36C24419R0052-011.pdf

Department of Veterans Affairs POLICY 113WB-15-1341

Medical Center July 2, 2015

Wilkes-Barre, Pennsylvania 18711

HEALTH CARE FOR WOMEN VETERANS

1. SCOPE/EFFECT: This Medical Center Policy (MCP) affects all clinical services involved with the treatment of women veterans. The services most affected are Primary Care Service, Surgical Service, Mental Health and Behavioral Service, Rehabilitation and Prosthetics Service, Geriatrics and Extended Care Service, Imaging Service, Pathology and Laboratory Medicine Service, and Business Office and Health Administration Service.

2. PURPOSE: To establish Medical Center policy for the provision of medical care and related services to women veterans.

3. POLICY: The Women Veterans Health Program will be delivered through established Women’s Primary Care, Women’s Health, or Primary Care Clinics. The Women’s Veterans Health Program is a component of Primary Care. Women will have equity of access to services and care at this Medical Center as well as the CBOC’s at Sayre, Allentown, Berwick, Northampton, and Williamsport. VHA Handbook 1330.1 mandates that eligible women veterans have access to all necessary medical care, including gender-specific conditions, that is equal in quality to that provided male veterans. The Women Veterans Health Program will provide integration of clinical care, education, and research on women related issues. Women veterans will be treated in a respectful, sensitive manner by all medical center employees. Excellence in health care for women veterans will be driven by the performance standards established by the Veterans Health Administration. The promotion of quality improvement will be monitored by the PC&MS Continuous Quality Improvement/Quality Management Committee. Health promotion and disease prevention will be addressed by the members of the primary care team, with the Preventive Health Care Standards and other approved Medical Center Standards of Care and Practice acting as the basis for services rendered to women veterans. Gender specific educational programs will be available for women as well as individual and group education. The Customer Satisfaction Surveys will further define the needs of the women veterans.

4. PROCEDURE:

a. Specific health services including a pap smear and a breast examination are provided as part of a complete physical examination to women. Preventive health services including mammography and osteoporosis screening are provided. General reproductive health including birth control, infertility, pregnancy, and treatment of menopause are available.

b. Pap Smear: The VA National Center for Health Promotion and Disease Prevention and the U.S. Preventive Services Task Force suggests screening can safely be delayed until 3 years after onset of sexual activity or until age 21, whichever comes first, recommends screening at least every three years, suggests cervical cancer screening can be stopped at age 65, recommends screening in older women, who have not been previously screened when information about previous screening is unavailable, or when screening is unlikely to have occurred in the past. Gynecology consultant for consultation.

If a gynecologic examination is not performed, the reason must clearly be documented in the Medical Record.

c. Mammography: The VA National Center for Health Promotion and Disease Prevention and the U.S. Preventive Services Task Force recommends that women age 40 and older have a mammogram every one to two years.

d. The health management of all gender-related problems of women veterans will be conducted in a private environment.

e. The names, locations, and telephone numbers of the Women Veteran Program Managers are posted in a prominent area at the Medical Center, Allentown Outpatient Clinic, and Sayre Outpatient Clinic to assist all women veterans access to an individual who will assist them, if need be, in the provision of equitable care and treatment.

f. Eligibility of Women Veterans: Women veterans have the same basic eligibility for medical care as male veterans. Public Law 102-585, Veterans Health Care Act of 1992, authorized the Department of Veterans Affairs to provide gender-specific services. Public Law 103-452, Veterans Health Program Extension Act of 1994 provided authority and priority for counseling and treatment for sexual trauma while on duty in the military. Sections 1720D and 1712 extend date for service and make law gender neutral. M-2, Part 1, Chapter 29, revised in 1994, give clear guidance for primary health care for women veterans, including preventive health services and gender-specific care. Pregnancy services, sterilization, and infertility services excluding invitro fertilization and abortion, are available under the Uniformed Benefit Package for 1999.

g. Privacy Accommodations:

(1) Examination tables with stirrups are located in every examination room, providing a private environment to perform physical examinations with a private bathroom adjacent to the examining room. The examination tables in the outpatient area are positioned in a manner in which the examination table is not visible from the doorway. Another staff member will be present with the provider during the examination.

(2) Privacy curtains are to be used in all areas including emergency services, examination rooms, and inpatient rooms. All patient care units in the Medical Center and Nursing Home Care Unit have private rooms with bath and toilet facilities available for the women veterans.

(3) The Women Veterans Program Manager is an active participant in the plan and design process for facility construction and renovation projects.

h. Provision of Gynecologic Services:

(1) Outpatient Services are available through:

(a) Primary Care Women's Health, Primary Care, and Gynecology Consultant.

(b) Women Veterans' Health Care Clinic.

(c) Fee basis providers if the woman veteran meets eligibility requirements.

(2) Inpatient Services - Inpatient gynecologic services for hospitalized women Veterans can be provided through Gynecology Consultation.

i. Other Considerations:

(1) The Women Veterans Health Program will be staffed by an interdisciplinary primary care team.

(2) Gynecology consultant appointments are scheduled upon receipt of the consult.

(3) Contraceptive therapy and hormone replacement therapy, as well as diagnostic gynecologic procedures, are available.

(4) The Women Veterans Program Manager will be a member of the Primary Care Team.

(a) Infertility evaluation will be provided.

(b) Maternity care will be provided.

(5) Domestic Violence Counseling is available by the Coordinator for Domestic Violence.

(6) Military sexual trauma counseling and treatment is available by the Coordinator for Military Sexual Trauma for any veteran who has experienced sexual trauma while on active duty.

(7) Hospital gowns, pajamas, and robes will be provided in sizes and styles appropriate for women for diagnostic tests, procedures and treatment to protect privacy.

(8) Toiletries and some women's clothing are available for purchase at the canteen service.

(9) Feminine hygiene products are available in lavoratories in the outpatient areas.

5. RESPONSIBILITY:

a. The Chief of Staff has the responsibility to ensure that medical care and related services are afforded women veterans, both on an inpatient and outpatient basis.

b. The Chief, Mental Health and Behavioral Services is responsible for counseling and referrals as described above.

c. The Women Veteran Program Manager at this Medical Center, and CBOC’s is responsible for overseeing all activities pertinent to the woman Veteran and for ensuring equitable treatment to the woman veteran.

6. CUSTOMER SATISFACTION: Patient/family satisfaction issues were considered in the development of this policy.

7. RESCISSION: Medical Center Policy 113-12-1341, same subject, April 19, 2012.

8. REFERENCES: VHA Handbook 1330.1

VHA Handbook 1330.2 M-2, Part IV, Chapter 9, Change 1, September 11, 1991, Preventive Medicine M-2, Part XIV, Chapter 9, Change 27, Sexual Sterilization and Abortion, July 26, 1977 M-2, Part XIV, Chapter 11, Gender Reorientation VHA Directive 2005-015, March 25, 2005, Military Sexual Trauma Counseling VHA Directive 1102.2, Elective Sterilization and Reversal, July 16, 2004 VHA Directive 2002-049, Combat Veterans are Eligible for Medical Services for 2 years after separation from military VHA Directive 2003-061, Combat Veteran Intake Inprocessing

9. DISTRIBUTION: Electronic Access to All Employees

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