Preliminary report: Delay in care rampant through VA healthcare system

A preliminary report verifies that 1,700 veterans had to wait months for an appointment at the Phoenix VA medical facility, but care delays are a "systemic" problem throughout the Department of Veterans Affairs health system.

The VA's Office of Inspector General released the preliminary report Wednesday, a week after President Barack Obama called for a nationwide investigation into the allegations that several VA facilities kept "secret waitlists" to hide the fact that veterans had to wait months for care.

Although the report isn't complete, the OIG said the office "substantiated that significant delays in access to care negatively impacted the quality of care at this [Phoenix] medical facility."

The report set out to determine whether the waitlist purposely omitted the names of veterans waiting for care and whether the deaths of veterans were related to the care delays.

The OIG said it deployed rapid response teams to visit VA medical facilities throughout the country with no advance notice. So far, the teams have investigated 42 facilities and identified "instances of manipulation of VA data that distort the legitimacy of reported waiting times."

The preliminary investigation focused on interviews with staff, including scheduling clerks, supervisors and patient care providers; collections of scheduling reports; and a review of medical records, emails and complaints.

"Our reviews at a growing number of VA medical facilities have thus far provided insight into the current extent of these inappropriate scheduling issues throughout the VA healthcare system and have confirmed that inappropriate scheduling practices are systemic throughout VHA, " the report said.

The report found that 1,400 veterans did not have a primary care appointment but were appropriately included on the Phoenix facility's electronic wait list (EWL). However, it found an additional 1,700 veterans who were waiting for a primary care appointment but were not on the EWL.

"These veterans were and continue to be at risk of being forgotten or lost in Phoenix HCS' convoluted scheduling process," the report said. "As a result, these veterans may never obtain a requested or required clinical appointment. "

The OIG noted that by failing to place veterans on the appropriate waitlist, the Phoenix VA leaders understated the wait times for new patients, a factor for awards and salary increases.

The report found that 226 veterans waited an average of 115 days for their first primary care appointment. However, the report said at least 25 percent of the veterans received some level of care, such as treatment in the emergency room, walk in clinics or mental health clinics.

In addition to the care delays, the OIG said it is investigating allegations of mismanagement, inappropriate hiring decisions, sexual harassment, and bullying behavior by mid- and senior-level managers at the Phoenix facility. Teams also continue to investigate whether any of the care delays led to patient deaths.  

Meanwhile, until the final report is complete, the OIG recommends VA Secretary Eric K. Shinseki take the following acitons to ensure all veterans receive appropriate care:

  • Review and provide appropriate healthcare to the 1,700 veterans identified as not being on any existing waitlist.

  • Review all existing waitlists at the Phoenix Health Care System to identify veterans who may be at greatest risk because of a delay in the delivery of healthcare (i.e., veterans who are new patients to a specialty clinic).

  • Initiate a nationwide review of veterans on waitlists to ensure that veterans are seen in an appropriate time, given their clinical condition.

  • Direct the Health Eligibility Center to run a nationwide new enrollee appointment request report by facility of all newly enrolled veterans and direct facility leadership to ensure all veterans have received appropriate care or are shown on the facility's electronic waiting list.

Shinseki  issued a statement late Wednesday indicating that he will aggressively and fully implement the recommendations to ensure the VA reaches all veterans that the OIG identified in the report.

"I have reviewed the interim report, and the findings are reprehensible to me, to this Department, and to veterans," Shinseki said in the statement. "I am directing that the Phoenix VA Health Care System immediately triage each of the 1,700 veterans identified by the OIG to bring them timely care."

To learn more:
- here's the preliminary report (.pdf)
- read Shinseki's statement

Related Articles:
Deepening VA scandal spurs calls for resignation, reform
Obama calls for nationwide investigation of VA facilities
VA wait list cover-up may extend beyond Phoenix system
Secret wait list reveals 40 vets died while awaiting treatment
Investigation into VA wait lists expands to more hospitals

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