Internal memos show the
VA
has been playing whack a mole for at least six years with employees who
use dozens of different scheduling tricks to hide substantial
delays in health care
for America’s veterans. And whenever the VA tries to stop its staffers
from “gaming the system,” the staffers come up with new techniques.
Whistleblowers around the country
are now accusing the VA of hiding a backlog in patient care with
bookkeeping tricks, and a former doctor at a VA facility in Arizona says
the delays may have contributed to the deaths of 40 patients.
In an April 26, 2010 memo,
the VA’s deputy undersecretary for health administrative operations,
William Schoenhard said, “It has come to my attention that in order to
improve scores on assorted access measures, certain facilities have
adopted use of inappropriate scheduling practices sometimes referred to
as ‘gaming strategies.’ … This is not patient centered care.”
Schoenhard
then listed two dozen different tactics identified in a 2008 study that
facilities around the country were using to cut down on the officially
recorded time that patients had to wait for care.
The
techniques included pretending that appointments cancelled by the
clinic were cancelled by the patient, and refusing to schedule
appointments for patients when there was no appointment available within
30 days. Patients were told to wait a month and then call back.
Two
of the techniques described in the memo closely resemble the methods
described by the whistleblowers who have gone public recently with
claims that VA facilities have disguised actual patient waiting time.
The
2010 memo discusses how a written appointment log book can be used to
avoid entering long wait times into the electronic waiting list system,
and forbids the use of any written log. Dr. Samuel Foote, the Arizona
whistleblower, now says that as recently as 2013 the Phoenix VA was
using paper records with actual patient wait times to avoid entering
those wait times into the official electronic system.
The
2010 memo also describes how staffers manipulated the “Desired Date” of
a patient’s appointment. The date the patient wants to see a doctor is
supposed to be entered as the “Desired Date,” but those dates are often
sooner than a doctor is available. Facilities were able to hide the
difference between what the patient wanted and what the patient got,
according to the memo, by either entering the wrong date, neglecting to
enter any date or entering the earliest available date as the patient’s
desired date.
The memo reveals
that some clerks look inside the electronic scheduling system to see
what dates are actually available before filling in the “Desired Date.”
“[T]he clerk [finds] the availability of future appointments. Once a
date/time is found, the clerk exits the system and then starts over
using the identified date/time as the Desired Date.”
The
method closely resembles what whistleblower Brian Turner alleges
occurred at VA facilities in Austin and San Antonio within the past year
and a half. It also mirrors what a coordinator at a facility in Wyoming
seems to be advising schedulers to do in an email from June 2013.
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With
his job on the line and a growing number of critics calling for his
resignation, Shinseki will go before the Veterans Affairs' Committee.
The retired decorated Army general will be asked to explain just how the
VA's wait-list scandal became such a mess.
Shinseki is likely to
be grilled about delays at numerous VA hospitals and a long list of
serious problems and allegations of falsifying wait times, many of which
were exposed and reported by CNN.
For six months, CNN has been
reporting on deadly delays in medical appointments suffered by veterans
across the country and veterans who died or were seriously injured while
waiting for appointments and care.
The most disturbing and
striking problems emerged in Arizona last month as inside sources
revealed to CNN details of a secret waiting list for veterans at the
Phoenix VA. Charges were leveled that at least 40 American veterans died
in Phoenix while waiting for care at the VA there, many of whom were
placed on the secret list.
After Phoenix, allegations emerge nationwide
But
even as the Phoenix VA's problems have riveted the nation's attention,
numerous whistle-blowers from other VA hospitals across the country have
stepped forward in recent weeks. They described similar delays in care
for veterans and also varying schemes by officials at those facilities
to hide the delays -- in some cases even falsify records or "cook the
books."
The secret waiting list in Phoenix was part of an
elaborate scheme designed by Veterans Affairs managers there who were
trying to hide that 1,400 to 1,600 sick veterans were forced to wait
months to see a doctor, according to a recently retired top VA doctor
and several high-level sources who spoke exclusively to CNN.
"The
scheme was deliberately put in place to avoid the VA's own internal
rules," said Dr. Sam Foote, a 24-year Phoenix VA physician who just
retired this year and who appeared in an interview for the first time on
CNN last month.
The VA requires its hospitals to provide care to patients in a timely manner, typically within 14 to 30 days.
"They
[Phoenix VA officials] developed the secret waiting list," said Foote, a
respected physician. He told CNN that the elaborate scheme in Phoenix
involved shredding evidence to hide the long list of veterans waiting
for appointments and care. Foote and the other sources say officials at
the VA instructed their staff to not actually make doctor's appointments
for veterans within the computer system.
Instead, Foote says,
when a veteran is seeking an appointment, "they enter information into
the computer and do a screen capture hard copy printout. They then do
not save what was put into the computer so there's no record that you
were ever here," he said.
According to Foote and the sources, the
information was gathered on the secret electronic list and then the
information that would show when veterans first began waiting for an
appointment was actually destroyed.
"That hard copy, if you will,
that has the patient demographic information is then taken and placed
onto a secret electronic waiting list, and then the data that is on that
paper is shredded," Foote said.
"So the only record that you have
ever been there requesting care was on that secret list," he said. "And
they wouldn't take you off that secret list until you had an
appointment time that was less than 14 days so it would give the
appearance that they were improving greatly the waiting times, when in
fact they were not."
From the Phoenix VA officials: Denials of a list
Phoenix
VA officials denied any knowledge of a secret list, and said they never
ordered any staff to hide waiting times. They acknowledged some
veterans may have died waiting for care there, but they said they did
not have knowledge about why those veterans may have died.
The
number of veterans who died recently waiting for care in Phoenix is at
least 40, said Foote and the sources. "That's correct. The number's
actually higher. ... I would say that 40, there's more than that that I
know of, but 40's probably a good number," said Foote.
Thomas
Breen, a Navy veteran, was one of those veterans in Phoenix who died,
waiting for care on that secret list, according to Foote and several
other inside VA sources who spoke to CNN.
As the veteran urinated
blood, Breen's son, Teddy Barnes-Breen, and daughter-in-law, Sally,
rushed him to the Phoenix VA Emergency room last fall. But they were
told they would have to wait for any primary care appointment for him,
despite a note indicating an "urgent" need on his chart from ER doctors.
No
one called from the VA with a primary care appointment. Sally says she
and her father-in-law called "numerous times" in an effort to try to get
an urgent appointment for him. She says the response they got was less
than helpful.
"Well, you know, we have other patients that are
critical as well," Sally says she was told. "It's a seven-month waiting
list. And you're gonna have to have patience."
Sally says she kept
calling, day after day, from late September to October. She kept up the
calls through November. But then she no longer had reason to call.
Thomas
Breen died on November 30. The death certificate shows that he died
from stage 4 bladder cancer. Months after the initial visit, Sally says
she finally did get a call.
"They called me December 6. He's dead already."
"They did not treat him right," said Teddy.
Sally
says the VA official told her, "We finally have that appointment. We
have a primary for him.' I said, 'Really, you're a little too late,
sweetheart.' "
The director of the Phoenix VA, Sharon Helman, was
put on administrative leave by Shinseki two weeks ago, along with two of
her top aides. But sources inside the VA in Phoenix tell CNN the wait
times and problems are still ongoing there.
As a direct result of
allegations by Foote and other insiders in Phoenix, investigators from
the VA's Inspector General's Office have gone to Phoenix and have been
conducting an investigation there for months.
CNN's ongoing investigation into VA health care
But
months before revelations of what happened Phoenix came to light, CNN
had reported about other veterans who died or were injured while waiting
for care at different VA hospitals.
Last summer, CNN started investigating delays in care and appointment wait times at VA facilities across the country.
Since
our first report on delays in care at two VA hospitals in Georgia and
South Carolina ran in November of 2013, CNN has continued to uncover
delays in care at many facilities across the country. Numerous VA
staffers have stepped forward to become whistle-blowers and allege
dangerously long wait times for veterans and varying efforts to cover
them up by officials at the VA.
"I just try to live every day like
it's my last day," said Barry Coates, a 44-year-old Gulf War vet who is
one of the veterans who has suffered from a delay in care and who spoke
to CNN in January.
Coates was having excruciating pain and rectal
bleeding in 2011. For a year, the Army veteran went to several VA
clinics and hospitals in South Carolina, trying to get help. But the
VA's diagnosis was hemorrhoids, and aside from simple pain medication,
he was only told he might need a colonoscopy yet not given any
appointment for one.
"The problem was getting worse, and I was
having more pain," Coates said, talking about one specific VA doctor who
he saw every few months. "She again examined me and gave me some
prescriptions for other things as far as pain and stuff like that and I
noticed again she made another comment -- 'may need colonoscopy.'
"I
told her that something needed to be done," said Coates. "But nothing
was ever set up ... a consult was never set up. ... I had already been
in pain and suffering from this problem for over six months, and it
wasn't getting better," Coates said.
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Forrest Burnson
David Kadlubowski / Corbis 
