the patient’s 5th digit and metatarsal with fast response in a hospital setting? That question is unknown, however, having the resources for the patient to be seen rapidly and given adequate care is needed. Obviously, there are 3 sides to the story.

What I learned from this situation is to empower the patient to stand their ground for recommended specialist treatment. And if not heard as an office, jump through the hoops with the VA to get authorization for the patient to be seen at the local hospital.

Darryl Martins DPM