Doctor refuses to acknowledge VA doctor - page 2

I work in a long-term care facility. Our medical director doesn't have the best bedside manners, but he is our medical director and we should have some respect for his position. Yesterday a... Read More

  1. by   Simplepleasures
    Quote from kukukajoo
    Exactly- the doc may not have a license in that state. And there have been cases where the docs do not have ANY license to work in federal. One example would be a retired doc.

    You are incorrect about Nurse aides- they are LICENSED in NH, ID, WY, WI- they are called LNA's and you do need the license to work. There are several other states that require licensing as well.
    I dont know about the other states , but here in WI we call them CNAs, and they are not liscensed but but pass a certfication test, they are certified.Ive never heard of an LNA.
  2. by   CHATSDALE
    one of the 'rights' of ltc resident is to choose their own doctor
    most use the medical director of the facility because of the extra cost of a private md...
    perhaps the md at the va clinic could call the medical director and discuss the plan of this resident
  3. by   Noryn
    I think we need further clarification of the exact situation. Is this a typical nursing home type facility or an assisted living facility? Also is the medical director just allowing the pt to have 5 days worth of medication or is he just saying that the pt has to report to the nurses every 5 days to get refills.

    I would ask the medical director the rationale, and go from there. He may have a good reason he doesnt want the pt to have the full 30 day supply of meds at one time. Safety is the big reason that immediately comes to mind. I honestly dont see what the big deal is, of having the pt pick up a 5 day supply or even having the nurses take this to him every 5 days. When I worked home health, I had many patients tell me they were very uncomfortable with keeping 60-90+ oxycontin in their house.

    Now if the medical director is only allowing the pt to have 5 days worth of medication for the whole month, that is a different story. Administration needs to be notified and the family needs to contact the ombudsman.
  4. by   Jolie
    Quote from kukukajoo
    And there have been cases where the docs do not have ANY license to work in federal. One example would be a retired doc.

    You are incorrect about Nurse aides- they are LICENSED in NH, ID, WY, WI- they are called LNA's and you do need the license to work. There are several other states that require licensing as well.
    Thank you for the information about LNA's. I am not familiar with that status and will look into it.

    However, I still believe that you are mistaken about unlicensed doctors practicing in the federal system. Retired does not equal unlicensed. One can be retired from active practice, but still possess a license and be legally qualified to practice. I am "retired" from nursing because I am unwilling to work in the field at this time, but I still have an active license in good standing, and am legally qualified to practice nursing in my state of licensure, or in any federal facility across the US and the world.
  5. by   kukukajoo
    LNA is Licensed Nurses Aide. Sorry I meant that is what they are called here in NH. Not sure of what they are called in the other states but I was under the impression all other states I listed had to have a license issued from the state. I could be wrong, but I was under the impression CNAs in WI had to be licensed by the state. I edited my post so it made sense to others as I think I was the only one understanding my thoughts and even now I question if I do, lol!

    Was distracted while posting by my new puppy we just got today and my daughters sweet 16 party was getting a bit out of hand. I should know better than try to be quick, I just fuddle things all up.

    Not all states require licensing but many do now and more are adding this as a requirement. You take a test or get certified and receive a license in that state. Regardless if they are called certified or licensed, if you have to carry a license from the board of nursing or other entity within the state, then you are licensed.

    Then in other states it gets even more complicated- you have to be licensed for home care, not facility care and vice versa. I can't keep up the requirements change so much. It was just a few years ago they changed from calling them CNA to LNA here in NH. in MA they also have Certified Home Health Aide and they usually get CNA and HHA together.

    It would be like saying RN's are registered and not licensed (but Rn's have to be licensed in all states and LNA/CNA's don't have to be). Even Certified Nurse Midwifes, Certified Nurse Practicioner, etc. They all have to be licensed.

    Anyhow, back to my op, I did not mean to insunuate VA docs are not real docs at all and I am sorry for sure.
  6. by   kukukajoo
    Jolie, I know of one specific case here in NH and VT that made headlines some years ago. The doc working at the VA was not licensed at all and it did not come to light until something went wrong and then it made headlines and it was explained that they don't have to be licensed. When it first hit the news it appeared the doc was totally screwed but really he was within his scope and also the law.

    Also I just corrected my post about LNA- NH is the only state I am aware of that calls them that.

    Many retirees keep up licensing and many don't. If they are practicing then they have to adhere to same standards of care, etc. wether licensed or not. I applaud you for keeping your license- we had a woman who worked for us until she passed away at 78 years old!

    Physicians don't have to be licensed in a specific state in the following circumstances:

    1.Responding to emergencies
    2.Establishing state residency requirements to obtain licensing
    3.When employed by the US Armed Forces, Public Health Service, Veterans Administration, or other federal facility
    4.When engaged soley in research and not treating patients
  7. by   blueheaven
    Call the public affairs office at the VA Hospital or Clinic that your resident goes to.
    VA has to approve nursing facilities outside the system for LTC. I will check on Wed. when I go back to work to find out specifically who you need to call. Let your facility get threatened with losing their VA status...I guarantee you that they will straighten out.
    SHAME on that doctor!!!!!!!!!!!!!!!
  8. by   blueheaven
    When I saw the heading before I read the post, I was thinking that maybe the VA doc was not a real licensed doc- if you work for the govt you dont need a license to practice- Doctor, nursing, and aides!!

    You need to find out the truth before you go spouting information that is false!! :lol_hitti All of the doctors that I work with are "real" as well as the nurses!! Yes, we are able to practice in any of the 50 states, Puerto Rico on one states license, but this really isn't as big of a deal as you seem to want to make of it. VA utilizes PAs and NPs in their clinics and they are "real" too. As for the not needing a license....I wish!! Just got through spending $50. to renew my Ky. nursing license!
  9. by   NRSKarenRN
    I work with 5 VA facilities so have great familiarity with the system.

    All VA professional employees are required to have ACTIVE license in at least one US state/territory in order to work for VA; they do not have to have license in state facility located.

    There is no need for the Medical Director to restrict pateint to only 5 days of meds if VA physician is writing RX and VA suppling med unless pt appears obtunted from the drug.

    When these type issues not addressed by owners/Sr mgmt and swept under the rug, word on the street gets out that pateints care is less than satisfactory and that kills facilites reputation with decreased patient's willing be admitted = loss of business. Call in your ombudsman to help smooth out this issue if nursing supervisor/DON unwilling to approach medical director---or can pharmacy service get involved??? No one should have uncontrolled pain.
    Last edit by NRSKarenRN on Aug 21, '07
  10. by   chocokitten
    Quote from porcelina
    I work in a long-term care facility. Our medical director doesn't have the best bedside manners, but he is our medical director and we should have some respect for his position.

    Yesterday a resident came back from a visit with his VA doc and was given a 30 day supply of pain medication. Our nursing facility MUST call our medical director and get an ok from him before we can give the medication. Medical director says we can only give the resident 5 days of the medication and no more. Resident is so upset that he is refusing to take the medication at all now. This really upsets me. The resident is in pain. (He was hurt in Korea and has a bad knee). I see this type of behaviour all the time from this doc. Very arrogant and teetering on the malpractice side. Families are mad, complaining and I hear the brunt of it all. It's maddening to try to make these residents happy and be a good RN, then to have a doctor to make life miserable for our residents. Is this normal behaviour of a medical director?
    I saw this at the AL that I worked at also. The "house" doctor didn't like getting orders from outside docs >_> was always a pain in teh butt
  11. by   happydays352
    Thanks to everyone who cleared up the license issue and the VA/federal employee thing. My mom is a federal employee (RN) and my Dad is an army doc so I was all gung ho to start busting skulls and setting facts straight . You guys are always on top of things!

    I think if the op could fill out a few details that were pointed out we all might be able to give better advice.
  12. by   P_RN
    VA doctors don't have to be licensed by each individual state as long as their practice stays within the VA. My spouse gets his meds there and they honor Rx's from our internist also. There is a very good rapport with our VA Hospital and clinics here.

    I wonder if the ECF doctor is thinking an injury 50 years ago necessitated narcotics this far along? Just thinking out loud here don't holler at me.
  13. by   getoverit
    Quote from Jolie
    I would also consider contacting the State Board of Medicine, as well as the credentialing board of the local hospital where this doctor has admitting privileges. Failure to collaborate with a patient's primary physician, and failure to adequately conrol pain are serious issues.
    Absolutely! That's good advice. Not only is the medical director on a power trip, but it's not putting the patient's best interests in front. What kind of person would do that?
    I didn't think the medical director could even stop someone from taking their own pills that were prescribed for them?

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