The disturbing and ongoing machinations occurring at the Veterans Affairs Department (VA) are reaching critical mass. At a House hearing last month, lawmakers from both parties accused VA officials of allowing veterans to die, due to delayed or withheld medical treatments at VA facilities. Moreover, the VA is stonewalling the follow-up investigation that has been conducted by the Veterans Affairs Committee for more than a year.
Back in January, a congressional delegation led by Veterans Affairs Committee Chairman Jeff Miller (R-FL), visited the Dorn Veterans Administration Medical Center in Columbia, SC, and the Charlie Norwood Medical Facility in Augusta, GA. The visit followed a CNN report that at least six deaths had occurred at the two facilities, and as many 20 might eventually be confirmed due to delayed or denied care.
Unfortunately, such tragedies are not anomalous. According to an April 2014 fact sheet provided by the VA, cancer screening delays accounted for the deaths of at least 23 patients in VA facilities nationwide, with another 53 patients suffering some other type of harm due to improper care related to gastrointestinal cancer testing or treatment. The VA did not directly admit the deaths were caused by the delays, but noted that “institutional disclosure” requires them to contact "the patient or their representative when the patient has either been harmed, or may have been harmed during their care” by the VA.
Last week the number of unnecessary deaths caused by institutional neglect increased yet again. Three officials at the VA Center in Phoenix were placed on leave when it was alleged that as many as 40 patients had died because officials maintained a fake waiting list making it appear veterans were being treated, even as a list revealing that as many as 1,600 patents had been waiting months to see a doctor was concealed. Phoenix VA Health Care System Director Sharon Helman, Associate Director Lance Robinson and another aide were placed on leave by Secretary of Veterans Affairs Eric Shinseki. “We take these allegations very seriously,” said Shinseki in a statement released last Thursday afternoon. “We believe it is important to allow an independent, objective review to proceed. These allegations, if true, are absolutely unacceptable and if the Inspector General’s investigation substantiates these claims, swift and appropriate action will be taken.”
One wonders about Shinseki’s sincerity. The first person to allege wrongdoing by officials at the Phoenix VA was Dr. Sam Foote, who recently retired after 24 years of service at the center. In October of 2013, he filed a complaint with the Office of Inspector General, alleging that wait-time data were being misrepresented using several methods. He further alleged that administrators were getting achievement bonuses through the Wildly Important Goals (WIG) program that touted a dramatic reduction in waiting times for patient appointments. He reported that 40 patients had died awaiting care, 22 of whom were on an electronic wait list for primary-care appointments, and 18 who died awaiting consultations with specialists. Foote also told CNN that the VA worked off two separate lists. "The scheme was deliberately put in place to avoid the VA's own internal rules," said Foote. "They developed the secret waiting list.”
In December, inspectors descended on the facility and interviewed workers there, including Helman. Helman acknowledged the visit, but last month she claimed she was shocked by the allegations. She and colleague Dr. Darren Deering, the medical center's chief of staff, insisted they were unaware of such allegations until they were revealed by U.S. Rep. Jeff Miller (R-FL), chair of the House Committee on Veterans' Affairs. When asked how she could be unaware four months after the December inspection, she cited confidentiality regarding her Q&A with investigators.
Yet as the AZ.com website reveals, a July email exchange between employees questioned the veracity of the WIG program, and an employee named Damian Reese complained the data were misleading. "I think it's unfair to call any of this a success when veterans are waiting six weeks on an electronic waiting list before they're called to schedule their first PCP (primary-care provider) appointment. Sure, when their appointment was created, (it) can be 14 days out, but we're making them wait 6-20 weeks to create that appointment. That is unethical and a disservice to our veterans,” he wrote. Helman was included in that message string.
Moreover, the secret list to which Foote referred might have been destroyed were it not for a second whistleblower. VA physician Dr. Katherine Mitchell, a 16-year veteran at the same facility, revealed that she and a co-worker discovered a plan by VA officials to destroy the potentially incriminating documents. To prevent it, they made paper copies of the electronic documents and delivered them to an investigator with the Office of the Inspector General. "I had no doubts they were capable of destroying evidence," said Mitchell. "So there I am, a 47-year-old doctor with two degrees, trying to figure out where to hide stuff.”
Hiding stuff seems to be a VA specialty. According to the Washington Examiner, the VA cancelled more than 1.5 million medical orders, absent any guarantee that patients actually received treatments or tests required by those orders. Since last May, veteran medical centers nationwide have been pressured to clear out 2 million backlogged orders, and were granted “wide latitude” to cancel appointments older than 90 days. As of a month ago, the reduction in what the agency refers to as “unresolved consults” had been reduced to 450,000. What happened to the other 1.5 million appointments cannot be determined by anyone, including the agency’s top-ranked officials.
“We found they closed consults but there was no evidence as to why it was closed,” Debra Draper, health care director for the Government Accountability Office (GAO), told the Examiner. “By not having that independent verification or any other controls, there isn’t any way of knowing whether they were appropriately closed out. You don’t know whether people received the care or if they received it in a timely manner. There’s no audit trail. There’s no way to know whether they were appropriately closed,” she added.
In testimony on April 9 before the House Committee on Veterans Affairs, Draper revealed that a GAO review of the process the VA used to close out files was poorly documented and lacked independent verification, making it impossible to determined whether patients received care or their orders for that care were simply cancelled. "Our ongoing work identified examples of delays in veterans receiving requested outpatient specialty care at the five VAMCs (Veterans Affairs Medical Centers) we reviewed,” she told the Committee. "VAMC officials cited increased demand for services, and patient no-shows and cancelled appointments, among the factors that hinder their ability to meet VHA’s (Veteran’s Health Administration) guideline for completing consults within 90 days.”
She then cited examples of consults that were not completed within the 90-day period. They included 3 of 10 gastroenterology consults where patient care was delayed from between 140 and 210 days from the dates the consults were requested; 4 of the 10 physical therapy consults delayed between 108 and 152 days; and 4 of 10 cardiology consults that were cancelled without patients being seen, due to multiple appointment cancellations by the patients themselves.
Last February, the Examiner revealed a previous mass purging by the VA that consisted of 40,000 appointments “administratively closed” in Los Angeles, and an additional 13,000 cancelled in 2012 in Dallas. The VA refused to provide documentation revealing when the practice began or how widespread it was, but the Examiner noted that the DVA has an established pattern of falsifying wait times, despite the reality that performance reviews and bonuses of top hospital administration are linked to meeting department goals. A report," VA Accountability Watch" by the House Committee on Veterans Affairs, hammered that reality:
“Despite the fact that multiple VA Inspector General reports have linked many VA patient care problems to widespread mismanagement within VA facilities and GAO findings that VA bonus pay has no clear link to performance, the department has consistently defended its celebration of executives who presided over these events, while giving them glowing performance reviews and cash bonuses of up to $63,000.”
The VA’s abusiveness and ineptitude is nothing new. Back in the 1990s Congress was aware that the VA was delaying care for months on end, and that veterans were needlessly dying. In 1996 they passed a law requiring that veterans needing care been seen within 30 days. Yet in both 200 and 2001, the GAO reported that excessive wait times were still a problem. A similar conclusion was reached in 2007 and again in 2012 by the VA’s Inspector General, who determined that VA appointment schedulers routinely cheated to hide excessive wait times.
On Monday, the nation’s largest veterans service group decided they’d had enough. "As national commander of the nation’s largest veterans service organization, it is with great sadness that I call for the resignations of Secretary Shinseki, Under Secretary of Health Robert Petzel, and Under Secretary of Benefits Allison Hickey,” American Legion Commander Daniel Dellinger announced at a press conference.
Dellinger praised Shinseki for his patriotism and service to the nation, but insisted his performance and those of his colleagues with regard to running the VA "tells a different story. The existing leadership has exhibited a pattern of bureaucratic incompetence and failed leadership that has been amplified in recent weeks,” he explained.
It was failed leadership amplified by yet another revelation that a VA outpatient facility at Fort Collins, CO was engaged in the same falsification of appointment records that occurred in Phoenix.
In fairness to the VA, they are overwhelmed by a demand for medical care that exceeds their ability to handle it. Two practical solutions have been proposed to address the problem. A proposal offered by Reps. Peter King (R-NY) and Steve Israel (D-NY) would give the vets the opportunity to be referred to civilian caregivers for mental health issues. Healthcare expert Betsy McCaughey suggests the creation of a voucher system allowing vets to see private, civilian caregivers for non-combat-related conditions such as colonoscopies, heart care, and diabetes management,. such a system would allow those who served their country to escape the current wait lists and get the treatment they need in a timely manner.
McCaughey rightly believes that waiting for the government to solve the problem is a waste of time. It is far worse than that. For many veterans, it could mean the difference between life or death.