Angela Chandler spends most of her days lying in bed, afraid to move.
Diagnosed with torn cartilage in her hips, the former 1st Cavalry specialist said she pleaded with her primary care manager at Fort Hood’s Monroe Health Clinic, but was repeatedly denied even a referral to orthopedics to see if she was eligible for treatment or surgery.
“I got hurt more by my own damn people,” Chandler said, thinking back to her deployment to Afghanistan, where she served as part of a female engagement team.
Chandler, a Killeen resident, is the second soldier to speak out about being denied a referral from the Monroe clinic.
“I did everything I could internally,” she said. “But this is a big problem. And there are still other soldiers.”
Staff Sgt. Lupe Maldonado’s story was reported in the Killeen Daily Herald in May. He was denied a referral to get a colonoscopy, despite having blood in his stool. After going off-post without a referral, Maldonado learned he had aggressive colon cancer.
Maldonado and Chandler were not only denied at the same clinic, but by the same care manager.
While Chandler’s time of service ended on Aug. 20, she said she wants to get her story out to help other enlisted soldiers get the treatment they need and deserve.
“I can’t live with myself if I don’t help others,” she said.
Chandler, 47, joined the Army at 41, because she said she always enjoyed being outdoors, and what she called “redneck stuff.” Hiking in the mountains of North Carolina, where she’s from, is one of her favorite pastimes. “Now I can’t go back to my life,” Chandler said.
Unfortunately, she said, she learned of resources such as Carl R. Darnall Army Medical Center’s ombudsman and patient advocacy offices too late. Instead, she tried repeatedly to get help from the care managers at her assigned clinic before getting out of the Army in early August.
Chandler was working earlier this year and suffered the second fall of her Army career — the first occurred at an obstacle course during basic training. While patrolling the barracks one night last February, Chandler fell down about 10 feet of steps and felt pain and numbness in her limbs, reaggravating her old hip injury.
A week later, she said she went to Darnall’s emergency room, where she was diagnosed with compressed nerves, and they transferred her to Scott & White in Temple. Doctors ruled out cauda equina syndrome, a neurologic condition.
She followed up later with her care manager at Monroe, a female captain, who rarely saw Chandler in person during clinic visits. Instead, Chandler explained what was going on to a medic, who would then go to another room, speak to the physician’s assistant, and come back with a response.
Darnall officials didn’t deny this is common procedure.
“Medics often bridge communication between patients and providers as part of the care team,” Col. Roger Gallup, Darnall’s deputy commander of clinical services, said in an email. Medics and nurses screen patients when they arrive for an appointment. Patients then see their assigned care manager if they are available or another provider at the clinic.
There are 27 providers supporting 15,400 active-duty soldiers at Monroe, Gallup said.
Chandler’s referral was denied, as was an exception to participate in morning physical training and pain medication.
“They didn’t even want to help me a little bit,” Chandler said.
In one denied referral dated July 19, her care manager referenced Chandler’s quickly approaching separation date from the Army.
“(A separation) date does not change the level of care provided,” Gallup said.
However, providers are always cognizant of important events such as station moves, separation dates, retirement, deployment and temporary changes of station that may impact a soldier’s treatment plan availability within the standard of care, he said.
Gallup was not able to provide the percentage of referrals that are denied at Darnall, but cited only administrative reasons for which ones would be denied.
“A referral may be denied because it was entered under the incorrect clinic. It also may be returned for further information. At times, the consultant provides input for the primary care provider for further care at the primary care level before referral,” Gallup said.
When asked if care managers are ever encouraged to deny referrals for any reason, he said they are “encouraged to provide care within the scope of their clinical practice following applicable clinical practice guidelines.”
Chandler took matters into her own hands, and went directly to the orthopedic clinic at Fort Hood to ask for the prerequisites she needed to be seen, so she could then go to Brooke Army Medical Center in San Antonio.
Eventually, she made it to San Antonio within days of her separation date and was told they couldn’t help her anymore — she now needed to start with Veterans Affairs.
Now Chandler is fighting a new battle, access to the VA health care system. There, the backlog of claims is dropping, but it still hovers above 400,000.