Veterans Affairs Secretary Eric Shinseki is set to testify before the Senate Veterans Affairs Committee, amid controversy and calls for his resignation because of allegations that 40 veterans died while awaiting care on fraudulent waiting lists at the Phoenix V.A.
The Phoenix story has lit a media fire under the issue of veterans’ access to care, but more than a year ago, the GAO reported on the same practices being alleged in Phoenix, and in a subsequent Congressional hearing, V.A. officials testified about deaths related to the long wait times.
In addition to Shinseki’s upcoming testimony, President Obama has ordered an investigation into the Phoenix allegations on top of an ongoing Inspector General’s investigation, but those allegations, that administrators at the Phoenix VA had been keeping two separate sets of appointment books, in order to make it appear that veterans were getting appointments in a timely fashion, were foreshadowed in a December, 2012 report by the Government Accountability Office. That report took a comprehensive look at the causes of long wait times, including changing appointments on the waiting list in order to meet V.A. performance standards:
During our site visits, staff at some clinics told us they change medical appointment desired dates to show clinic wait times within VHA’s performance goals. A scheduler at one primary care clinic specifically stated that she changes the recorded desired date to the patient’s agreed-upon appointment date in order to show shorter wait times for the clinic. A provider at a specialty care clinic at another VAMC said providers in that clinic change the desired dates of their follow-up appointments if a patient cannot be scheduled within the 14-day performance goal.
Later in the report, GAO also identified a practice almost identical to the one alleged in Phoenix:
One of the clinics we visited did not use the VistA scheduling system to determine available medical appointment dates and times, and to schedule medical appointments, as required by VHA’s scheduling policy. Officials noted that this clinic lacked a full-time staff person dedicated to scheduling, and therefore, the providers called their patients to schedule their own medical appointments. Clinic staff reported that providers recorded medical appointments on sheets of paper and gave those sheets to a scheduler, who maintained a paper calendar of all medical appointments; this scheduler later recorded the appointment into the VistA scheduling system.
Based on that report, the House Committee on Veterans Affairs held a hearing on March 14, 2013, at which two Department of Veterans Affairs officials were asked about deaths due to the long wait times. First, Rep. Mike Coffman (R-CO) asked William Schoenhard, V.A. Deputy Under Secretary for Health for Operations and Management, “According to VA documentation, in many instances, veterans were harmed or died due to delays in getting treatment. How many adverse events nationwide is VA aware of due to these delays?”
Schoenhard responded that “We have undertaken review of our facilities, and we are in the process of completing that review,” and passed the question along to Assistant Deputy Under Secretary for Health Clinical Operations and Management Dr. Thomas Lynch, who promptly changed the subject.
Later in the hearing, Rep. Coffman asked Dr. Lynch “I believe you stated in your testimony that you were not aware of any deaths of any veterans due to delayed care; is that correct?”
This prompted another digression from Lynch, which Coffman interrupted. “May I rephrase the question? Are you aware of any deaths of any veterans due to delayed care?” Coffman asked.
“With respect to the consult look back, no, sir,” Lynch replied. “With respect to what had occurred in Columbia and Augusta, we are aware that there were some clinical disclosures made and that there were veterans who had died with a disease process that could potentially have been related to consult delay.”
“Well, yeah, I think you have via the internal documents here, and you are actually fairly specific,” Coffman said. “It is in May that it, in fact, the delay in treatment did cause the death of a veteran in South Carolina, and another date in May—another internal document, last year, May 15, speaks to the Dorn facility, speaks to another death due to delay in care, so I think that clearly there are, by your own internal documents, there are issues concerning the quality of care related to timeliness and, unfortunately, the loss of life unnecessarily of veterans, and that is particularly alarming.”
The V.A. has taken steps, some described in the testimony, since the GAO report was issued, and it is important to note what that report said about the V.A. with regard to the practices that occurred in Phoenix. One of the problems they identified, overall, was a lack of clarity in the V.A.’s policy and training with regard to scheduling appointments, which is a politically attractive line of attack. However, that was not the case with regard to the changing of appointment dates to meet performance goals:
Although unclear about when to use the patient’s or provider’s desired date, VHA’s scheduling policy clearly instructs that, in all circumstances, desired date should be defined without regard to schedule capacity, and should not be altered once established to reflect a medical appointment date the patient accepts because of lack of medical appointment availability on the desired date.
So, the problems alleged in Phoenix were not over a question of policy or training, but of oversight. Disturbingly, GAO found administrators at every facility they visited who were engaging in the practice of changing the desired appointment dates to fit availability. These people need to be fired, not re-trained, and certainly not bonused.
It will be tempting to play politics with this issue, but the most important thing is that it gets fixed, right away, and to that end, the President and Congress should not be distracted by a rush to fix blame, or to avoid it.