Audit finds VA scheduling irregularities widespread
About 100,000 former military members nationwide are experiencing long delays getting medical care because of widespread problems dogging the appointment scheduling system at the Department of Veterans Affairs, according to an internal agency audit released on Monday.
Between May 12 and June 3, teams of investigators from the Veterans Health Administration, the VA's medical wing, inspected 731 hospitals and clinics across the United States to determine the scope of difficulties patients face when seeking care, including visits to the VA Pittsburgh Healthcare System hospitals as well as facilities in Butler, Altoona and Erie.
VA slated more than one out of every three hospitals or clinics for reinspection because of concerns about potentially irregular “scheduling and access management practices,” including VA Pittsburgh's University Drive hospital in Oakland and VA facilities in Altoona and Erie.
The investigators' findings are being shared with the VA's Office of Inspector General, which is conducting a separate probe and released a scathing interim report on May 28 that mirrored many of the latest audit's conclusions and a Tribune-Review investigation. Pittsburgh VA insiders told the Trib that local VA schedulers duped patients, federal lawmakers and their own supervisors by delaying or erasing patient appointments to make it appear as if the agency met the needs of veterans when it often failed to do so.
The latest VA audit found the agency's “overly complicated” scheduling system was frowned upon by the private sector and sparked a “high potential to create confusion among scheduling clerks and front-line supervisors.” The survey revealed that more than one out of every 10 schedulers had been encouraged to fake a veteran's desired appointment date — conduct that occurred at three out of every four facilities visited.
In 70 percent of the inspected facilities, investigators uncovered irregular “alternative” appointment procedures in place of the official Electronic Wait List process. Teams found “non-count clinics” that failed to properly track or schedule patient appointments or improperly canceled physician consults.
Staffing problems, especially a shortage of primary care providers, bedevil the system, and many workers feared that they “would be subject to disciplinary action” if they detailed other irregular scheduling practices, the latest report states. Because of pervasive “pressures” placed on schedulers to use “inappropriate practices in order to make waiting times ... appear more favorable,” the investigators asked VA to “re-examine its entire performance management system.”
“This behavior runs counter to VA's core values; the overarching environment and culture which allowed this state of practice to take root must be confronted head-on if VA is to evolve to be more capable of adjusting systems, leadership, and resources to meet the needs of veterans and families. It must also be confronted in order to regain the trust of the veterans that VA serves,” the report said.
American Legion National Commander Daniel M. Dellinger issued a statement criticizing the falsified reporting: “This is not just ‘gaming the system.' It's Russian roulette, and veterans are dying because of the bureaucracy.”
In Washington, U.S. Rep. Jeff Miller, chairman of the House Committee on Veterans Affairs, issued a statement that called the latest audit “more disturbing proof that corruption is ingrained in many parts of the VA health care system.” The Florida Republican urged the Department of Justice to join the ongoing investigations and for the Senate to pass legislation that has cleared the House designed to “fire failing VA executives, including all supervisors who ordered their subordinates to cook the books.”
Miller's committee held an oversight hearing on Monday night on data manipulation and access to VA health care with testimony by the agency's Inspector General, the Government Accounting Office and the VA.
In a news release, acting VA Secretary Sloan Gibson conceded that the latest audit “shows the extent of the systemic problems we face, problems that demand immediate actions. As of today, VA has contacted 50,000 veterans across the country to get them off of wait lists and into clinics. Veterans deserve to have full faith in their VA, and they will keep hearing from us until all our veterans receive the care they've earned.”
A former scheduler at the VA's Oakland hospital, Karen Santoro, 47, of the South Side told the Trib that the new audit echoes what employees have been saying for years but were afraid to tell Congress or the agency's Inspector General.
“When the audit team came through, VA employees were terrified about speaking out, so they hoped that retired schedulers would take up the challenge for them,” said Santoro, who resigned from VA's Oakland campus in 2011 and has talked to House investigators about irregularities she encountered there. “My hope is that by the time the audit team reviews Pittsburgh VA for the second time, Congress will have gotten serious about protecting whistleblowers from retaliation.”
Pittsburgh VA officials declined comment but reported that of the 636 patients seeking initial primary care appointments in May, 240 remained. Most veterans had been contacted by telephone or mail and 197 had scheduled initial appointments, the local VA said.
Carl Prine is a staff writer for Trib Total Media. He can be reached at 412-320-7826 or firstname.lastname@example.org.