Balancing Safety Against Obstruction to Health Care Access: An Examination of Behavioral Flags in the VA Health Care System

In 2003, the Veterans Affairs (VA) instituted an alert, known as behavioral flags, in the veteran’s nationwide electronic medical record. The flag can be placed for those who demonstrate physical or verbal aggression, and functions as a “warning” to staff that the patient poses an increased risk of harm to others. The flag also gives directives regarding actions to be taken before seeing the veteran (such as, VA police presence, restricting appointments to areas with metal detectors, restricting care to specific clinics or medical centers). Critics have alleged that behavioral flags are a method to punish those who complain about their health care by imposing restrictions at VA facilities. Indeed, data suggest that the overwhelming majority of “flagged” VA patient behaviors have been verbal. Behavioral flags may discourage veterans from seeking needed VA care, particularly, when restrictions such as VA police escorts to clinic appointments may be perceived as humiliating. Given this, alternatives to flag placement would be a comprehensive violence risk assessment and interventions that enhance a veteran’s control over disruptive behavior.