New patients face long waits at Texas VA hospitals

Greg Jaffe and Josh Hicks (c) 2014, The Washington Post. WASHINGTON — A nationwide audit by the Department of Veteran Affairs found that 57,000 veterans have been waiting more than 90 days for an appointment and that an additional 64,000 requested medical care but never made it onto VA waiting lists.

“This data shows the extent of the system problems we face,” acting VA secretary Sloan Gibson said, “problems that demand immediate actions.”

Gibson — who took over on May 30 after his predecessor, Eric Shinseki, resigned under pressure — outlined a series of emergency measures Monday to ensure that veterans stuck on long waiting lists will receive care as quickly as possible in the coming days and weeks.

The interim VA secretary said he would spend $300 million to increase hours for VA medical staffers and contract with private clinics to see veterans who are unable to get care through VA medical centers. Gibson also promised to institute new patient satisfaction surveys and said he had eliminated the 14-day scheduling goal for VA appointments, a measure that VA officials said was unrealistic and led to widespread cheating among hospital administrators whose bonuses were tied to hitting the mark.

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The near-term measures, however, are not likely to fix deeper problems that plague an VA health-care system that has struggled to accommodate more than 2 million new patients over the past five years. Some of the new veterans using VA medical centers fought in the Iraq and Afghanistan wars and appear to be using VA services at rates that are significantly higher than in previous wars. VA also has struggled to handle an aging population of Vietnam veterans who have flooded the system with severe health problems, some of them linked to Agent Orange.

VA has taken steps to address scheduling problems at the Phoenix VA clinic, where allegations of fraud and fake waiting lists spurred the inspector general’s investigation into what quickly became a nationwide scandal. In Phoenix, the department removed three senior officials, contacted all patients on waiting lists and deployed mobile medical units to speed care.

VA officials said they are still trying to figure out how much money and how many doctors and nurses they will need to fix the health-care system, which has seen its budget grow to almost $55 billion.

“We’re trying to get our hands around it,” said a senior VA official who was not authorized to speak on the record.

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White House press secretary Josh Earnest said that the audit’s release shows President Barack Obama’s commitment to solving VA’s problems and that the collection of data provides “a look at exactly what the scope of this problem is.”

The internal VA audit showed wide variation in wait times at VA health-care facilities across the country. For example, the wait time for an initial primary-care appointment in Baltimore was 81 days, compared with 17 days in Bedford, Mass. The big differences reflect a VA that has struggled to meet the needs of a rapidly changing veteran population that has dispersed over the past decade and is increasingly concentrated in large cities and coastal communities.

“There’s no question that there are parts of the country that we don’t have the doctors and nurses that we need,” said Sen. Bernard Sanders, I-Vt., the chairman of the Senate Veterans’ Affairs Committee. “On the other hand, I would not be surprised that in terms of allocating resources the VA could do a lot better.”

Sanders has led a bipartisan effort to pump about $500 million into the VA health-care system to pay for more doctors and nurses, co-sponsoring a bill that he and Sen. John McCain, R-Ariz., introduced Monday night. In the House, which has moved more quickly and frequently on veterans issues in recent months, Republican leaders announced plans to hold a vote this week on a bill that would allow veterans to seek immediate care from doctors and private medical centers closest to them.

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To free up more money to bring on more health-care personnel, senior VA officials also pledged to trim back a bureaucracy that lawmakers and critics charged has become bloated and slow. VA said it would immediately freeze all hiring at its central headquarters in Washington and at its large regional offices across the country.

VA’s biggest challenge, however, will probably be winning back the trust of veterans and lawmakers who have been shocked by the widespread fraud at the VA, which included secret waiting lists designed to hide months-long wait times that many veterans faced when seeking care. A recent interim report by the Office of the Inspector General found that gaming the system to hide long waits was “systemic” and may have been motivated by some managers’ desires for bonuses and promotions.

VA’s own audit found that 13 percent of VA schedulers were told to falsify appointment request dates to make patient wait times appear shorter and that at least one instance of that fraud was found at 76 percent of the VA facilities.

An additional 8 percent of scheduling staffers used unofficial lists to track patients who had waited at least 90 days for appointments, according to the report. Those lists kept the most extensive treatment delays off the books. Employees at 24 sites said they felt “threatened or coerced” to enter incorrect information.

Some Republican lawmakers questioned whether VA’s internal audit could be trusted, given its recent troubles.

“If this cursory investigation discovered thousands of veterans who have yet to receive care, I have no doubt these numbers only scratch the surface of the problems plaguing veterans,” said Sen. Jerry Moran, R-Kan. “While more than 3,772 VA staff were interviewed, I’d like to know how many veterans themselves — if any — were interviewed. Let’s ask our veterans if they are satisfied with the quality of care that they’re receiving and let them be the judge of whether or not good things are happening at the VA.”

Gibson, the interim secretary, promised new measures on Monday to hold top VA leaders accountable for fraud at the audited sites but was vague on the subject of whether anyone should be fired or prosecuted. His caution contrasted sharply with a bipartisan group of senators who called for a criminal investigation into whether VA officials purposely and knowingly lied about wait times in order to secure bonuses.

“This report makes it clear that the only people benefiting from our current VA health-care system are the bureaucrats who put their own bonuses over veterans’ care,” said Sen. John Cornyn, R-Texas. “President Obama must direct the FBI to investigate the allegations of criminal misconduct.”

Washington Post staffers Wesley Lowery, Ed O’Keefe and Katie Zezima contributed to this report.