Dr. Timothy Ballard on VA ambulance changesHealth S ense

By Dr. Timothy Ballard Alaska VA Healthcare System O ver the last several years, the Alaska VA Healthcare System has been authorizing and reimbursing ambulance transportation for all Alaska veterans regardless of their beneficiary travel eligibility in accordance with 38 USC III and 38 CFR part 70.

An audit in 2019 revealed that this practice was in error. Therefore, effective immediately, we will no longer be authorized to approve or reimburse ground or air ambulance transportation for Alaska veterans who are not eligible for travel benefits in accordance to these laws.

I apologize for this change. However, during my most recent town halls, I tried to explain that this had the potential of occurring soon. However, I did not realize that the VA Central Office decision would be finalized so quickly. As one of the least-resourced states for health care services, air ambulance transportation is an essential facet of emergency care coordination for many Alaskans. It is incredibly expensive. Therefore, I strongly recommend that all Alaska veterans — particularly those who do not qualify for travel benefits — immediately research their options for ground ambulance and/or air ambulance coverage to protect themselves from a potential financial catastrophe.

If you have any questions about your eligibility for VA travel benefits, please call the beneficiary travel office at 907- 257-4738.

To ensure widespread awareness of this critical change in our operations, my staff will also send out emails and post this information via social media. In addition, we will also be contacting all Alaska hospitals and emergency departments to notify them of this critical update.

If you are travel eligible, these are the items for which the VA will reimburse you:

Airfare and ferries • Will reimburse up to the maximum government rate allowed for the most economical or medically required common carrier.

• All common carrier methods of travel must be preapproved by the VA BENEtravel department. Hotels • Hotels must be preapproved by the VA BENEtravel department and are only reimbursed at up to 50% of the government employee rate.

• If the veteran is inpatient, hotel is not reimbursable regardless of nonmedical attendant being present. Taxi, UBER and Lyft • Will reimburse if a date, starting location and ending location are annotated. Only reimbursable travel is between airports, hotels and appointments. No stops in between will be reimbursed.

• The VA will not reimburse for extra trips, for example to meal locations, or trips from appointments to the hotel if you are flying out the same day

• Will not reimburse for rental cars, fuel or tips of any kind.

• Must be preapproved by BENEtravel department.

Meals • Will reimburse up to the local per diem rate for the city you are scheduled for a medical appointment in. Each city has a different per diem rate, please contact BENEtravel for local per diem rates. Reimbursed at up to 50% of the government employee rate.

• Receipts must be itemized, if receipts are not itemized there will be no reimbursement for that amount. All receipts must have a date legible for reimbursement.

• Will only reimburse for food items; no tobacco, alcohol or medications • Will not reimburse for tips. Will reimburse for taxes and surcharges.

• Must be preapproved by BENEtravel department.

Parking • Can reimburse for parking fees associated with preapproved common carrier (flight) fees.

Dr. Timothy Ballard is director of the Alaska VA Healthcare System.

By Aliza Sherman T he child of a Lutheran minister and a retired nurse, Thor Brendtro really wanted to do something meaningful from a young age and wanted to make a difference in people’s lives. His parents taught him that you should want to try to make this world a better place.

Today, the 2019 Nurse of the Year awardee provides intensive medical case management for about 140 patients — referred to as customer owners at Southcentral Foundation – living with human immunodeficiency virus, or HIV.

“It’s really hard to get some of the customer owners into care. I make sure their needs are met — safety, support, housing — and work with them on getting HIV medications onboard as soon as possible.”

Brendtro explains that Southcentral Foundation takes a unique approach to health care, a “relationship-based approach” to HIV. Working as a case manager, his office is located in a primary care setting so he can easily see patients as they come in to see their primary care providers.

“They call on me to come in if there are any concerns, and I consult with providers, making sure there are appropriate labs, health screenings, immunizations,” says Brendtro. “It really comes down to relationships with patients and providers. I leave messages about medical health records and see what’s going on if they haven’t been seen in a while and are overdue to follow up or not picking up their HIV meds. I leave messages and alerts in their health records to re-engage.”

Twice a week, Brendtro is in clinic half the day seeing patients with their providers. The majority of his time is spent on the phone or with patients who drop into his office. Patients have access to his work cellphone and can contact him via text, and he calls them right back.

Says Brendtro: “So many issues are related to stress and what’s going on in their lives.”

Brendtro is the person patients can talk with to coordinate appointments and receive guidance. He encourages them to stay on their meds and helps coordinate follow-up appointments. He also checks up on the patients he knows are newly engaged in care to make sure they’re doing OK. If they need help with housing or food, he refers them to nonprofit organizations that can help, typically local AIDS organizations like Alaskan Aids Assistance Association. He even helps patients with their paperwork.

To assist homeless patients, Brendtro spends time at Beans Cafe and Brother Francis Shelter where Anchorage’s homeless population gathers and receives services. He also meets with patients at the primary care clinic within Brother Francis that Southcentral Foundation co-manages with Providence Hospital to provide support. “So many are lost to follow-up and lost to care. If they end up in the psychiatric ward, for example, public health will let us know they have a patient there in their care, and I make sure they are on the right meds and that their lab work is done,” Brendtro said. He also works with the Department of Corrections to access patients.

Typically, Brendtro sees HIV patients every three months if they are having some challenges, or if not, every six months for follow-ups, labs, even dental referrals and optometry as HIV patients tend to have issues with their eyes and have the potential for getting oral infections. Brendtro says he is behind a desk phone a lot with a headset on at his computer, seeing who is due for follow-up, what kind of appointments they need, which specialists they are seeing and tests they’re undergoing. He says Southcentral Foundation has a large number of specialties under one roof, including Traditional Healing and Integrative Behavioral Health Counselors. Brendtro says he looks forward to going to work. “I know there are patients out there that I can have an influence on for the better. Ultimately, there are choices and lots of opportunities.”

Brendtro is one caring person in patients’ lives who guides the way.

The March of Dimes Nurse of the Year awards honor “extraordinary nurses” in local communities who “go above and beyond to deliver compassionate care.” Brendtro was one of several recipients in different categories in 2019. You can nominate a nurse when events are announced at nurseoftheyear.marchofdimes.org.

Southcentral Foundation provides health and wellness services for Alaska Natives and American Indians in the Anchorage area, the Matanuska-Susitna Borough and nearby villages. It also supports residents of 55 rural villages in an area stretching 107,400 square miles across Southcentral Alaska, from the Canada border to the Aleutian Chain and Pribilof Islands.

By Aliza Sherman A n accident can change the course of one’s life. Asha Ashley Smith twice felt the impact of accidents, and her entire life changed.

If you followed Asha, a dance instructor and country music singer/songwriter who spent a number of years living in Alaska, you would think she was living in a Lifetime television movie. Her life from childhood through most of her adult years is vastly different from her life today at age 56.

Asha’s story is one of resilience and healing through persistence, faith and finding a new way to live despite injury and illness. Difficult early years Before moving to Alaska the first of several times, Asha grew up on the Washington coast with an abusive father and a prescripSinger’s resilience pays off after devastating accidents derail career

Top, a promo for Asha Ashley Smith’s first record, before accidents left her with serious health problems. Bottom, Asha four hours before trying to record her songs in Nashville Studio recently. She suffered asthma attacks on the plane and two severe ones in the motel room and needed breathing machines and emergency inhalers. Courtesy of Asha Ashley Smith

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From left, Asha, then about 12, hugs her younger siblings. 2. An outing in Alaska. 3. Asha holds her son and her sister’s young children. 4. Promo photo. Asha had a promising singing and dance career until another accident in 2000. Photos courtesy of Asha Ashley Smith

tion drug-addicted, alcoholic mother. She was put into her first group home at 9 years old. Typical of the foster care system, reunification was a priority, and she was returned to her parents only to be removed again when she was 11.

“At about 13, I became a ward of the court and became homeless when I was about 17 or 18,” Asha tries to recall, her memory foggy.

She tried to be a parent to her two younger siblings while her mother was barely able to function through addiction but ended up responding to an ad for a job in Seattle thinking she could make it on her own.

The ad for dancers wasn’t the kind of dancing she imagined. She took the next job she could find and pieced together barely enough money to put a roof over her head and send some back home to her mother and siblings. Around 1984 she saw an ad for a job in Alaska and took a chance. She headed north, ending up in Valdez and working that summer for Peter Pan Seafoods. After the season ended, she wound up in Anchorage and soon flew her sister up to live with her.

While in Anchorage, she began dating a man she met at her apartment complex and soon found out she was pregnant.

“Because of the condition of abuse I endured, everything I had been through, I was told I would never have children, but I was with child, and it was an absolute shock to my system,” Asha says. Around the same time, she realized the relationship was not working out, so she returned to Washington state to help her mother. Not only was she alone and pregnant but also trying to care for her mother and her siblings. She turned to religion for support. “I didn’t have the support system of any family or anything,” Asha said. “Even when you’re getting a little older, struggling, wishing you could have one person you could rely on, I didn’t really have that. I really had no structure … I finally said ‘I need help’ and called upon a higher power to help me.”

Asha found the support, stability and consistency she was seeking in the Church of Jesus Christ of Latter-day Saints and was baptized into the church when her son was around 5 years old.

In 1991, Asha met her first husband, a blue-collar worker, and the couple welcomed a daughter in 1993.

Living with hidden damage While still in Washington, Asha was in a vehicle accident in which another car ran a stop sign at 50 mph and struck hers.

Asha, who was driving, leaned over and put arm in front of her mother, who was in the front passenger seat, to protect her from the impact. Both of her children were in the back seat. The other car slammed into hers on the driver’s side.

Her mother, son and daughter all came away with minor injuries. Asha, however, suffered damage to several of the vertebrae in her neck, although the extent of the damage was not clear at the time. She spent the next few years trying to manage the near-constant pain.

In 1996, she and her then-husband moved back to Alaska. Her husband took a job on the North Slope, and the family bought a home in Wasilla. They would move away from and back to Alaska several more times, including living and working in Glennallen for a spell.

“I always wanted to stay in Alaska. I Asha and her husband, Sterling.

Asha in front of the Grand Ole Opry during her 2019 trip to Nashville to record her new songs.

always considered Alaska my home. It gets in your blood. You can’t ever get it out. Just the way it is. I’ve always felt like I was an Alaskan,” says Asha, who currently lives in Idaho.

Eventually, Asha and her family moved away for her husband’s job, buying a house in South Dakota where Asha began teaching dance classes — modern, jazz, and ballet — and taking online courses to become a certified nurse assistant.

One day, she heard one of her young dance students, an 8-year-old, singing and encouraged the girl to enter a local singing contest where the grand prize was a chance to sing at The Corn Palace, South Dakota’s equivalent to Nashville’s Grand Ole Opry.

“The girl pointed to something on my office wall, my bucket list, and the first thing on the list was to sing in public, and she said ‘I’ll do it if you do it,’ so I did, and I won.”

Asha suddenly found herself doing what she had only dreamed of for years — singing. She won contest after contest and began performing at rodeos, casinos, fairs and clubs.

A frightening turn She was offered a singing contract in Nashville and was considering it when she was involved in a second car accident, in South Dakota around 2000. The second accident seemed much less severe than the first. She was rearended and the other car wasn’t traveling very fast. Her condition following the impact, however, was extreme.

“It knocked me out. I was taken by ambulance to the hospital. I could not move. I was screaming in so much pain,” Asha recounts.

Over the next five years, she lived with intense pain — even after physical therapy and chiropractic care. Her health issues were compounded by severe asthma. And she had migraines that led to a diagnosis of glaucoma.

Around 2008, Asha and her family relocated to Idaho, another move for her husband’s work. It wasn’t until she passed out in her garden that summer and ended up in the Idaho Neurosurgical Center that the extent of her neck damage was discovered.

Doctors found two things: a hairline fracture in her neck that was most likely caused by the first car accident and a physical anomaly on the right side of her head limiting the blood flow to her brain.

Over the next five years, she lived with Jackson Brumley, who was road manager for Loretta Lynn,Merle Haggard and Buck Owens, was so impressed with Asha that he wanted to meet her even though he has long ago retired. When Asha and her friend joined Brumley at Starbucks in Nashville she asked “Why did you want to see me?” Brumley said “ I like your style, music and your voice.” Asha has several releases planned over the next year and a visit back home to see her son Spencer in Girdwood.

“I was told if I turned my head to the left, I would have a stroke and die,” she said.

She was flown to Utah for surgery on her badly deteriorated neck vertebrae. Doctors rebuilt her neck with titanium rods and screws. During the surgery, her vocal cords needed to be moved and were inadvertently damaged.

Her dreams of a singing career — and even her dance career — seemed finished.

“I just had resigned myself when I came out of the surgery, and months went by where my sound was not the same — it’s still not the same — so I gave up,” says Asha, adding that she decided to focus more on songwriting since singing seemed out of the question.

“Imagine everything you wanted and never thought possible being completely ripped out from underneath you.”

About a year and a half after her surgery, Asha’s first husband walked out on the family and the couple divorced. Her son, by then, was living and working in Alaska. She and her daughter remained in Idaho for a year as her health continued to suffer and then relocated to Oregon to get away from the agricultural chemicals from the farmlands surrounding her Idaho home.

A dream reborn While in Oregon, Asha began online dating on a website for Latter-day Saints singles. She met her current husband, a medical lab scientist, through the site. Her husband played guitar on the side and shared Asha’s love of music. They married about a year later. He encouraged her to continue pursuing her songwriting and singing.

While her vocal cords did heal, Asha’s vocal quality was permanently altered. High doses of albuterol for her asthma also made her singing voice shaky, but she continues to work through those challenges.

“Sometimes, we think because we’re not the same or not at the same level or didn’t get what we wanted, we quit. We don’t necessarily pursue it because we can’t pursue it in the same way,” says Asha, who soon learned that pursuing a dream, even in the face of tremendous adversity, could pay off.

Within the last year, Asha reached out to old contacts in Nashville, and the response was positive to both her song lyrics and her singing. Music business doors began to open for her again.

Today, she is getting her songs in front of artists such as Sheryl Crow and the Oak Ridge Boys.

A song she co-wrote with her sisterin-law, “Gimme Something I Can Work With,” is getting airplay on several Nashville radio stations and is available on Spotify, Amazon Music, iTunes, Pandora and YouTube.

Says Asha, “Sometimes you have to find a way. It may be a different way, but you can still work at it. I will never sound like I did before, but that doesn’t mean people won’t like what I have to offer now.”

Aliza Sherman is a freelance writer in Anchorage. Comments about this story? Email editor@AlaskaPulse. com.