Deliberate falsification of patient wait times was confirmed at the Department of Veterans Affairs hospital in Phoenix in 2008, but the agency’s inspector general kept its findings secret, a report obtained by the Washington Examiner shows.
The 2008 investigation confirms the IG and VA officials were aware that schedulers were using bogus tactics to “game” the system, allowing them to falsely claim patients were getting the medical care they needed within agency deadlines.
The tricks used to hide the delays are virtually identical to those that were revealed earlier this year, leading to a nationwide scandal and confirmation that the use of falsified waiting lists was deliberate, “systemic” and potentially criminal.
Yet the 2008 investigation by the IG was deemed “restricted,” meaning it was not publicly released. So the problems identified in 2008 festered at the Phoenix facility until a whistleblower took charges of manipulation of patient records to the House Veterans’ Affairs Committee, which in April directed the IG to thoroughly investigate the practices.
“The OIG actually identified many of the Phoenix VA Healthcare System’s wait time issues in a 2008 report that it refused to make public, effectively keeping the problems hidden,” said Rep. Jeff Miller, R-Fla., chairman of the House veterans’ committee. “It does appear that the IG missed the forest for the trees, often labeling what we now know to be systemic and willful manipulation of medical care appointment data as basic procedural problems and breakdowns in training.”
The Examiner reported earlier this month that over the past 10 years the VA inspector general confirmed improper scheduling practices at hospitals nationwide, but routinely dismissed them as training issues or failure to understand agency procedures. Whistleblower allegations of deliberate falsification were investigated in about 20 separate facilities with little fanfare since 2005.
Only one of the investigations mentioned the possibility of deliberate manipulation of patient records, but that 2007 report stated the IG “did not investigate whether schedulers were intentionally ‘gaming’ the system.”
In April, Miller disclosed new whistleblower allegations that schedulers at the Phoenix hospital were using paper waiting lists to make it appear patients were receiving care within agency deadlines.
Meeting those time frames is critical for managers to get positive performance reviews and performance bonuses.
Within two months of being directed by Miller to get to the bottom of the allegations, the IG confirmed falsified waiting lists were being used at VA medical facilities nationwide. It labeled the problem “systemic” and has recommended at least 17 agency employees be prosecuted.
The U.S. Attorney’s Office has declined to seek charges.
The IG’s findings led to the resignation of then-Secretary Eric Shinseki in May.
The 2008 report shows the IG and VA administrators knew at least six years ago that the improper scheduling practices were routinely being used at the Phoenix hospital.
“We found that it was an accepted past practice at the medical center to alter appointments to avoid wait times greater than 30 days and that some employees still continue this practice,” the 2008 report on the Phoenix investigation states.
The VA policy at the time required patients to be seen within 30 days of the date they desired. When the hospital could not meet that standard, it used a series of tricks to make it appear no one was waiting for an appointment.
Schedulers said they were instructed by their supervisors to alter patient appointment records to show a zero-day wait time.
“Two medical center schedulers told us that it was common practice to alter appointments to obtain a 0-day wait time to avoid wait times greater than 30 days,” the 2008 report says. “A supervisory scheduler explained that, in the past, schedulers ‘conditioned themselves’ to ‘fix’ appointments so that they reflected zero. She said that they did this to avoid making appointments that showed up on a ‘negative list’ generated by supervisors that listed appointments with more than a 30-day wait time.”
Another scheduler told IG investigators that appointments were made and cancelled to make it appear patients got care when they desired. That scheduler said she made one such change to a patient’s record an hour before meeting with the IG investigator.
“They [supervisors] will ding the heck out of you if they see a number on the bottom of their report,” the scheduler told the IG investigator.
A different Phoenix employee said that when she arrived at the Phoenix facility in 2004, it was standard practice to alter appointments, “and employees readily admitted to her that it was ‘gaming’ the system,” the unreleased IG report states.
To fix the problem, the IG recommended hospital administrators ensure managers and schedulers comply with VA scheduling policies.
A spokeswoman for the VA IG did not respond to questions Wednesday about why the report was deemed restricted, and whether it was sent to congressional committees with oversight responsibilities over the agency.
The only recipient listed on the 2008 report was the director of the Phoenix VA Health Care System.
The Examiner filed a Freedom of Information Act request for the report Sept. 26. It was not provided by the IG. The Examiner obtained the report through other sources.
In its final report on the recent Phoenix investigation, issued in August, acting inspector general Richard Griffin claimed his office had long warned of improper practices identified in Phoenix, and cited 18 previous investigations that were publicly released since 2005.
A review of those reports by the Examiner found that even when the improper practices were confirmed, they were dismissed by the IG as mistakes that could be fixed with better training and oversight.
The 2008 investigation, though not publicly released, is mentioned in a brief note in one of the appendices on page 92 of the 143-page final report on the Phoenix investigation issued in August.
Griffin has come under scrutiny recently because of an assertion in the final report that investigators could not “conclusively assert” delays confirmed at the Phoenix facility this year caused patient deaths. He acknowledged that line was not in the original draft of the report sent to agency administrators for comment, but insisted it was inserted by his people, not the agency’s.
During a Sept. 17 congressional hearing, Griffin admitted delays may have contributed to patient deaths.
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