June 17, 2014 PNLR E-Newsletter

VA has long known of deadly delays for sick and injured veterans 

Courtney L. Davenport


Recent revelations about Department of Veterans Affairs (VA) hospitals’ systemic efforts to hide long waiting times for veterans’ health care appointments have shocked the public, but government reports and whistleblower accounts show the VA has known for years that patients are dying as they wait for care.
 

Recent revelations about Department of Veterans Affairs (VA) hospitals’ systemic efforts to hide long waiting times for veterans’ health care appointments have shocked the public, but government reports and whistleblower accounts show the VA has known for years that patients are dying as they wait for care.

The issue first came to light after the media learned of massive backlogs at Phoenix Health Care System. Late last month, the VA Office of the Inspector General (OIG) issued an interim report confirming that 1,700 veterans who were waiting for physician appointments were never even entered into the electronic scheduling system, putting them “at risk of being forgotten or lost in Phoenix HCS’s convoluted scheduling process.”

Veterans are supposed to be treated within 14 days of the date on which they want to be seen, known as the “desired date.” Hospital staff must enter the desired date and the appointment date into an electronic system, and those dates are used to determine budget and performance reports. But the OIG found that Phoenix and many other hospitals were manipulating the dates.

“Our reviews at a growing number of VA medical facilities have thus far provided insight into the current extent of these inappropriate scheduling issues throughout the VA health care system and have confirmed that inappropriate scheduling practices are systemic throughout [the VA health system],” said the agency. “Clearly there are national implications associated with inappropriate and non-compliant scheduling practices, including the impact on patient care and a lack of data integrity.”

For example, in 2013, Phoenix reported that its sample of 226 veterans waited an average of 24 days to see a doctor, with only 43 percent waiting longer than 14 days. But the OIG found that the hospital manipulated the dates and that the veterans actually waited an average of 115 days, with 84 percent waiting longer than 14 days.

The OIG found multiple waiting lists not included in the electronic system, indicating staff may have created “secret wait lists.” They also scheduled appointments for the next available date, then listed that as the desired date; deleted pending consults; and canceled appointments that had long wait times by replacing them with a new appointment that makes it look like there has been zero wait time. Since the report was released, former employees in several facilities have said they were trained to “cook the books.” Walter Oleniewski of Silver Spring, Md., who represents veterans in medical negligence cases, said some of the allegations are shocking.

“I was not surprised to learn of the extreme waiting times for appointments,” he said. “However, I was surprised to learn that some of the hospitals were covering up the lengthy waits to justify their conduct and award extra pay and bonuses for their personnel.”

Phoenix also disabled the system’s audit controls, limiting VA oversight, which San Diego attorney Katrina Eagle, who represents veterans, said is particularly alarming.

“Someone turned off the audit controls—that’s not an ‘oops, I didn’t realize I pushed yes instead of no’; that’s malicious intent. Someone knowingly did that,” she said. “It’s disgusting.”

But this isn’t the first time scheduling delays have dogged the VA: The interim report discussed 18 OIG reports detailing the problems since 2005, when it found that as many as 10,000 veterans may have been left off appointment lists. The Government Accountability Office has also issued numerous reports. Both agencies have reported several times that the VA was submitting unreliable scheduling numbers.

In 2012, the VA said it was making improvements. But last year, the OIG investigated William Jennings Bryan Dorn VA Medical Center in Columbia, S.C., after a patient’s esophageal cancer was linked to months of canceled endoscopies that would have detected the cancer in time to save him. The OIG found that in July 2011, facility staff realized there were 2,500 delayed consults for endoscopies and colonoscopies, 700 of them “critical.” By December 2011, there were 3,800 delays. Between 2011 and 2012, 52 servicemembers were diagnosed with malignancies associated with diagnosis or treatment delays. The VA confirmed six deaths, although a former Dorn doctor said there were at least 40 delay-associated deaths.

Eagle and some veterans’ organizations have said that another significant problem is being largely overlooked: the VA’s pervasive refusal to provide disability benefits to injured servicemembers. Without these benefits, veterans cannot obtain health care outside of the VA system and, if they are unable to work, cannot support themselves or their families.

“Unless systematic and drastic measures are instituted immediately, the costs to these veterans, their families, and our nation will be incalculable, including broken families, a new generation of unemployed and homeless veterans, increases in drug abuse and alcoholism, and crushing burdens on the health care delivery system and other social services in our communities,” said Veterans for Common Sense in a lawsuit against the VA to force the agency to pay benefits.

Although the VA has begun addressing the claims backlog—at one point, there were more than 600,000 claims—there are many pending appeals of denials that have not yet been addressed. Eagle said the entire VA system needs to be overhauled.

“The spotlight and attention has to stay on the entire VA system until an outside auditor says it has really improved,” she said. “The people running the show have shown they don’t have the veterans’ interests at heart.”