A Department of Veterans Affairs audit has found that the VA's medical scheduling issues go far beyond the Phoenix VA facility, with more than 57,000 veterans nationwide waiting more than 90 days for medical check-ups after making their initial appointments.
An additional 64,000 veterans over the last decade were found to have never had medical appointments after having enrolled in the VA health care system. The audit also found that some VA schedulers felt pressure from supervisors to falsify dates in appointment records in order to meet the goal of a 14-day waiting period for medical appointments.
Conducted over three weeks, the audit reviewed scheduling practices at 731 VA hospitals and clinics and found 57,436 veterans waiting for care 90 days after their appointments were scheduled. The audit also found another 63,869 veterans who had enrolled in the VA's health care system over the past decade had never been seen by VA doctors despite having made initial appointments.
Former VA Secretary Eric Shinseki ordered the nationwide "face to face" audit of VA scheduling issues after revelations by a whistle-blower that scheduling delays at the Phoenix facility may have resulted in 41 deaths. The VA's Office of Inspector General has so far not found any links between the delays and patient deaths, though a preliminary report concluded "that inappropriate scheduling practices are systemic throughout VHA [Veterans Health Administration]."
The VA's nationwide access audit released today was in line with the IG's conclusions, which found that 13 percent of VA schedulers indicated that supervisors had told them to falsify appointment dates to make waiting times appear shorter.
According to the audit, schedulers at 90 clinics "provided responses indicating they had altered desired dates that had been entered." It also found that "in virtually all cases, they indicated they were instructed by supervisors, but many believed the policy of altering dates was coming from facility leadership."
In a statement, VA Acting Secretary Sloan Gibson said today the audit "shows the extent of the systemic problems we face, problems that demand immediate actions."
"It is our duty and our privilege to provide Veterans the care they have earned through their service and sacrifice," said Gibson. "As the President has said, as Secretary Shinseki said, and as I stated plainly last week, we must work together to fix the unacceptable, systemic problems in accessing VA healthcare."
The VA has contacted 50,000 veterans nationwide to get them off of wait lists and into clinics, Gibson said, adding: "Veterans deserve to have full faith in their VA, and they will keep hearing from us until all our Veterans receive the care they've earned."
Schedulers at 24 clinics "felt threatened or coerced to enter specific desired dates," the audit found, and schedulers at 14 other locations reported being sanctioned or punished over scheduling practices. At two clinics, schedulers said they'd been "written up" for not complying with supervisors' orders "to inappropriately enter or alter recorded desired dates, or for expressing concerns over what they were being asked to do."
The preliminary VA Inspector General investigation of appointment scheduling at the Phoenix VA facility identified 1,400 veterans on the electronic wait list who did not have a primary care appointment. It also found an additional 1,700 veterans who had made appointments but were not on the electronic wait list and were "at risk of being lost or forgotten." Gibson said last week that all of the veterans in the IG's report had been contacted for future appointments.
White House spokesman Josh Earnest said the audit's findings are "helpful" and "a sign of our commitment to be transparent about this process."
Rep. Jeff Miller, chairman of the House Veterans Affairs Committee, said in a statement that "today's report is more disturbing proof that corruption is ingrained in many parts of the VA health care system."
"The only way to rid the department of this widespread dishonesty and duplicity is to pull it out by the roots," he added, urging the Senate to pass a bill passed by the House that would give the VA secretary broader authority to dismiss VA executives at failing facilities.
In a statement accompanying the audit, the VA said: "Where audited sites identify concerns within the parent facility or its affiliated clinics, VA will trigger administrative procedures to ascertain the appropriate follow-on personnel actions for specific individuals." It added that "where appropriate, VA will initiate the process of removing senior leaders. Acting Secretary Gibson is committed to using all authority at VA's disposal to enforce accountability among senior leaders."
The VA has already initiated the process of terminating some administrators at the Phoenix VA facility. A VA official said accountability actions at other VA facilities will depend on the outcome of further reviews.
Gibson also ordered an independent external audit to look at the VA's scheduling practices, the removal of the 14-day scheduling goal from employee performance contracts and a hiring freeze. The hiring freeze will be directed at administrators and managers and would not affect the hiring of health care professionals, a VA official said.
Meanwhile, top presidential aide Rob Nabors continues conducting his broader review of the VA's health care procedures and policies. Nabors' recommendations are expected to be presented to President Obama later this month.