Inside the VA's scheduling crisis

By Anthony Brino
09:35 AM

A 71-year-old Navy veteran went to the Phoenix VA emergency room last September after noticing blood in his urine, was told his case was “urgent” and that he would be seen in a week by a GP or urologist. At the end of November, after failing to secure the appointment, he died of what was later discovered to be advanced bladder cancer.

"Well, you know, we have other patients that are critical as well. It's a seven-month waiting list. And you're gonna have to have patience,” the veteran’s daughter-in-law recalled the VA telling her when she tried to book an appointment, according to CNN

What’s worse, Sam Foote, MD, who recently retired after 24 years with the Phoenix VA, told CNN that VA officials could just “remove you from that list, and there's no record that you ever came to the VA and presented for care.”

Learn on-demand, earn credit, find products and solutions. Get Started >>

The allegations at the Phoenix VA come amid similar problems reported at other Veterans medical centers, including Colorado, Georgia, Missouri, Texas and Wyoming.

Elsewhere around the U.S.
Secret wait lists are also rumored to have been artificially showing appointments kept within a 14-day window at VA medical centers in Colorado and Wyoming. “

Yes, it is gaming the system a bit,” one employee at the Cheyenne VA Medical Center wrote in an email obtained by the Daily Beast. “But you have to know the rules of the game you are playing, and when we exceed the 14-day measure, the front office gets very upset, which doesn’t help us.”

Which may be the reason why Foote described the scenario in Phoenix as consisting of two lists: the so-called official list that the Phoenix VA shares with Washington to suggest things are running more smoothly than the real list, which actually indicates wait times longer than a year.

"The scheme was deliberately put in place to avoid the VA's own internal rules," Foote told CNN. "They developed the secret waiting list.”

The former chief of psychiatry at the St. Louis VA, meanwhile, alleges he was demoted for complaining of waitlist backlogs not long after assuming the job in 2012, and a VA scheduler in Texas is claiming that a similar "secret waiting list" has been the norm at VA facilities in Austin and San Antonio.

According to CNN, at one point 7,000 veterans in Columbia, South Carolina and Augusta, Georgia, were on a backlog list for colonoscopies or other endoscopies.

Cynthia McCormack, director of the Cheyenne VA Medical Center, which also oversees the Fort Collins VA, said at a news conference that scheduling processes have been "misunderstood," as the LA Times reported. "We are now correcting our misunderstanding of how to schedule our veterans," she said.

Secretary in hot seat
What with evidence and anecdotes accumulating, a number of veterans groups and lawmakers are now calling for VA Secretary Eric Shinseki to resign, including the American Legion. Some also point out that if the allegations are true, it could be grounds for criminal charges against those involved.

Shinseki, a four-star Army general who earned a purple heart in Vietnam, wants to stay on the job — now in his sixth year — as long as President Obama wants him to. Shinseki is “mad as hell,” he told lawmakers, and has ordered an inspector general investigation into the Phoenix VA allegations. The VA's top healthcare official, Robert Petzel, VA undersecretary for health, has resigned, although he was planning to retire in the near future.

In the short-term and the long-term, it’s not clear what Shinseki's ouster or resignation would accomplish in the way of systematic reform — something Shinseki himself agrees is necessary, if difficult to effectuate.

"I signed on to do this to help him make things better for veterans in the near term, as quickly as possible, but also to put in place for the long term those changes to this department that will continue to help veterans well into this century,” Shinseki told NPR this month.

While many veterans and veterans groups report receiving high quality care, problems have been plaguing the VA for more than a decade, with similar allegations of manipulated data appearing and some $200 million paid out by the agency for wrongful deaths since 9/11. Recently, there were also what were determined to be preventable adverse events stemming from miscommunication at the Memphis VA Medical Center and a Legionnaires' disease outbreak in the water systems at the Pittsburgh VA that was kept quiet by officials.

“This is not a new problem,” said Paul Rieckhoff, founder and CEO of Iraq and Afghanistan Veterans of America in a media release. “Veterans have been dying in line for care for decades, but we still get business as usual.”

As veterans from the wars in Iraq and Afghanistan have returned with complex physical wounds, post-traumatic stress disorder and substance abuse problems and as Vietnam veterans become seniors, the VA’s budget has been increasing, from $50 billion in 2009 to $66 billion this year. But there is still a debate about whether smart investments are being made to improve service at the point of care and grow the ranks of VA clinicians to support demand.

First steps forward
With veterans' health and welfare needs showing no signs of abating, the case for a systematic reform and reevaluation of priorities at the VA has never been greater.

As Bernie Sanders, the Vermont Independent who chairs the Senate Veterans’ Affairs Committee and opposed both of the wars, put it: “in a system as large and bureaucratic as the VA, it is imperative that we uncover the problems that exist in the system and address them boldly.”

“It’s not just about leadership,” said Rieckhoff, an Army vet stationed in Iraq in 2003 and 2004. “There is a glaring lack of leadership, accountability and oversight."

Taking a first step, Iraq and Afghanistan Veterans of America are pushing a new bill, the VA Management Accountability Act.

The bill would give the VA “complete authority” to fire or demote VA senior executive service or equivalent employees based on performance and replace a convoluted termination process that currently leaves top officials presiding over mismanagement “more likely to receive a bonus or glowing performance review than any sort of punishment,” as sponsor Jeff Miller (R-Fla.), chairman of the House Committee on Veterans’ Affairs, described it.

IAVA is also partnering with the Project on Government Oversight, offering whistleblowers a new outlet to report wrongdoing at vaoversight.org.

The crisis could spur a bipartisan action that helps the VA reform. In the meantime, veterans groups and the public await the Office of the Inspector General’s investigation — and one from the Obama Administration. Obama has ordered White House deputy chief of staff Rob Nabors to oversee a review of the VA appointment rules.

Long-term, beyond making sure appointments can be made in reasonable time, the challenge for the VA will be regaining the trust of veterans, their families and taxpayers.

Want to get more stories like this one? Get daily news updates from Healthcare IT News.
Your subscription has been saved.
Something went wrong. Please try again.