Roughly 90% of Dr Kerry Summerscales’ patients are veterans, with some of them travelling to her clinic in Mackay, on Queensland’s east coast, from as far away as Victoria in their desperation to find a GP who will provide quality, subsidised care.
Summerscales is one of the diminishing number of GPs accepting veteran white cards, which entitles the holder to treatment for injuries and conditions the department of veterans affairs (DVA) accepts were incurred during service.
As Guardian Australia revealed on Monday, veterans have been receiving letters from their GP saying they no longer accept the white card because the DVA rebates are not high enough to cover the cost of providing often complex health services.
Some clinics are also no longer accepting the gold card, which entitles a veteran or their dependant, widow or widower to DVA rebates for all clinically necessary health care needs and conditions, whether they are related to war service or not.
An army veteran of 30 years service, Summerscales feels compelled to accept the cards because she knows better than most the complexity of health needs veterans face. They often require long consults and experience physical and mental health conditions.
She says she receives $30 more from non-veteran patients who pay a private fee than she does from the department for treating a veteran. “Each gold or white card patient I see leads to my practice losing money, which is a big issue for the business,” Summerscales says.
“As a veteran myself, I suppose my chosen charity has become veterans’ health.
“I understand the system, whereas many GPs are taught nothing about veterans and their culture. Even GPs that do accept the white card often don’t understand the basics of what it was like to be in Timor or Afghanistan, and so then there is a risk red flags get missed or that veterans have to explain and repeat their trauma.
“One veteran told me they were a RAAF airfield firefighter and told me where they served. I said: ‘Where were you on the 12th of June, 1996?’. And he just said: ‘Yep’.”
That was enough information for Summerscales to know he was involved in the 1996 Blackhawk accident, when two Australian Army Blackhawk helicopters collided in the Townsville Field training area, resulting in 18 deaths.
“I have patients who have come from Melbourne, from Townsville, and who have traveled up from Brisbane to see me,” she says. “I still essentially lose our practice money for every single veteran patient.
“I’m not going to complain about my income. I’m not reduced to eating 2-minute noodles each night, and I think it’s really rude for a doctor to claim their income is too low. But when a high proportion of a clinic’s patients are veterans, and those patients require longer, complex consults, you can see why some clinics are no longer accepting the cards.”
She is concerned that if veterans are privately billed, or bulk billed through Medicare if they can find a bulk-billing doctor, data on veteran health conditions normally collected by the DVA through white and gold card claims will be lost.
“There are nearly 600,000 veterans in Australia, and at least one person in their families, whether a spouse or a child, would be impacted by their service. So that’s 1.2 million people,” Summerscales says.
“Yet in our GP training, we never learn anything about veteran culture. They don’t lose that culture once they take their uniform off. If you had a group of veterans and you yelled ‘grenade’, I bet you they would all drop to the floor.”
Clive Buckingham, a gold card holder and a Vietnam veteran, recently went to his GP of three years in Bundaberg, Queensland, for numerous concerns including shingles, swelling of his ankles and numbness in his toes and leg. The GP told Buckingham that all of these symptoms were just a result of medication, and to come back in one year if the symptoms persisted.
“My concern was that the symptoms were also possible diabetes or kidney issues,” Buckingham says. “I asked for a blood test to allay my concerns, this was refused. I then asked for a PSA [prostate-specific antigen] test as I had prostate cancer that was treated by radiation and my last test was three years ago. He said it was not needed.”
Buckingham then told his GP that he had a gold card, thinking this would cover all of his health costs and prompt the GP to provide the health care Buckingham was asking for.
“His reply was ‘I charge more than the gold card rebate’. I was told they no longer accept a gold card and I was charged $80.
“I now have to try to find another doctor who will accept my card. I’m only on a pension and cannot afford to have my further concerns addressed.”
Another veteran and gold card holder, who did not wish to be named, told Guardian Australia: “While living in Tasmania for the last 16 years it was impossible to find a GP who accepted my gold card and now, having just moved to regional Victoria, I can’t find a GP who will accept it here either.”
When Guardian Australia approached the office for the minister for veterans affairs, Matt Keogh, for comment, a spokesperson for the minister sent a link to an interview with the minister on radio 6PR. Keogh said during the interview that; “We’ve seen a decline in doctors’ bulk billing, and this is really the same problem manifest in the veterans’ community now as well”.
Keogh said veterans having trouble finding a GP or a specialist that will accept the white card should contact the department. When Buckingham contacted the department, he was told to find another doctor and seek a partial refund from Medicare. “The department will not refund me,” he said.
Lisa Cena*, a veteran who lives in Brisbane, was seeing a psychologist for PTSD – a DVA-accepted condition covered by her white card – arising from her army service.
“The psychologist provided 10 Medicare sessions a year, as per the Medicare limit, but I paid about $130 out of pocket per session for those and would then need to wait about seven months after our 10 fortnightly sessions to access treatment again.
“She was unable to provide DVA-funded treatment in the intervening months as she’d have been operating at a loss. I’d have been prepared to fund the out-of-pocket as I did with Medicare, but DVA won’t permit this so we couldn’t proceed.”
Cena gave up psychological treatment.
“I still see a psychiatrist funded by DVA at about triple the cost of a psychologist, but I’m not getting the gains I had with my psychologist,” she says.
“DVA will say that there’s free counselling available to veterans through Open Arms, and I’m one of the many ex-serving members who received an official apology from the Department of Defence for my experiences of institutional abuse.
“After several attempts on my part to access therapy through Open Arms, the Brisbane contact for Open Arms advised me that they do not have the necessary expertise to deal with this sort of complex trauma.”
Guardian Australia has contacted the RSL for comment.
Summerscales says she fears the inability to receive adequate medical care will drive up suicide rates.
“Especially if they were medically discharged from service, they often already feel unworthy,” she says. “Once again, they’re being told: ‘You’re not worthy. You’re not worthy of care and time’.”
* Name has been changed
Do you know more? Email melissa.davey@theguardian.com
Crisis support services can be reached 24 hours a day: Lifeline 13 11 14; Suicide Call Back Service 1300 659 467; Kids Helpline 1800 55 1800; MensLine Australia 1300 78 99 78; Beyond Blue 1300 22 4636
