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IG: 69 VA facilities probed for manipulating appointments

Jun. 9, 2014 - 06:00AM   |  
Debra A. Draper, Philip Matkovsky, Richard J. Grif
Richard J. Griffin, right, acting inspector general for the Department of Veterans Affairs, testifies June 9 as the House Committee on Veterans' Affairs holds hearing on Capitol Hill in Washington. He is joined by Debra A. Draper, director of health care for the Government Accountability Office, far left, and Philip Matkovsky, assistant deputy under secretary for health for administrative operations at the Department of Veterans Affairs. (J. Scott Applewhite / AP)
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Rep. Jeff Miller, R-Fla., right, chairman of the House Committee on Veterans' Affairs, confers with Rep. Mike Michaud, D-Maine, the ranking member, as the panel holds a hearing June 9 on Capitol Hill in Washington. (J. Scott Applewhite / AP)

The Veterans Affairs Department’s inspector general is investigating 69 medical facilities for manipulation of appointment wait times and has contacted the Justice Department in cases where staff has found evidence of potential criminal or civil wrongdoing.

In a hearing Monday on scheduling problems at VA health facilities, VA acting Inspector General Richard Griffin said his office is making surprise visits to facilities and has uncovered “indications” that supervisors instructed staff to manipulate scheduling data.

“We have had discussions with the Department of Justice as to whether they rise to the level of criminal prosecution,” Griffin said.

The House Veterans Affairs Committee conducted the hearing as part of its continued oversight of VA during a nationwide scandal into patient wait times and delays in care at VA medical facilities.

Earlier in the day, VA released the results of a national audit that found more than 100,000 veterans are experiencing long wait times for medical appointments. Nearly a quarter of those waited 90 days to 120 days for an appointment with their primary care doctors.

That investigation also found that 13 percent of scheduling staff were instructed by supervisors to alter appointment dates to make wait times appear shorter, while 8 percent said they used other systems to track patients’ appointments besides VA’s approved electronic system or health records system.

In more bad news for the Veterans Affairs Department, the Government Accountability Office released a report Monday that found the department also appears to be unable to provide timely specialty care for patients who need it.

In a look at patient referrals for specialty care, or consults, at five major Veterans Affairs Medical Centers, GAO investigators found that of 150 consults, 86 — or 57 percent — resulted in patients getting the follow-on care, but just 28 — or 19 percent — got that care within 90 days.

And 64 percent never got the requested care.

In one case involving a patient who needed surgery to repair two aneurysms, the patient did not get the surgery scheduled for nearly two months and died the day before the surgery was set at a non-VA facility.

VA did not decide for a month that it did not have the staff to do the surgery in-house.

“I included this case because while non-VA care expands capacity, there are pitfalls. It requires coordination between the VA, the non-VA provider and the patient,” GAO analyst Debra Draper said.

In the audit released today, analysts said VA’s complicated appointment system and pressures placed on schedulers to meet a 14-day target for getting patients into care — a goal auditors deemed unrealistic — created confusion and represent an “organizational leadership failure” at VA.

House Veterans Affairs Committee Chairman Rep. Jeff Miller, R-Fla., introduced legislation Monday requiring VA to offer private care to veterans who can’t be seen at a VA medical facility. Roughly 57,000 have waited at least 90 days for their first appointment, according to the audit.

“The continuing revelations of data manipulation and interminably long patient wait times have made it disturbingly clear that VA is unwilling to utilize that authority as often as it should,” Miller said.

The VA has taken several steps since May to resolve some of the problems. It initiated a new access-to-care program at Phoenix and other troubled facilities to expedite treatment for those on wait lists, including expanding private care for those waiting.

It also has initiated a hiring freeze at its Washington, D.C., headquarters and all regional offices so VA’s human resources offices can concentrate on hiring clinical staff and fill positions related to patient care and began proceedings to dismiss the top administrators at the VA Phoenix Healthcare system.

The department plans to spend at least $3 million in the next several months on the effort.

“We now know that within some of our Veterans Health Administration facilities, VA has a systemic, totally unacceptable lack of integrity. ... Let me apologize,” Philip Matkovsky, assistant deputy under secretary for health for administrative operations, said at the hearing.

The increased emphasis on private care might help Reno, Nevada, resident Peter Frank, 63, who suffers from poorly managed hypertension and recently was told he is in renal failure.

But he cannot get an appointment at the VA Sierra Nevada Healthcare System for a diagnostic ultrasound to determine the scope of his health issues until Aug. 30.

And last Thursday and Friday, the ailing Frank was sent home from that facility’s emergency room with a fever topping 103 degrees.

“It’s baffling to me what’s going on. I feel like if VA had given him the care he needed in the past 10 years for his high blood pressure, he wouldn’t be in this situation,” said his son, Peter C. Frank.

“I want to think it’s going to get better but, realistically, unless they have a complete overhaul of the system, it’s going to get worse,” he added.

Matkovsky said VA has enacted numerous changes in the system and is working hard to “restore America’s trust ... one veteran at a time.”

“VA leaders and our dedicated workforce — over a third of whom are veterans — are fully engaged,” Matkovsky said.

Peter C. Frank hopes it won’t be too late for his father.

“I feel like he wouldn’t be in this situation if he’d gotten good care in the first place. He’s only 63. I don’t want to lose him,” Frank said.

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