When allegations first surfaced about long wait times for U.S. military veterans seeking treatment at Veterans Affairs medical facilities, the Obama administration sought to put the best spin on things.
President Obama himself suggested that, while embarrassing, the problems weren’t a matter of life and death. “The wait times were for folks who may have had chronic conditions, were seeking their next appointment but may have already received service. It was not necessarily a situation where they were calling for emergency services,” he said.
His last VA Secretary Bob McDonald went even further, suggesting the problems were no worse than wait times at a famous amusement park. “When you go to Disney, do they measure the number of hours you wait in line? What is important is, what is your satisfaction with the experience,” McDonald said to bipartisan howls.
Now three years and more than 100 criminal investigations later, there is overwhelming evidence the VA wait times were in fact systematic, consequential and involved a widespread cover-up to hide the denial of timely care.
Even worse, life-threatening problems persist at VA facilities, like in the nation’s capital where the political debate on fixing the VA has malingered.
The latest evidence emerged this week just before a grateful nation celebrates its veterans on Memorial Day. An internal probe of the VA facility in Montgomery, Ala., concluded patient wait time records were altered and patients were denied timely care.
A medical review board review “substantiated that nurses in primary care at the Tuskegee campus maintained paper wait lists; MSAs had scheduling access removed, thus preventing them from scheduling or viewing availability with certain clinics; desired dates were manipulated or altered ... and consults were being canceled, denied, or administratively completed without patients being scheduled for an appointment or receiving the requested care,” a report by the VA’s inspector general disclosed
While the consequences were real to veterans, they were less so for responsible VA personnel. “The U.S. Attorney closed his investigation without taking any action,” the inspector general reported, meaning the only form of punishment in this case was the removal of four senior managers from the facility.
Just a few weeks earlier, the same inspector general issued an urgent report confirming that patients at the VA hospital in Washington DC were placed in serious jeopardy by widespread equipment and other problems whose fixes were, you got it, delayed.
The problems included:
+18 of 25 sterile satellite storage areas for supplies were dirty;
+The facility lacked an effective inventory system for managing the availability of medical equipment and supplies;
+There was no system to ensure that supplies and equipment that were subject to patient safety recalls were not deployed on patients;
+The facility failed to fill numerous and critical open senior staff positions
The VA facility in Washington, just a few miles from the U.S. Capitol, “suffers from serious and troubling deficiencies” that have been known by senior VA management “for some time without effective remediation.”
Yes, the VA’s shameful treatment of veterans persists, according to more than three dozen recent internal investigative reports reviewed by Circa. And evidence has now formally surfaced that delays in care did create life-and-death issues for veterans, contrary to some of the initial spin.
VA officials don’t dispute the scope of past and ongoing problems, instead pointing to the fact that new VA Secretary David Shulkin just created an office to hold VA officials accountable for misconduct and bad care and to protect whistleblowers who bright problems to light.
“We need to hold our employees accountable for their actions if they violate the public trust, and at the same time protect whistleblowers from retaliation,” Shulkin said.
While the new office stands up its operation, the consequences of past delays continue to mount. Take for instance a fresh VA inspection report this week that confirmed a patient in Las Vegas whose diagnosis for lung cancer was breathtakingly delayed.
“We substantiated a delay of approximately 6 months occurred in the evaluation of the patient’s pleural effusion, and delays occurred in the diagnosis and treatment of the patient’s lung cancer,” the report concluded, its bland medical language unable to mask the seriousness of the problems.
“In conjunction with the delay in evaluation, the patient was not timely notified of test results. We identified several contributing factors, including lack of follow-up related to a non-VA provider’s lung biopsy recommendation.”
A review earlier this year at the VA hospital in Los Angeles provided a sobering assessment of the consequences of delayed treatment: 225 patients died awaiting treatment, including 117 patients who “experienced delays in obtaining requested consults” to determine what was ailing them.
The probe said it could conclude anyone died specifically because of the delays though at least two patients suffered moderate or mild consequences from the delays.
Hospital by hospital, the numbers of veterans who died awaiting treatment continues to mount. At the Phoenix VA, which became the poster child of the VA wait time scandal, things haven’t improved much.
A report last October found that 215 vets died while waiting for care in 2016, specifically chronicling the story of one veteran whose death could have
been forestalled if could have gotten cardiac diagnosis and treatment.
Half way across the country in Battle Creek, Mich., areport this week confirmed it took long period of times for the VA to disclose a medical aide who performed unsafe blood transfusions, creating at least one life-threatening adverse patient reaction.
“We substantiated that a hospitalist engaged in unsafe packed red blood cell transfusion practices, which resulted in a patient’s adverse reaction,” the new report showed. The problem occurred in 2014 but was not substantiated until three years later.
In March, the inspector general corroborated that the VA’s highly touted Veterans Crisis Line telephone program - created to intervene and stop suicides - misserved a veteran in dire straights.
“We found that VCL staff did not respond adequately to a veteran’s urgent needs during multiple calls to the VCL and its backup call centers. The failure to respond adequately, to the veteran’s urgent needs resulted in missed opportunities to provide crisis intervention services,” the report said, noting that the VA still has not completed fixes to seven issues it flagged a year ago.
In Georgia, a probe confirmed a VA doctor filled out forms indicating he had consulted with patients when in fact he had not.
“We reviewed 119 consults completed by the subject physician in January 2013 and found that nearly 25 percent of the patients did not receive care within 90 days or did not receive care at all. We identified five patients for whom delays in consult completion were of clinical concern,” the latest report said.
Translated: patients were put in jeopardy by the bogus recordkeeping and delays.
Fresh evidence has emerged in the last month as well that the effort to fix the delays in fact has involved more coverup of the connection between slow care and mortality.
The Atlanta Constitution Journal reported in April that the nationwide VA project to clear the backlog of hundreds of thousands of health care applications “deliberately suppressed critical information from VA hospitals that would have allowed them to help veterans gain access to care.”
The newspaper interviewed a whistleblower who alleged the culture of cover-up still persists. “They did not want to validate the findings of the inspector general report that veterans died before receiving their health care benefits,” Scott Davis told the newspaper.
President Donald Trump and congressional leaders are pressing ahead with reforms to better empower veterans to skip the VA and get care they need from private providers, the so-called Choice program.
Meanwhile, tens of thousands of pages of internal reports that have emerged in the last few months make clear the VA delay scandal that emerged in 2014 was no Mickey Mouse matter but rather a true crisis of life and death.