The Veterans Affairs Department's chief inspector says widespread abuse of appointment schedules can be linked to a VA leadership that allowed officials in the field to ignore directives and then lie about it.
"It's hard to explain the why of that, but when people do not follow the directives of senior leadership and then misleads them about it, there has to be a consequence," acting Inspector General Richard Griffin told the Senate Veterans Affairs Committee on Tuesday.
While Griffin's testimony suggests that leaders at the top of the Veterans Health Administration must have known that managers and executives were not following directives, there is no indication that any of the ongoing investigations into possible wrongdoing are focused on Washington.
VA Secretary Bob McDonald, who testified before the Senate panel after Griffin, indicated in remarks outside the hearing hall afterwards that determining who knew what at VA headquarters is not a priority.
"I'm here to improve the future, learning from the past," he told Military.com. "I'm not here to spend a lot of time dwelling on the past."
That statement was in contrast to his statements regarding allegations of wrongdoing in the field, in particular the VA Medical Center in Phoenix, Arizona, where ongoing investigations were prompted by allegations that staff changed appointment dates, allegedly leading to the deaths of some veterans.
"Of course it bothers me," he said. "My view on integrity is very simple. I went to West Point – you don't lie, cheat or steal and you don't tolerate people who do. You don't want people in your family who lie, cheat and steal. And if you see people who are doing that in your family you obviously sort them out from the family."
McDonald, the former head of consumer products giant Procter & Gamble Co., was confirmed as the new VA secretary in late July. Since then he has been on a whirlwind tour of VA hospitals, meeting with staff, managers, union representatives and veteran service organizations in an effort to improve communications across the system.
During Tuesday's hearing he told lawmakers he is out to change the culture at VA, to make employees throughout the system more involved, and feel more empowered to highlight problems and pose solutions.
Griffin told lawmakers that after the Phoenix allegations came out the IG received about 225 allegations concerning the hospital, and 445 additional claims of manipulated wait times at VA hospitals and clinics elsewhere in the country.
The IG opened investigations into 93 sites, focusing on whether mangers ordered schedulers to falsify the wait times or to obstruct investigations.
The investigations are ongoing, in coordinating with the Justice Department and the FBI, Griffin told the Senators on Tuesday. On Monday, the VA said there are more than 100 investigations underway.
In its report on Phoenix, the IG said that while the manipulated wait times caused delays to care none of the deaths could be directly linked to the scheme. That determination was not in earlier drafts of the report, and lawmakers pressed Griffin to know whether VA officials had any input into the final version.
Griffin was adamant that the report is based solely on what the IG investigators found. He said his office reviewed VA and non-VA medical records of patients who died while on a wait list or alleged to have been linked to delays in care.
The office also reviewed more than 1 million emails, about 190,000 files from 11 encrypted computers and more than 80,000 messages from the Veterans Health Information Systems emails. The investigation encompassed electronic health records and more for 3,409 veteran patients at Phoenix, including 40 identified by whistleblowers as having died while on a secret wait list.
According to the IG, there were 28 instances of significant delays in care tied to the scheduling. Six of those 28 died. The review also identified 17 care issues not related to appointments or access, of which 14 patients were deceased.
In all, the IG found 45 cases that showed "unacceptable and troubling lapses in follow-up, coordination, quality and continuity of care."
After the Phoenix allegations came out the IG received about 225 allegations concerning the hospital, and 445 additional claims of manipulated wait times at VA hospitals and clinics elsewhere in the country.
The IG opened investigations into 93 sites, focusing on whether mangers ordered schedulers to falsify the wait times or to obstruct investigations. The investigations are ongoing, in coordinating with the Justice Department and the FBI, the IG said.
The wait time manipulations at the 93 sites looked at by the IG including using the next available appointment date as the one desired by the veteran, a move that "zeroed-out" wait times in those instances.
Schedulers also cancelled appointments and rescheduled them, making it appear that wait times were less than they were. In one instance the IG said it found management directed schedulers to use the ploy.
Facilities also used paper wait lists rather than the authorized Electronic Wait List. The EWL is used so VA can track how much demand there is for appointments and how it is or is not meeting the demand. A paper wait list basically keeps requested appointments off the books until schedulers move the names onto the EWL or actually book an appointment for the veteran.
Schedulers cancelled doctor-patient consultations without appropriate clinical review and altered clinic utilizations rates to make it appear the clinic was meeting goals, the IG found.
-- Bryant Jordan can be reached at firstname.lastname@example.org