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VA audit sparks outrage in Congress over long waits for medical care

Hospitals and ClinicsU.S. Department of Veterans AffairsAmerican LegionTulsi GabbardDurham (Durham, North Carolina)Eric ShinsekiCorporate Performance
'America's veterans deserve better,' congressman says after VA audit on wait times
U.S. warriors are 'begging for care when they come home,' congresswoman says of VA audit
New VA audit shows 57,000 veterans waited more than three months for a doctor's appointment

A new audit that finds 57,000 veterans have waited more than three months for an appointment at Veterans Affairs facilities sparked more  outrage Monday on Capitol Hill even as the VA inspector general said its investigation has widened to include additional hospitals.

“America’s veterans deserve better,” Philip Matkovsky, the VA's assistant deputy undersecretary, said in an apology at a hearing Monday evening before the House Veterans Affairs Committee. "This is a breach of trust. It is irresponsible. It is indefensible. And it is unacceptable.

"I apologize to our veterans ... and the American people," he said.

U.S. Rep. Tulsi Gabbard (D-Hawaii) called the 145-day wait time for primary care appointments in Hawaii revealed in Monday’s audit — the longest in the country —  "infuriating and deeply disappointing.”

“It makes me sick knowing that our returned warriors are subject to begging for care when they come home,” she said in a statement.

The inspector general announced it is now investigating 69 sites across the country based on reports of employees falsifying records to conceal long waits for care, according to testimony presented Monday evening to the Veterans Affairs Committee.

The audit provided details of wait times at hundreds of VA facilities across the country, further angering lawmakers from both parties as they touched on facilities close to home.

Waits for mental health care for new patients identified in the audit ranged from 17 days in Canandaigua, N.Y., to 104 days in Durham, N.C.

VA facilities in Florida, Oregon and Tennessee had the most patients unable to get an appointment within 90 days.
 
A senior VA official said the additional reviews were prompted by findings that scheduling staffers received instructions to enter a date different from the one requested by the patient.

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

Dan Dellinger, national commander of American Legion, called 57,000 patients waiting for more than 90 days for their initial appointments "disgraceful."

There are nearly 64,000 veterans who have enrolled in the VA system over the last decade but have not been seen for an appointment at all, according to the audit. 

"This is not just ‘gaming the system,’’’ Dellinger said.  It’s Russian roulette and veterans are dying because of the bureaucracy.”
 
Separately, the Government Accountability Office issued a report on delays in veterans receiving outpatient specialty care, finding that 43% of a sampling of patients at five VA facilities did not receive the requested care.

The GAO found one case, a gastroenterology consult, in which it took 210 days for the patient to receive the care.

In another case, a veteran died while waiting for surgery for aneurysms.  The patient was diagnosed last September and scheduled for surgery in  November, but the operation was canceled "due to staffing issues."

In December, the patient was referred to a local hospital, but the patient’s information was lost. A day before the surgery was rescheduled, in mid- February, the patient died. The case has been referred to the inspector  general.

The inspector general is already reviewing medical records of Phoenix VA  patients  "whose death occurred while on a waiting list, or is alleged to be related to a delay in care.” Complaints about the Phoenix wait list were what originally launched the nationwide reviews.

The audit of 731 sites is separate from the inspector general investigation, which could lead to criminal charges. It is due to be complete in August.

The audit, ordered by former VA Secretary Eric K. Shinseki before his resignation last month, 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.

It concluded that the department’s goal of trying to schedule veterans within 14 days of their desired appointment dates was "simply not attainable." Creating the expectation that patients could be seen that quickly represented an "an organizational leadership failure," it added.

The 14-day goal is believed to have contributed to VA staff falsifying records to mask long waits.

"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.

Sloan Gibson, the acting VA secretary, announced steps he is taking 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. In some cases, mobile medical units will be dispatched to VA facilities to help reduce waiting 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 suspending senior executive bonuses for this year.

Copyright © 2014, Los Angeles Times
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Hospitals and ClinicsU.S. Department of Veterans AffairsAmerican LegionTulsi GabbardDurham (Durham, North Carolina)Eric ShinsekiCorporate Performance
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