Vietnam veteran: VA hospital paralyzed my vocal chords

RICHMOND, VA (WWBT) - Clarence Wright, a 66-year-old Vietnam veteran who lives in Rustburg, Virginia, says he went to McGuire VA Medical Center for an outpatient procedure and left with his quality and quantity of life forever altered.

Candi-Leigh Wright, his daughter, now speaks on his behalf.

In 2015, when Clarence Wright was 63, he was experiencing a phlegm buildup in his throat. He went to the McGuire VA Medical hospital, where he says, the doctor recommended he receive Botox injections.  After months of back and forth and second opinions, Clarence Wright decided to go through with the procedure.

"They said it can change your vocals slightly - like the pitch of your voice - but there is no permanent side effects and in 90 days the pitch of your voice goes back to normal," Candi-Leigh Wright said.

THE INJECTIONS

On July 9, 2015, Clarence Wright had Botox injected into his vocal folds at McGuire.

"The expressions and clenching I saw, it was very painful," Candi-Leigh Wright described what it was like to watch her father receive Botox injections. "My dad couldn't speak immediately afterwards. They never said he could lose his voice."

Almost three years later and Clarence Wright can still barely make a sound. He also has trouble breathing now and uses an oxygen tank.

"So clearly something was done incorrectly," Candi-Leigh Wright said. "When we went home, dad began having issues that day with his breathing, he felt like he couldn't catch his breath and that was very abnormal as he never had any problems with his breathing prior."

THE NEXT STEPS

Candi-Leigh Wright said physicians at the hospital  forcefully encouraged Clarence Wright to get a tracheotomy, which is a surgical procedure.

"Dad was like absolutely not, I'm not having that hard of a time breathing," Candi-Leigh Wright said. "I just need a little oxygen."

Clarence Wright's primary care doctor set him up with oxygen at home that he has been using since the Botox procedure.

There had been several followup appointments at McGuire, many with a patient advocate, a person who is employed by the VA, but who is expected to advocate for patient rights. The advocate accompanied them to an appointment with the doctor too.

"Because of the way we were treated previously, we asked for a patient advocate to please accompany us," Candi-Leigh Wright said. "Prior to going in, dad told her she was welcome to ask any questions or speak in any way on his behalf as she felt necessary."

According to Candi-Leigh Wright, much was written down during that meeting.

"During the appointment she asked the physician what actually caused this to happen? (Referring to Clarence Wright's inability to speak and constant need for oxygen now.) And his words were, 'unfortunately this sometimes happens with Botox.' ... I will never forget those words," Candi-Leigh Wright said.

HIRING A LAWYER

According to Candi-Leigh Wright, those words were written down by the patient advocate, as was everything said in the appointment. The Wrights then hired a lawyer named Les Bowers in order to file a medical malpractice lawsuit against the VA.

"When a patient goes to a VA hospital that's an arm of the federal government, so when there is a claim you're going to make against the federal government, you have to go through special processes that are set up by federal statutes ... it's called the Federal Torte Claims Act," Bowers said.

Bowers filed a torte claim seeking compensation for Clarence Wright on Nov. 2, 2016.

"You file a document saying here is the basis of our claim, here is how much we're alleging it's worth and then there is an administration claims process that can take six months or more," Bowers said.

THE APPEALS

Eventually, the Wrights found out, their claim was denied. 

They appealed.

"There is a six month or more period where the government gets to investigate the claim, but you don't get any information from the government in exchange," Bowers said.

Their appeal was denied again.

"So this is where we ran into the issue of we didn't have sufficient information by way of documentation by way of images of the procedure itself," Bowers said.

According to Bowers and the Wrights, documentation, like the patient advocate notes from Clarence Wright's appointment, were missing from their file.

"We went back to the patient advocate to say where are your records? Where is your records of this?" Candi-Leigh Wright said. "[The patient advocate] went into the computer and she's like 'Everything is here,' and then seemed genuinely shocked that her records were gone."

MISSING RECORDS

That day, the Wrights say, the patient advocate wrote a summary of what she could remember from her time with the Wrights.

"Three months or more of records are just not there," Candi-Leigh Wright said. "There is no record of our meetings and we had seen her numerous times to get guidance on what could be done."

In the summary written by the patient advocate it states the doctor "provided an injection in his throat that caused the veteran to have multiple medical issues to follow. Clarence Wright lost his voice box which was in tact prior to the Botox."

The Wrights used the Freedom on Information Act (FOIA) to get a copy for their personal records.

"During the first torte we weren't aware that all the patient advocate notes were not there," Candi-Leigh Wright said. "We were unaware that everything was gone. For me personally, it makes me absolutely livid. Dad is an honorably discharged Army veteran. He stood up for this country and now they aren't standing behind him and admitting what they did wrong."

THE LACK OF INFORMATION

"Whatever their title may be, a patient advocate isn't employed by the patient. He or she is employed by the hospital and as a result he or she is working for the hospital," Bowers said. "These cases, both cases against VA hospitals and cases against private hospitals are incredibly difficult for several reasons, but one of the biggest reasons is the healthcare providers in the hospital system control all the information."

The lack of information is the reason a medical expert Bowers consulted with said there was not enough images and documentation to directly prove that Clarence Wright's complications were due to medical malpractice.

If the documentation was there, the lawyer could take the case to federal court, but without a medical expert stating that malpractice was done, no lawsuit can be filed. The Wrights and Bowers believe if they had the months of notes from the patient advocate, they would have had more of a chance.

Bowers said there have been many times where he'd been able to obtain more documentation that was hidden, in cases like this. In order to do that, he would need to get in front of a federal court judge. But with the medical expert not able to sign off that malpractice was done, they can't get in front of a judge at all to request that documentation.

"So without the facts there could be no lawsuit and without a lawsuit there was no mechanism for us to obtain the additional facts that had been hidden from us," Bowers said.

MISSING ELEMENTS FOR A LAWSUIT

"Roughly speaking there are four elements in any medical malpractice case, which is what Mr. Wright was looking into," said Bowers.

Those are:

• Duty, which is a health provider, patient relationship.
• Breach, which is breach of standard of care.
• Causation, where you have to prove because someone did something wrong it caused injury.
• Damages, which is to prove the extent of damages

"The issue for us was elements two and three because we didn't have enough for an expert to say, 'We see a breach in the standard of care and because we didn't have enough facts and images, we didn't have enough to prove despite what appears to be obvious,'" said Bowers. "We didn't have enough to prove that the negligence performance from the Botox injection caused his permanent paralysis or whether it was something like an underlying condition."

Candi-Leigh Wright said her father was checked for an underlying condition before the procedure and none were found.

"What I suspect happened here is the facts collected by the patient advocate and others were never put in the patients medical records and therefore were not available to us," Bowers said. "Frankly the result is Mr. Wright will be taken care of by the federal government in one way or another through the various forms of welfare we have, but the problem is there is no one to hold accountable because all of this information was missing. The short term loser is Mr. Wright  and long-term loser is vets being cared for at the VA Medical Center."

'I MISS MY DAD'S VOICE'

Candi-Leigh Wright explains that this has negatively impacted her father's quality and quantity of life.

"I really miss hearing my dad's voice. My dad is the most important thing to me," Candi-Leigh Wright said. "The main thing at this point and I'm speaking for both of us, is we don't want this to happen to someone else."

Clarence Wright now uses a whiteboard to communicate.

When NBC12 asked him how it makes him feel that this happened to him he wrote, "The cover up of government concerns me,"

"What do you hope happens by speaking to us?" we asked.

Clarence Wright answered on his white board: "Compensation for the damages and the truth to come out."

THE VA'S RESPONSE

In response, the Public Affairs for the VA said:

The claim submitted by counsel for Mr. Wright was thoroughly investigated and denied because the evidence did not support this claim. As part of that process, the entire medical record is closely reviewed.

Please note that patient advocates are not clinical care providers and we hope you mention that in your story. The Patient Advocate Tracking System (PATS) is separate from the medical record which is documented by clinicians, and no evidence was found of any PATS information being removed or deleted.

As is the Veteran's right, he now has the option to pursue the matter further in Federal District Court.

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