An investigation of medical care at Veterans Affairs facilities has found "systemic" problems and "manipulation" of waiting lists, prompting new calls for VA Secretary Eric Shinseki to resign.
"We are finding that inappropriate scheduling practices are a systemic problem nationwide," the VA inspector general said in an interim report Wednesday that disclosed that the investigation has expanded to 42 sites from the previously reported 26.
The reaction on Capitol Hill was swift.
Rep. Jeff Miller (R-Fla.), chairman of the House Veterans' Affairs Committee who had resisted fellow Republicans' calls for Shinseki to resign, said Wednesday that it was time for Shinseki to go.
So too did one Democratic senator, Mark Udall of Colorado, who said the systemic problems at the Department of Veterans Affairs are "so entrenched that they require new leadership to be fixed."
Shinseki issued his own response Wednesday, calling the findings "reprehensible to me, to this department, and to veterans" and reiterated that he was taking steps to ensure that veterans receive timely care. He showed no sign of stepping down.
But with the critical report drawing fresh bipartisan outrage from Capitol Hill, it is becoming tougher for the retired four-star general to save his job.
There was no immediate response from the White House.
At the Phoenix VA Health Care System, the main subject of the interim report, investigators "substantiated that significant delays in access to care negatively impacted the quality of care," finding about 1,700 veterans waiting for an appointment but not on a waiting list.
"These veterans were and continue to be at risk of being forgotten or lost," the report says.
Phoenix leaders, whose bonuses were based on performance, "understated" the time patients waited for appointments, the report says. They asserted that a sampling of 226 veterans waited on average 24 days and only 43% waited more than 14 days.
In reality, according to the report, the 226 veterans waited on average 115 days -- and an estimated 84% waited more than 14 days.
The inspector general cited a number of "scheduling schemes" in use, many of them previously reported in a 2010 VA memo on "gaming strategies" that has drawn widespread attention in recent weeks.
Miller, who was due to hold a hearing on the VA mess late Wednesday, said the report confirmed "beyond a shadow of a doubt what was becoming more obvious by the day: wait time schemes and data manipulation are systemic throughout VA and are putting veterans at risk in Phoenix and across the country."
Sen. John McCain (R-Ariz.), a respected voice on military affairs, also called for Shinseki's resignation on CNN.
Sen. Joe Manchin (D-W.Va.), while stopping short of calling for Shinseki's resignation, said Congress' patience with the VA is "vanishingly thin."
Added Sen. Patty Murray (D-Wash.), "We are at the point where good intentions are no longer good enough. We need to see real actions to make sure our veterans are getting the support and care they expect and deserve, and we need to see that right away."
Investigators identified "multiple types of scheduling practices that are not in compliance" with Veterans Health Administration policy, including lists that "may be the basis for allegations of creating 'secret' wait lists."
"It appears that a significant number of schedulers are manipulating the waiting times," the report says.
The inspector general said he is working with the Justice Department to determine whether criminal charges are warranted.
Sally Barnes-Breen, whose father-in-law waited two months last fall for a follow-up at the Phoenix VA, said Wednesday that the inspector general's confirmation of a "ridiculous" wait time showed exactly why Thomas Breen, a 71-year-old Navy veteran, died of bladder cancer in November.
"They just blew themselves up," she said. "Now, what do they want to do about it? They are criminals."
During their investigation of Phoenix VA, the inspector general said his office also has received "numerous allegations daily of mismanagement, inappropriate hiring decisions, sexual harassment, and bullying behavior by mid- and senior-level managers at this facility." The inspector general said it is still assessing the validity of the complaints.