When it was revealed in April that Veterans Affairs officials maintained secret wait lists and covered up wait times for veterans seeking health care at the VA facility in Phoenix, the alleged deaths of at least 40 such veterans stoked national outrage.
But those long wait times and cover-ups didn't cause any deaths at the Phoenix VA hospital, according to a report released today by the VA's inspector general.
"While the case reviews in this report document poor quality of care, we are unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans," the report said.
The VA's investigators identified "28 instances of clinically significant delays in care associated with access to care or patient scheduling." Of those 28, six patients died -- but not necessarily because of a lack of timely care, according to the report.
The report acknowledges that in several instances, delays in care "could have," "may have," or "might have" led to patients' subsequent deterioration. Investigators also acknowledged that early interventions "might have forestalled ... death" for one patient who died of heart trouble or "might have altered the outcome" for two patients who succumbed to suicide.
Dr. Sam Foote, the man who exposed unethical practices at the Phoenix VA Health System, where he worked, disagreed with the OIG assessment.
"If [a delay] was clinically significant then it would have had an impact, and if the patient died and it was clinically significant and had an impact, then it had an impact on the death," Foote said in an interview with ABC News. "That's how any normal, logical thinking person would interpret those statements."
The families of patients who died while waiting place the blame squarely on the VA. Sally Breen's father-in-law, a Navy vet, was unable to schedule an appointment at the Phoenix VA and died of bladder cancer.
"The VA, they're at fault why my dad is dead," she said. "We watched him die and it was disgraceful."
Breen has retained a lawyer and plans to file suit against the VA, she told ABC News.
Overall, the inspector general's office outlined 45 clinical cases, and while it found "unacceptable and troubling lapses in follow-up, coordination, quality and continuity of care," it also said the original claim by Foote and other whistleblowers that 40 patients died while waiting was unsubstantiated because the whistleblower who sparked the investigation -- and the ensuing national outcry -- didn't provide investigators with enough information.
The unspecified "whistleblower did not provide us with a list of 40 patient names," the inspector general's report said.
Foote called that claim "false and misleading," writing in a rebuttal that 45 patients had died while waiting for care and that he had provided the VA’s investigators with 24 names of patients from specific lists he knew about.
Dr. Katherine Mitchell, a VA medical director who also blew the whistle on the organization, agreed with Foote, adding that the VA should not have been responsible for evaluating itself to begin with.
"My general view is that the VA should never have been trusted to interview itself or investigate itself," Mitchell said. "It hasn't done a good job in all the OIG investigations its done thus far, and there's no reason to believe it'd be different in this particular case.
"Early intervention for patients improves outcomes. That's not rocket science," she added. "Either they don't have the medical expertise [to evaluate the cases] ... or they wanted to avoid any liability the VA might have for contributing to the cause of death."
The report recommended that the Phoenix VA reevaluate its scheduling system and expand psychotherapy services to ensure continuity of care. It also suggested the Veterans Health Administration require directors to alert officials when their facilities are unable to meet quality of care standards.