Veterans Health Administration (VHA) medical facilities in North Carolina and Virginia fail to provide veterans with health care within 30 days of patient requests in more than one-third of all cases, according to an audit conducted by the Department of Veterans Affairs’ (VA) Office of Inspector General (OIG).
Staff members create false records to hide the delays, the study reported. VA Secretary David Shulkin disputed the conclusions of the report.
Approximately 36 percent of veterans seeking treatment in 12 VHA medical facilities waited for an average of 59 days between requesting care and receiving appointments, states the 99-page report released on March 2, 2017. Inspectors visited the facilities, which are located in Veterans Integrated Service Network 6 (VISN 6), in May and June of 2016.
Medical facility staff manipulated appointment data to show shorter wait times, inspectors concluded.
“Of the estimated 20,600 appointments with wait times greater than 30 days, staff entered incorrect clinically indicated or unsupported preferred appointment dates for 15,300 appointments (74 percent) that made it appear as though the wait time was 30 days or less,” the report states.
Shulkin disputed the audit’s methodology, saying OIG “ignored the dates patients told us they wanted to be seen and selected an earlier date to use for calculating wait times,” the Citizen-Times (Richmond) reported on March 11.
In 2014, in a separate investigation, OIG found 35 veterans had died due to long wait periods, which had been inaccurately recorded at a VHA hospital system in Phoenix, Arizona. In the same system, more than 200 veterans died awaiting specialist consultation appointments, a subsequent OIG investigation found in 2016.
Dan Caldwell, director of policy at Concerned Veterans for America, says falsification of records at VHA medical facilities is a recurring problem.
“Manipulated wait lists are very much a persistent and widespread problem across the entire VHA, even today,” Caldwell said. “Just last November, the OIG found that over two years after the Phoenix wait-list scandal broke, VA nurses were still falsifying nearly half of specialist consultations there.”
The new OIG report demonstrates false reporting at VHA is a systemic failure.
“[The] OIG report showed that these widespread wait-time inaccuracies were also an issue at VA medical facilities in North Carolina and Virginia,” Caldwell said. “It’s clear that the VA hasn’t done enough to address this issue.”
Complaints of Inconsistency
VA officials say the OIG report records some appointments veterans had made before reforms had been implemented.
“Much of the data covered in the audit captures a period extending back into 2014, offering a refracted portrayal of our care for veterans, since the environment has been in a state of continual regulatory and operational change,” reads an official statement provided to Health Care News by Steve Wilkins, acting communications director for VISN 6.
OIG inspectors’ standards differed from VHA protocols, according to a statement the Charles George VA Medical Center in Asheville, North Carolina provided the Citizen-Times.
“The discrepancies between [OIG] and VHA wait times are the result of OIG’s use of a methodology that was inconsistent with VHA policies at the time of the audit,” the statement says. “All scheduling audits and follow-up training at [Charles George VA] were compliant with VHA requirements.”
Waiting vs. Choosing
Caldwell says the VHA wait times reflect subpar care for veterans by any standard.
“Even when the VA’s ‘different criteria’ are taken into account, the OIG still shows that schedulers were understating how long veterans were waiting in over half of the appointments they handled,” Caldwell says. “No matter how you slice it, inaccurate wait times are a continuing problem at the VA.”
A voucher system allowing private health care providers to compete with the VA would serve veterans better, Caldwell says.
“[Concerned Veterans for America] has for years proposed empowering veterans with choice over where and when to see a doctor,” Caldwell said. “Our proposal advocates for the creation of a government-chartered nonprofit that would oversee the distribution of benefits and let vets decide whether to seek care inside or outside of the VA.”
Veterans deserve the chance to choose providers capable of serving them, Caldwell says.
“Veterans chose to serve,” Caldwell said. “They should be able to choose their doctor, especially given the fact that the VA is objectively failing to properly care for them.”
Support for Reforms
Market-based reforms expanding veteran patients’ choice are on the horizon under President Donald Trump, Caldwell says.
“The Trump administration has done an excellent job identifying top priorities for reforming the VA, laying out a bold vision including choice and strong accountability measures,” Caldwell said. “New VA Secretary David Shulkin has heavily suggested that pursuing ‘Choice 2.0’ will be one of his first courses of action, and he also supports the VA Accountability First Act of 2017.”
The VA Accountability First Act of 2017, House Resolution 1259, would make it easier to fire bad VA employees and allow the VA Secretary to revoke bonuses given to employees who engage in misconduct. The bill passed the House by a 237–178 vote on March 16 and was referred to the Senate Committee on Veterans’ Affairs on March 21.
Caldwell says lawmakers and Shulkin owe veterans a higher standard of care and stricter enforcement.
“We encourage the president and Secretary Shulkin to continue ignoring pressure from special interests and big labor to resist these important reforms,” Caldwell said. “Ultimately, it’s up to Congress to get these changes written into law. Until VA employees understand that there will be consequences for manipulating wait times, they’re going to keep trying to stack their numbers.”