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VA audit shows waits of 90-plus days across U.S.; times vary in L.A.

The VA is eliminating the 14-day scheduling goal from employee performance contracts
Of more than 6 million appointments in the VA system, nearly 64,000 veterans had not been seen

Some 57,000 veterans have waited more than 90 days for an  appointment at a VA facility, according to a nationwide audit released hours before a  congressional committee is due to put Veterans Affairs officials through another round of grilling on Capitol Hill.

"This data shows the extent of the systemic problems we face," acting VA Secretary Sloan Gibson said in releasing the audit, which provided the first look at wait times at each of the major VA facilities from Los Angeles to New York.

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FOR THE RECORD

An earlier version of this post said that of the nearly 260,000 appointments scheduled in Los Angeles, Long Beach, Loma Linda and San Diego, nearly 95% were set for 30 days or less. In fact, more than 95% were set for 30 days or less.

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"This audit is absolutely infuriating, and underscores the depth of this scandal," said Paul Rieckhoff, chief executive of Iraq and Afghanistan Veterans of America.

Rep. Jeff Miller (R-Fla.), chairman of the House Veterans Affairs Committee, called the audit "more disturbing proof that corruption is ingrained in many parts of the VA healthcare system."

In Southern California, patients already in the system received appointments promptly, according to the audit. In the VA Greater Los Angeles Health Care System, they waited an average of four days to see a primary care doctor, six days for a specialist and two days for a mental health appointment.

The problem, the audit showed, is getting enrolled in the system. In Los Angeles, patients who hadn't used the VA in more than two years had to wait 56 days for a primary care appointment and 55 days for specialty care.

Most worrisome, it took an average of 39 days for new patients to see a mental health specialist.

The data showed similar patterns at VA facilities in Long Beach, Loma Linda and San Diego. (Waits for mental healthcare for new patients ranged from 17 days in Canandaigua, N.Y., to 104 days in Durham, N.C.)

In all, there are nearly 260,000 appointments scheduled in Los Angeles, Long Beach, Loma Linda and San Diego. More than 95% were set for 30 days or less.

However, 1,903 new patients had been told that no appointments were available within 90 days. And another 3,665 veterans who enrolled over the last decade still had not scheduled an appointment.

Three facilities in Southern California were flagged for further review and investigation: the Sepulveda Ambulatory Care Center in North Hills, the VA Escondido Clinic and the VA Imperial Valley Clinic in El Centro.

A senior VA official said the additional reviews were prompted by findings that scheduling staffers had received instructions to enter a date different from the one requested by the patient.

The audit of 731 sites, including all of the major VA medical centers, concluded that the department’s goal of trying to schedule veterans within 14 days of their desired appointment dates was "simply not attainable," and creating the expectation that patients could be seen that quickly represented "an organizational leadership failure." The goal is believed to have contributed to VA staff falsifying records to mask long waits.

Of the 6 million appointments scheduled across the system, roughly 57,000 veterans who are waiting to be scheduled for care and another 63,869 who over the last decade have enrolled in the system have not been seen for an appointment, according to the audit.

Sloan said the VA was taking a number of actions in response to the audit, including contacting thousands of veterans who have been waiting for care to schedule them at a VA facility or with a private doctor and providing $300 million to accelerate healthcare and dispatching mobile medical units to VA facilities to help reduce wait times.

The VA also is eliminating the 14-day scheduling goal from employee performance contracts to "eliminate incentives to engage in inappropriate scheduling practices" and is suspending senior bonuses for this year, he said.

The audit is likely to stoke debate on Capitol Hill over whether the VA has enough funding, as the House and Senate prepare to take up legislation that would allow more veterans facing long waits at VA facilities to seek private care.

"Based on the findings of the audit, VA will critically review its performance management, education and communication systems to determine how performance goals were conveyed across the chain of command such that some front-line, middle and senior managers felt compelled to manipulate VA’s scheduling processes," the audit says.

"This behavior runs counter to VA's core values; the overarching environment and culture which allowed this state of practice to take root must be confronted head-on if VA is to evolve to be more capable of adjusting systems, leadership and resources to meet the needs of veterans and families. It must also be confronted in order to regain the trust of the veterans that VA serves."

The audit led to new calls for President Obama to create an independent commission to review veterans’ care and for the Justice Department to play a bigger role in the investigation.

The VA audit is separate from a VA inspector general’s investigation that found a systemic problem nationwide in scheduling veterans for healthcare in a timely manner. That investigation, which could lead to criminal charges, is expected to be complete in August.

The internal audit was ordered by then-VA Secretary Eric K. Shinseki and confirmed the scheduling manipulation cited by the inspector general's report.

A summary of the audit, which Shinseki delivered to Obama along with his letter of resignation on May 30, found that 13% of the scheduling staffers received instructions to enter a date different from the one requested by the patient.

In some cases, "pressures were placed on schedulers to utilize inappropriate practices in order to make waiting times appear more favorable," the audit found.  

Simon reported from Washington and Zarembo from Los Angeles.

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Follow @AlanZarembo for medicine and military news

Copyright © 2014, Los Angeles Times
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