Government & Politics

Audit: More than 57,000 patients await their first VA appointments

The Kansas City VA Medical Center, which wasn’t flagged for further review in the audit released Monday, kept an unofficial patient list in its cardiology clinic. The hospital said delays scheduling appointments were caused by “a serious clerical mistake.”
The Kansas City VA Medical Center, which wasn’t flagged for further review in the audit released Monday, kept an unofficial patient list in its cardiology clinic. The hospital said delays scheduling appointments were caused by “a serious clerical mistake.”

The first comprehensive review of the Department of Veterans Affairs’ medical care system found widespread scheduling abuses, data falsification and — no surprise to veterans such as Robert MacLeay — long waiting times at dozens of hospitals and clinics.

MacLeay’s VA eye doctor told him in 2009 that he needed cataract surgery and put in a request to the Dwight D. Eisenhower VA Medical Center in Leavenworth. A year later, as his vision continued to deteriorate, MacLeay finally got a call from the hospital: He had been scheduled for surgery — in three months.

By then, the Army veteran who saw action in the Battle of the Bulge already had gone to a private eye surgeon.

“I was very, very frustrated,” said MacLeay, 89, of Lawrence. “I told them (at the Leavenworth VA), ‘I had it done, thank you.’”

MacLeay has plenty of company, according to the wide-ranging review released Monday by the VA.

More than 57,000 veterans have been waiting 90 days or more recently for their first VA medical appointments, and an additional 64,000 appear to have fallen through the cracks, never getting appointments after enrolling and requesting them, the VA said.

It is not just a backlog problem. Thirteen percent of schedulers in the facility-by-facility report on 731 hospitals and outpatient clinics reported being told by supervisors to falsify appointment schedules to make patient waits appear shorter.

“This behavior runs counter to our core values,” the report said. “The overarching environment and culture which allowed this state of practice to take root must be confronted head-on.”

The audit, conducted in May and June, is the first nationwide look at the VA network in the uproar that began with reports two months ago of patients dying while awaiting appointments and of cover-ups at the Phoenix VA center. A preliminary review last month found that long patient waits and falsified records were “systemic” throughout the VA medical network, the nation’s largest single health care provider serving nearly 9 million veterans.

“This audit is absolutely infuriating and underscores the depth of the scandal,” Paul Rieckhoff, founder of Iraq and Afghanistan Veterans of America, a New York-based advocacy group, said in a statement. “Our vets demand action and answers.”

The report said that 112 — or 15 percent — of the 731 VA facilities that auditors visited will require additional investigation because of indications that data on patients’ appointment dates may have been falsified or workers may have been instructed to falsify lists or other problems.

These include four facilities run by the VA’s regional office based in Kansas City: The Eisenhower VA Medical Center, which kept MacLeay waiting; the Marion (Ill.) VA Medical Center; an outpatient clinic in West Plains, Mo.; and the Robert J. Dole VA Medical Center in Wichita.

The director of the Wichita medical center said recently that his hospital had kept some veterans on an unofficial patient list. The Kansas City VA Medical Center, which wasn’t flagged for further review, also kept an unofficial patient list in its cardiology clinic. The hospital said delays scheduling appointments were caused by “a serious clerical mistake.”

A spokeswoman for the VA’s regional office did not return The Kansas City Star’s call Monday requesting comment on the audit report.

Sen. Jerry Moran, a Kansas Republican, expressed skepticism about the audit. It did not involve the VA’s inspector general and was “far from a comprehensive assessment and sincere look at the magnitude of the dysfunction at hand,” he said in a written statement. “I have no doubt these numbers only scratch the surface.”

Acting VA Secretary Sloan Gibson said VA officials have contacted 50,000 veterans across the country to get them off waiting lists and into clinics and are in the process of contacting 40,000 more.

The controversy forced Eric Shinseki to resign as VA secretary on May 30. Shinseki took the blame for what he decried as a “lack of integrity” through the network.

Legislation is being written in both the House and Senate to allow more veterans who can’t get timely VA appointments to see doctors listed as providers under Medicare or the military’s TRICARE program. The proposals also would make it easier to fire senior VA regional officials and hospital administrators.

The new audit said a 14-day agency target for waiting times was “not attainable,” given poor planning and a growing demand for VA services. It called the 2011 decision by senior VA officials to set the target, and then base bonuses on meeting it, “an organizational leadership failure.”

About 8 percent of scheduling staff interviewed for the audit said they used alternatives to the VA’s official electronic wait list. In some cases, staff said they were pressured to use unofficial lists or engage in “inappropriate actions” in order to make waiting times appear more favorable.

MacLeay, the veteran from Lawrence, said bonuses VA administrators may have received by using unofficial lists to give the appearance of short waiting times “just make my blood boil — that they do all this and get awarded for it because they have stellar records.”

The VA said it had suspended performance awards for all senior health executives for the 2014 fiscal year.

House Speaker John Boehner, an Ohio Republican, said the report demonstrated that Congress must act immediately.

“The fact that more than 57,000 veterans are still waiting for their first doctor appointment from the VA is a national disgrace,” Boehner said.

A previous inspector general’s investigation into the troubled Phoenix VA Health Care System found that about 1,700 veterans in need of care were “at risk of being lost or forgotten” after being kept off an official, electronic waiting list.

The report issued Monday offers a broader picture of the overall system. The audit includes interviews with more than 3,772 employees nationwide between May 12 and June 3. Respondents at 14 sites reported having been sanctioned or punished over scheduling practices.

Wait times for new patients far exceeded the 14-day goal, the audit said. For example, the wait time for primary care screening appointment at Baltimore’s VA health care center was almost 81 days. At Canandaigua, N.Y., it was 72 days. On the other hand, at Coatesville, Penn., it was only 17 days and in Bedford, Mass., just 12 days. The longest wait was in Honolulu — 145 days.

But for veterans already in the system, waits were much shorter.

For example, established patients at VA facilities in New Jersey, Connecticut and Battle Creek, Mich., waited an average of only one day to see health care providers. The longest average wait for veterans already in the system was 30 days, in Fayetteville, N.C., a military-heavy region with Fort Bragg Army Base and Pope Air Force Base nearby.

Gibson, the acting VA secretary, said the department is hiring new workers at overburdened clinics and other health care facilities across the nation and is deploying mobile medical units to treat additional veterans.

The VA thinks it will need $300 million over the next three months to accelerate medical care for veterans who have been waiting for appointments, a senior agency official said in a conference call with reporters. That effort would include expanding clinics’ hours and paying for some veterans to see non-VA providers. The official said he could not say how many additional health providers the VA would need to improve its service.

Gibson also has ordered a hiring freeze at the Washington headquarters of the Veterans Health Administration, the VA’s health care arm, and at 21 regional administrative offices, except for critical positions personally approved by him.

Boehner said the House would act on legislation this week to allow veterans waiting at least a month for VA appointments to see non-VA doctors, and said the Senate should approve it, too. An emerging bipartisan compromise in the Senate is broader than that, but senators have yet to vote on it.

The Associated Press and the McClatchy Washington Bureau contributed to this report. To reach Alan Bavley, call 816-234-4858 or send email to abavley@kcstar.com.

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