Inappropriate scheduling practices have compromised care of patients at Department of Veterans Affairs hospitals and clinics nationwide, according to a preliminary report by the VA inspector general.
The report revealed that the number of VA health care facilities under investigation for manipulating patient wait-time data to conceal treatment delays has expanded from 26 last week to 42.
Investigators also confirmed that 1,700 veterans were placed on an unofficial waiting list for primary care appointments at the VA hospital in Phoenix, but they did not determine whether the practice led to the deaths of 40 patients. Investigators will conduct a detailed review of medical records and autopsy results before drawing any conclusions about the link between the unofficial wait lists and the patients’ deaths.
The findings broadened the scope of a scandal that has focused new scrutiny on the management of VA, a massive federal agency that struggles to serve a booming veterans population despite record funding levels.
President Barack Obama “found the findings extremely troubling,” White House spokesman Jay Carney said in a statement.
“The VA must not wait for current investigations of VA operations to conclude before taking steps to improve care,” Carney said. “It should take immediate steps to reach out to veterans who are currently waiting to schedule appointments and make sure that they are getting better access to care now.”
The report prompted calls from both parties for VA Secretary Eric Shinseki to be replaced.
Democratic Sens. Kay Hagan of North Carolina, John Walsh of Montana and Mark Udall of Colorado joined a growing chorus of lawmakers demanding Shinseki step down, the first Senate Democrats to break ranks with the president.
“I am outraged by the findings detailed in the inspector general’s interim report,” Hagan said in a statement.
“Now that some of the most serious allegations have been confirmed by the independent investigation, we can no longer put our faith in the current VA leadership’s ability to fix these problems,” Hagan said. “Secretary Shinseki has served our country honorably over many decades, but in the interest of regaining the trust of our veterans, and implementing real and lasting reforms, I believe it is time for him to step aside and allow new leadership to take the helm at the VA to correct these failings immediately.”
Rep. Jeff Miller, a Florida Republican who chairs the House Committee on Veterans’ Affairs, said two things need to happen in response to the report: “Attorney General Eric Holder should launch a criminal investigation into VA’s widespread scheduling corruption and VA Secretary Eric Shinseki should resign immediately.”
VA needs a leader “who will take bold steps to replace the department’s culture of complacency with a climate of accountability,” Miller said Wednesday in a written statement. “Sec. Shinseki has proven time and again he is not that leader. That’s why it’s time for him to go.”
Sen. Bernie Sanders, a Vermont independent who chairs the Senate Veterans’ Affairs Committee, has yet to call for Shinseki to resign and did not do so on Wednesday.
Sanders, who caucuses with the Democrats, instead urged Shinseki to reconsider whether the VA’s goal for seeing patients within 14 days is realistic under its current budget.
“The VA must determine what new staffing may be needed at VA hospitals in parts of the country where there have been significant increases in patient loads,” Sanders said.
The report underscored the scope of the problem and the challenge in fixing it.
The government has greatly boosted spending on the VA, jumping 60 percent from $91 billion in 2008 _ the year Obama was elected _ to $153.8 billion in 2014.
At the same time, the VA system has been flooded by 1.4 million new patients, including 50,000 troops wounded in action in Iraq and Afghanistan.
Since Republicans took over the House of Representatives in 2010, Congress has authorized an average of $2 billion a year less in discretionary spending for VA than Obama requested, according to PolitiFact.com.
Still, funding levels are higher than ever, and the agency has been protected from across-the-board federal budget cuts known as sequestration.
Veterans groups complain that VA’s enormous budget increases in recent years have been misspent on hiring middle managers and administrators who don’t actually see patients on a regular basis.
The crux of the problem is that VA doesn’t have enough front-line health care providers to meet demand, said Richard Weidman, executive director for policy and government affairs for Vietnam Veterans of America.
The number of veterans who use VA health care has grown rapidly since the U.S. went to war in Iraq and Afghanistan.
Just under 4 million patients made 39 million outpatient visits to VA health care facilities in 2000, the agency’s data shows. Last year, more than 6 million patients made 85 million outpatient visits. That’s 236,000 appointments per day.
“People say fire the schedulers. They are not the people who are causing this,” Weidman said. “They can’t create out of thin air more people who are clinicians and therefore more appointments that they can fill.”
Weidman testified before the Senate Veterans Affairs Committee this month that all the funding models the VA has in place consistently underestimate the number of clinicians needed to run the system efficiently. He recommended a review of all VA positions that don’t involve direct patient care and a thorough reassessment of the number of clinicians needed in each discipline in each VA medical center. Salaries need to be “reasonably competitive,” too, he said.
Weidman thinks Shinseki should stay to fix the problem.
“If we had to go through the whole rigmarole to get another secretary on board it would be well into 2015,” he said.
“We favor justice; we’re not in favor of lynch mobs,” he said. “We should do this with hearings instead of, ‘Let’s get a rope and drag them out of the jail.’”
Congress is considering a number of bills to reform the VA, including legislation that would make it easier to fire senior executives at the department, provide an additional $5 million for a VA inspector general’s investigation, freeze bonuses to senior VA employees and require the department to publicly release Office of the Medical Inspector reports of investigations into wrongdoing at VA facilities.