Two Department of Veterans Affairs Office of Inspector General reports confirming allegations of wait time manipulation and mismanagement at the Southern VA Health Care System have been released. Arizona Senator John McCain calls the results of the reports “deeply disturbing.”
According to the report, “A former Southern Arizona VA Health Care System (SAVAHCS) employee, alleged that she became aware of a number of “game playing techniques” by SAVAHCS to improve the appearance of appointment access…… The complainant added that she wanted to make the OIG aware of the ways SAVAHCS “gamed” the system and was concerned patient care may have been delayed and patient harm may have occurred.”
The OIG interviewed the complainant and 23 VA employees from both Veterans Integrated Service Network (VISN) 18 and VAMC Tucson. The review included VA emails, VA memos, training materials, monthly appointment and consult audit reports, a Veterans Health Administration (VHA) issue brief, and a report regarding the 2010 VISN Unannounced Site Visit, and the facility’s response to the unannounced site visit.
McCain says that the reports confirm that the “problems plaguing our VA health care system nationwide extend to Southern Arizona. According to investigators, VA staff were improperly trained and directed to zero-out patient wait times in violation of VA policy – at one point leaving more than 75 appointments zeroed-out between December 2013 and August 2014. A separate investigation found employees failed to properly schedule approximately 400 Orthopedic appointment requests, as well as an additional 600 Urology appointment requests. Moreover, the OIG confirmed widespread scheduling misconduct, including in some cases cancelling appointments if wait times exceeded 30 days.”
The VA Office of Inspector General report summary reads:
The complainant, a former Southern Arizona VA Health Care System (SAVAHCS) employee, alleged that she became aware of a number of “game playing techniques” by SAVAHCS to improve the appearance of appointment access. The complainant alleged: (a) that in 2012, more than 400 Orthopedic appointment requests were on individual pieces of paper instead of being placed on the Electronic Wait List (EWL); (b) that, between 2008 and 2009, approximately 600 Urology appointments were on individual pieces of paper instead of the EWL; (c) that Palliative Care consults were placed in Veterans Health Information Systems and Technology Architecture (VistA) with the statements, “This consult placed for performance measures only. Do not take action on this consult”; and (d) that consults were discontinued with the comments, “Consult being discontinued because 30-day metric could not be met.
Please resubmit consult.” The complainant further alleged that she had reported these concerns to SAVAHCS management, but senior leader 1 dismissed her findings. The complainant also alleged that she reported the matters in 2010 to two senior leaders, who substantiated her complaints. The complainant added that she wanted to make the OIG aware of the ways SAVAHCS “gamed” the system and was concerned patient care may have been delayed and patient harm may have occurred.
In May 2014, an anonymous source also contacted the OIG Hotline and alleged that the Veterans Affairs Medical Center (VAMC) in Tucson had been under investigation 6 years ago for instructing scheduling clerks to falsify veteran “desired dates” in order to meet requirements. The anonymous source alleged that schedulers were now receiving training, but managers who previously told them to falsify desired dates were denying they instructed
scheduling clerks to falsify the appointment dates. The anonymous source stated that managers were “once again throwing the clerks under the bus as if they came up with this idea [to falsify the desired dates] themselves.” The anonymous source further stated that senior leader 1 “created a culture where he doesn’t communicate with most of the hospital staff, remains very isolated, rarely if ever leaves his office during weekdays and has created a culture of intimidation where employees are deathly afraid to bring him bad news or tell him the truth.”
In July 2014, VA OIG received a copy of an anonymous complaint routed from U.S. Representative Ron Barber’s office. The anonymous complainant stated that he/she was an employee at the Tucson VA and that the clinical nurse manager (CNM) praised nurses who entered a patient’s appointment dates as being 14 days or less. The anonymous complainant also stated that the CNM instructed him/her how to misrepresent the patient’s desired date to achieve the 14-day metric.