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Treatment rights of SCI veterans.

When immediate treatment or surgery must take place at a non-SCI center, it will be coordinated with the chief of the nearest SCI center, to which the patient will be transferred as soon as possible (paragraph 19.09, Veterans Health Service & Rehabilitation Administration Manual M-2, Part I). The SCI coordinator is responsible for notifying SCI chiefs of these emergency admissions and arranging for transfer to an SCI center within 24 hours, unless transfer is not feasible.

SCI patients in intensive care will remain there until properly discharged to the SCI unit by the physician in charge. While in intensive care, the patient is to be seen daily by an SCI physician and SCI nurse, and daily progress notes are to be recorded. Following surgery, SCI patients are to be returned to an SCI ward within 24 hours, except in extenuating circumstances (paragraph 19.10). Long-term SCI are must be provided at an SCI center for all SCI patients unable to return home or to a nursing home (paragraph 19.11).

Bowel and bladder care may, under some conditions, be authorized as a fee-basis outpatient medical service. Such care can be provided by a skilled, licensed provider or by family members who have been trained and certified by an SCI center (paragraph 19.12).

Urinary diversion surgery will not be performed without prior written permission from the assistant chief medical director (ACMD) for clinical affairs, VA Central Office. Any such surgery must be performed at an SCI center, except in an emergency (paragraph 9.13).

Complete urology studies will be done during the patient's initial admission and six months after injury or two weeks after return of bladder function, whichever comes first. Repeat studies are to be done one year after injury and thereafter, as indicated (paragraph 9.14).

No later than two months before the anticipated discharge date, SCI patients will undergo a sexuality and fertility evaluation, with urological and psychological consultation. The spouse or a close family member (if the veteran is unmarried) should be involved (paragraph 9.16).

Surgery fior urinary calculi (stones) will not be done without prior written approval of the ACMD for clinical affairs. If surgery is necessary, it will be done at an SCI center (paragraph 9.17).

All SCI centers will provide follow-up to discharged SCI patients through an SCI Home Care Program, which may include:

* Home evaluation

* Medical management and care

* Psychosocial support

* Referrals to community agencies

* Nutritional counseling

* Direct nursing care

* Assessment of equipment needs

* Education and support for patients, families, and care-givers

* Leisure-time counseling and training

* Support for vocational follow-up

* Establishment of a therapeutic regimen in the home

* Training and assistance in activities of daily living

All newly injured high-quadriplegic and ventilator-dependent patients will be referred for follow-up care. Patients placed in community nursing homes will be seen and followed by SCI staff as appropriate. Patients farther than 100 miles from an SCI center will be referred to an appropriate medical center and SCI coordinator (paragraph 19.18).

If you have questions concerning your rights or the care you are receiving at a VA SCI center or other VA hospital, contact your local PVA national service officer or the Veterans' Benefits Department in PVA's National Office, (800) 424-8200.
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Title Annotation:part 3
Author:Widger, Harry L.
Publication:PN - Paraplegia News
Date:May 1, 1990
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