A VA investigation of one of its outpatient clinics in Colorado reveals how ingrained delays in medical care may be for an agency struggling to rapidly treat nearly 9 million veterans a year amid allegations that dozens have died because of delays.
Clerks at the Department of Veterans Affairs clinic in Fort Collins were instructed last year how to falsify appointment records so it appeared the small staff of doctors was seeing patients within the agency's goal of 14 days, according to the investigation.
A copy of the findings by the VA's Office of Medical Inspector was provided to USA Today.
Many of the 6,300 veterans treated at the outpatient clinic waited months to be seen. If the clerical staff allowed records to reflect that veterans waited longer than 14 days, they were punished by being placed on a "bad boy list," the report shows.
"Employees reported that scheduling was 'fixed,' " the findings say.
After the VA endured a year of criticism that it took too long to deliver earned compensation to disabled veterans, the agency faces a new wave of attacks over slow medical care.
Department officials revealed last month that 23 deaths of veterans were linked to delayed cancer screenings dating back four years. More recently, a retired doctor, Sam Foote, alleged that 40 other veterans died because of treatment delays at a VA hospital in Phoenix. VA officials say there's no evidence so far to support those claims, but the hospital administrator was placed on leave pending an investigation by the agency's inspector general .
Sally Eliano, an Arizona woman, complained that her 71-year-old father-in-law, a Navy veteran, died after delays at the VA hospital in Phoenix in the treatment of bladder cancer.
The Medical Inspector's probe in the Fort Collins case could not confirm that patients had been harmed "due to the lack of specific cases evaluation."
A key allegation by the whistle-blowing retired doctor in Phoenix is that staff members manipulated records to hide delays. The same practice was found by the VA Office of Medical Inspector at the clinic in Fort Collins.
While investigators found that VA policies were violated, local medical leaders concluded that the violations were less intentional than the result of confusion and no disciplinary action was taken, says a VA statement released Saturday. Retraining and weekly audits were implemented, the statement says.
The VA in 2013 revamped some of its tracking procedures to better gauge wait times for nearly 100 million medical appointments each year at 151 hospitals and 820 clinics.
The agency found that only 41% of new VA medical patients were seen within 14 days last year, down from 90% reported in 2012 under an old, now-abandoned measurement method.
The VA found it wasn't doing so well with first-time mental health appointments, either. The agency reported in 2011 that 95% of new mental health patients were seen within 14 days, but the new tracking system found the rate in 2013 was 66%.
Mike Davies, the VA director of access, says the revised system for tracking new-patient appointments has finally provided accurate measurements on wait times. He says the department's commitment to track every single appointment is far more stringent than industry standards.
"I don't think there's any other health-care system that does this," Davies says.
He says the VA now can better determine what additional resources it needs to make sure veterans are treated more rapidly.
As a result of what happened at Fort Collins — the Medical Inspector's investigation was completed in December — the VA has done four site inspections to see whether timely treatment standards are being met, Davies says.
They found "other instances of misunderstanding" wait-time tracking requirements, "but we have not found any widespread patterns of misunderstanding," Davies says.
But federal investigators say that despite these efforts, the VA health-care system remains plagued by delays in treatment and opportunities to cover them up.
"Data has to be reliable to be useful," says Debra Draper, who directs an investigative staff for the Government Accountability Office. "So if you've people going in there and doing all kinds of things (to change the data), it really is not reliable."
Draper has led investigations into VA health care problems for years and says the agency has been struggling to accurately assess wait times for decades.
Draper says a key problem is a lack of oversight by top VA officials. The Fort Collins problems, for example, came to light only after a whistle-blower stepped forward.
Numbers of outpatient visits are spiraling, in large part because of an aging veteran population and young combat survivors suffering multiple medical and psychological issues.
At Fort Collins and the nearbyVA Medical Center in Cheyenne, Wyo. — which oversees seven clinics, including the one in Fort Collins — officials complained they didn't have enough doctors or supporting staff.
The result is jobs are left undone, VA investigators found. Staff required to follow up with veterans to schedule necessary appointments often didn't have time.
Investigators found that nearly half the clinic's 6,000 veteran patients did not have necessary medical appointments scheduled.
"Many of the (clerks) reported significant stress when trying to explain to veterans why they cannot make earlier appointments for them," the report says. "By entering (false data), the wait time for that patient appears to be zero days. ... The wait times were actually much longer."
Contributing: Dennis Wagner of The Arizona Republic.