Veteran gets locked up instead of lifesaving care

KEYSTONE HEIGHTS, Fla. – James Ponder knows about pain. He was just 21 when his knee was blown off by a 51-caliber machine gun round that shattered his right femur and left a gaping hole that he compares to a bite from a "big ol' shark."

A swiftboat gunner patrolling the southernmost tip of the Mekong Delta in November 1968, Ponder had been in country just four months when he went from being Vietnam conscript to medically discharged Vietnam Vet.

But Ponder – who has since suffered ailments including a ruptured colon, heart attack and abdominal hernia -- is philosophical about pain. "Pain is pain," says the 67-year-old Keystone Heights resident. "I feel I come out a better person for having experienced things in life that have brought me pain."

That said, Ponder describes a recent eight-week abdominal illness as a period of indescribable agony. "It was a pain I've never felt before," Ponder says. "It was very excruciating -- an extreme type of pain. There was just no way to escape it."

Three times Ponder went to the emergency room of the closest Veterans Administration hospital – twice in Gainesville and once in Live Oak. All three times, doctors misdiagnosed his pain as hernia-related.

Ponder was sure they were mistaken. "I genuinely felt like I was dying from within." He was so certain, he told his wife, Rebecca, to seek an independent autopsy in the event he died – simply to determine his true cause of death.

Doctors were reluctant to prescribe pain medicine, believing it would cause constipation and only aggravate his symptoms. Instead, they offered him a temporary painkiller – a shot of morphine – and sent him home to rest. Twice, he went home to "climb the walls" in pain. The third time, he refused to leave.

"I drew a line in the sand," says the 67-year-old, absentmindedly rubbing his useless leg. "I said, 'If I go home and I can't take the pain, I might have to be forced to find some way to end it myself.'"

Ponder's statement prompted yet another misdiagnosis. Doctors determined he was suicidal, and committed him to the hospital's psychiatric ward for a 72-hour involuntary lockup, known as a Baker Act. Made to surrender his possessions, including his electric wheelchair, and told he would not be able to have visitors, including his wife, Ponder compares the process to being arrested. It was, he says, the single most humiliating experience of his life.

"I'm not crazy," he wrote in a May 26 letter of complaint. "The VA is crazy for making me endure my awful pain for so long without pain medication!"

Reports of troubles at the nation's VA hospitals erupted last year amid allegations of substandard care and "secret" patient waiting lists. Alongside horror stories of veterans dying from misdiagnosis and delays, an internal VA audit in May found a "systemic lack of integrity" at some facilities. In June, a White House review in June found "significant and chronic system failures." And catching up with the patient backlog has proven a challenge. In June, the VA estimates, 46,000 new patients waited at least 90 days for a general care appointment.

The Malcom Randall facility in Gainesville is one of several in Florida that has been in the headlines. Targeted by inspectors for surprise visits earlier this year only to be turned away, it has been a prime target of Gov. Rick Scott, who announced he would sue the VA for "stonewalling."

Despite his recent experience at Malcom Randall, Ponder is a fan of the VA. Until recently, he says, he's gotten terrific care for myriad illnesses. Even in this case, he generously credits the team of vascular surgeons who ultimately diagnosed his illness as ischemia -- a potentially fatal lack of blood flow to the digestive system. "My small intestines were dying off," he says. "They saved my life, no question."
Ponder is determined that his experience teach the VA a lesson, however. He doesn't intend to sue, but he did write a scathing letter to the hospital director. "I demand you investigate this situation, and correct the problem where another veteran will never experience the hell I was put through," he wrote. "I've never been so embarrassed, insulted humiliated and disgraced by my nation."
Ponder's letter has gotten responses from Florida Sens. Bill Nelson and Marco Rubio. He also received a got a written apology from Thomas Wisnieski, facility director, and an apologetic phone call from an emergency medicine physician. "He told me they made a mistake, and they shouldn't have done that."

Dr. Bradley Bender, chief of staff of the North Florida / South Georgia Veterans Health System concedes that "in retrospect he may not have needed to be Baker Acted," but he stops short of calling what happened a mistake. He notes that Ponder did express a desire to "end it," and that "he fit all the risk factors for patients who commit suicide," including age, illness and combat experience.

"We actually did the right thing," says Bender. "I'd much rather be apologizing to you [about] why we put someone under a Baker Act who was not going to be committing suicide, then trying explain to you why we let a veteran go home who expressed he wanted to kill himself, and then apologizing to the media and to his wife for doing it."

Ponder didn't stay locked up the full 72 hours. The Baker Act was rescinded a few hours later when a staff psychiatrist determined he wasn't suicidal. "He said, 'you did the right thing you did the right thing in your case. You needed care,'" Ponder says of the doctor that rescinded the commitment.

Though reluctant to recommend his "solution," Ponder firmly believes that he would have died if he hadn't stood his ground.

"You have to do something like I did."

He clarifies, "I would not recommend you threatening to kill yourself or anything like that. [But] I did what I had to do to get the medical care I needed."

Veterans experiencing a mental heath crisis can contact the VETERANS CRISIS HOTLINE at 1-800-273-8255 Press 1


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