VA chief vows full wait-list probe

Initial evidence of cooked books ‘isolated,’ senators told

Veterans Affairs Secretary Eric Shinseki testifies Thursday before a Senate committee, where he faced tough questions about waiting lists for veteran health services.
Veterans Affairs Secretary Eric Shinseki testifies Thursday before a Senate committee, where he faced tough questions about waiting lists for veteran health services.

WASHINGTON -- Secretary of Veterans Affairs Eric Shinseki told lawmakers Thursday that allegations that waiting lists for medical care at veterans hospitals had been manipulated "makes me mad as hell."

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He also said he was aware of only isolated evidence that faked or off-the-books lists were created to cloak long delays that some veterans have faced to see doctors.

Asked by Sen. Bernard Sanders, I-Vt., chairman of the Veterans Affairs Committee, whether department employees were "cooking the books," Shinseki replied that he was aware of only "a number of isolated cases where there is evidence of that."

"But the fact that there is evidence in a couple of cases behooves us to take a thorough look," Shinseki told the committee.

Shinseki, a former four-star Army general who has been the only VA secretary during President Barack Obama's administration, faced tough questions about the waiting-list claims from senators at a hearing Thursday. But he declined to say whether he would remove any of his senior managers over the issue.

The ranking Republican on the panel, Sen. Richard Burr of North Carolina, told Shinseki that "VA leadership either failed to connect the dots, or failed to address this ongoing crisis."

Democratic Sen. Richard Blumenthal, D-Conn., suggested potential criminal wrongdoing over claims that as many as 40 deaths that may have resulted from long waits for treatment at the Phoenix VA facility, and said the FBI should be brought in to supplement a review underway by the VA inspector general.

Sanders, in opening remarks before Shinseki's testimony, said the allegations were very serious. But he added, "If we are going to do our jobs in a proper and responsible way, we need to get the facts and not rush to judgment."

"There has been a little bit of a rush to judgment," he said.

The Department of Veterans Affairs has been criticized for years about the long wait times for treatment and for having no reliable system for holding hospital administrators accountable for the delays.

Last year, the department took a step intended to strengthen its oversight of part of the system: It established a goal for new patients seeking primary care to be seen within 14 days of calling for an appointment, with the date of that request logged into a computer file so it could be tracked.

But veterans hospitals in Arizona, Illinois, Colorado, Texas, Wyoming and elsewhere have been accused of using off-the-books waiting lists or other artifices to hide how long it took for veterans to see doctors, with delays extending for months.

With new reports of purported waiting-list manipulation emerging almost daily, some Republicans in Congress have joined the American Legion in calling for Shinseki to resign.

A major factor behind long waiting periods, outside experts and department officials agree, is that demand for primary care has risen sharply in recent years, fueled by younger veterans who served in Iraq and Afghanistan and by a tide of Vietnam-era veterans, many with complex health problems relating to both their age and their military service.

The department has been unable to maintain enough primary-care doctors to keep pace with that rising demand. According to the department, the number of primary-care visits in the system rose by 50 percent during the past three years. The number of new nurses and other staff members increased a similar amount, but the number of full-time primary-care doctors rose by only 9 percent.

The pressure on doctors to see even more patients intensified after the department established its 14-day goal for new patients, whistle-blowers and congressional officials said. And that pressure is what led to the creation of an off-the-books waiting list in Phoenix, according to a retired doctor who has become the leading whistle-blower on problems there.

Dr. Sam Foote said veterans would commonly wait six to nine months after calling for an appointment before they would be booked in the official system. But the "creation" date of the original request would be falsely logged in the official system as falling within 14 days of the appointment date, making it appear that the hospital was meeting the department's time requirements.

"They went to the creation date to stop the cheating, but that's when the secret waiting list was used to get around the creation date," Foote said.

He blamed a shortage of doctors for the wait times and said that, as recently as 18 months ago, there were 15,000 veterans in Phoenix waiting to be assigned a primary-care doctor because their doctors had left or because they were new to the system.

At Thursday's congressional hearing, Richard Griffin, the department's acting inspector general, said that after an initial review of 17 people who died while awaiting appointments at the Phoenix VA hospital, none of the deaths appeared to have been caused by delays in treatment.

"It's one thing to be on a waiting list, and it's another thing to conclude that as a result of being on the waiting list that's the cause of death, depending on what your illness might have been at the beginning," Griffin told the Senate Veterans Affairs Committee.

Griffin said his office is working off several lists of patients at the giant Phoenix facility, which treats more than 80,000 veterans a year. He said a widely reported list of 40 patients who died while awaiting appointments "does not represent the total number of veterans that we're looking at."

He said his office has 185 employees working on the Phoenix case, including criminal investigators, and said he expects to have a report completed in August. The U.S. attorney's office in Arizona and the Justice Department's public-integrity section are assisting in the investigation.

Since reports of the Phoenix problems came to light last month, allegations about problems at VA facilities have spread nationwide. At least 10 new allegations about manipulated waiting times and other problems have surfaced in the past three weeks, Griffin said.

Auditors from the VA's Office of the Inspector General visited the Edward Hines, Jr. VA Hospital in Chicago on Wednesday to investigate allegations of an off-the-books wait list there.

U.S. Sen. Mark Kirk said the allegations targeting the Hines hospital are credible enough to warrant an expansion of the formal investigation targeting the Phoenix hospital.

The Phoenix hospital's director, Sharon Helman, also served as director of the hospital in Hines, Ill., from 2010-2012. Helman, who has been placed on leave while the investigation moves forward, has denied the claims, which have not been proved.

The Illinois hospital's current director, Joan Ricard, said there was no separate patient wait list at that facility. She said a spreadsheet was used by the mental-health department, but it was a "performance improvement tool" and was not linked to patient-appointment scheduling.

The Chicago allegation came from social worker Germaine Clarno, who also is president of the union representing the hospital's employees, the American Federation of Government Employees VA Local 781.

Clarno told CBS that executives and doctors were seeking "to make numbers look better for their own recognition and for bonuses."

Performance ratings and some compensation for hospital administrators are based partly on waiting times, according to a government official who has reviewed performance-plan documents.

"Giving bonuses to hospital directors for running a system that places priority on gaming the system and keeping their numbers down -- rather than provide care to veterans -- must come to an end," Sen. Patty Murray, D-Wash., said at Thursday's hearing.

In interviews this week, department officials declined to say whether they think that the 14-day goal for new patients is unrealistic, as some outside experts assert. Nor would they say whether they believe the policy, and the way the hospital administrators are rated, contributed to efforts to hide long wait times for medical appointments.

Information for this article was contributed by Richard A. Oppel and Timothy Williams of The New York Times; by Jason Keyser, Matthew Daly and Pauline Jelinek of The Associated Press and by Lisa Mascaro of the Tribune Washington Bureau.

A Section on 05/16/2014

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