An internal audit of access and scheduling practices at the Department of Veterans Affairs paints a grim picture of an agency whose ambitious performance efforts were unattainable and where government schedulers faced pressures that led to inappropriate practices.
As political pressure from the scandal over veterans' healthcare grew in recent weeks, attention focused on the internal audit, ordered by the White House and carried out by the Department of Veterans Affairs, to explain what had gone wrong and what needed to be done.
The report was released Friday after Secretary Eric K. Shinseki resigned and was replaced on an interim basis by Sloan Gibson, the department's deputy secretary.
At his news conference, President Obama said that Shinseki and White House Deputy Chief of Staff Rob Nabors, whom Obama named to investigate questions about the agency, discussed the audit before Shinseki offered to step down to avoid becoming a political distraction.
The audit showed that problems at the VA went beyond isolated complaints at the Phoenix facility.
"What they've found is that the misconduct has not been limited to a few VA facilities, but many across the country," Obama said. "That's totally unacceptable. Our veterans deserve the best. They've earned it. Last week, I said that if we found misconduct, it would be punished. And I meant it."
Complaints about how the department functioned have been a political staple for years, even preceding Obama, who pledged to work to eliminate backlogs and increase service to veterans. The latest audit, however, shows how far from that ideal the agency had fallen.
The audit looked at 216 sites and more than 2,100 scheduling staffers and is the first phase of the department's examination of its practices. The report found that appointments at more than 60% of the divisions had been changed at least once. In addition, the audit found that 13% of the scheduling staffers indicated they had received instruction to enter a date different from the one requested by the patient.
"Information indicates that in some cases, pressures were placed on schedulers to utilize inappropriate practices in order to make waiting times appear more favorable," the audit said. "Such practices are sufficiently pervasive to require VA reexamine its entire Performance Management system and, in particular, whether current measures and targets for access are realistic or sufficient."
In addition, 7% to 8% of scheduling staffers indicated they used something other than the official electronic list, a complaint made by whistle-blowers who charged that some veterans were pushed onto secret waiting lists because their needs could not be handled within the agency’s performance target of 14 days. The audit found at least one instance of such juggling in 62% of the facilities examined.
It was unclear whether the manipulation of dates and lists was "done through lack of understanding or mal-intent," the audit says. But where misconduct is confirmed, "appropriate personnel actions will be pursued promptly," it says.
Perhaps the biggest problem, the audit found, was the 14-day performance target for new appointments, a step imposed by the VA management to cut down on waiting periods. That goal "was simply not attainable given the ongoing challenge of finding sufficient provider slots to accommodate a growing demand for services," the audit found.
"Imposing this expectation on the field before ascertaining required resources and its ensuing broad promulgation represent an organizational leadership failure," the audit charged.
Among its recommendations was to remove the 14-day goal from performance targets and to suspend executive performance awards for the year. The audit also called for improving scheduling and access management.
"Scheduling is the initial touch point where veterans' access to care is managed, and it is also the point of greatest risk in providing timely access to care," the audit stated. The agency "must get this process right as all downstream functions derive from this front-line touch point. Ensuring integrity in this process and using valid assessments of actual timeliness to accessing care is a leadership issue."
In Arizona, the epicenter of the current scandal, some of those who said they had suffered from VA problems said they had expected the resignation and were wondering whether it would lead to changes.
Edward Laird, a 76-year-old Navy veteran who had more than half his nose cut away because of what he described as years of delayed care at the Phoenix VA, said it was a step in the right direction.
"The buck stopped with him. It happened on his watch. He took the job and he didn’t do nothing," Laird said. "He should have stood up and taken a few bullets for us."
The "writing was on the wall," he said. "He's just what you call collateral damage."
Still, Laird said the removal of one man would not fix what he called a deeper problem within the agency.
"They need to start all over. They are so steeped in bureaucracy and red tape that the guy before [Shinseki] couldn’t do anything and got stonewalled, too," he said.
In San Tan Valley, Ariz., Sally Barnes-Breen, whose father-in-law died of bladder cancer while waiting for a follow-up appointment at the Phoenix VA facility, said Shinseki's resignation was not enough.
"People are still dying," she said. "They need to fix the VA."
Times staff writer Michael Muskal in Los Angeles contributed to this report.