WASHINGTON – About 1,700 veterans in need of care were "at risk of being lost or forgotten" after being kept off the official waiting list at the troubled Phoenix veterans hospital, the Veterans Affairs watchdog said Wednesday in a scathing report that increases pressure on Secretary Eric Shinseki to resign.
The investigation, initially focused on the Phoenix hospital, found systemic problems in the VA's sprawling nationwide system, which provides medical care to about 6.5 million veterans each year. The interim report confirmed allegations of excessive waiting time for care in Phoenix, with an average 115-day wait for a first appointment for those on the waiting list – 91 days longer than the 24-day average the hospital had reported.
"While our work is not complete, we have substantiated that significant delays in access to care negatively impacted the quality of care at this medical facility," Richard J. Griffin, the department's acting inspector general, wrote in the 35-page report. It found that "inappropriate scheduling practices are systemic throughout" the VA's 1,700 health facilities nationwide, including 150 hospitals and 820 clinics.
Griffin said 42 centers are under investigation, up from 26.
Five Senate Democrats facing tough election campaigns – Colorado's Mark Udall, Montana's John Walsh, Kay Hagan of North Carolina, Al Franken of Minnesota and Jeanne Shaheen of New Hampshire – called for Shinseki to leave. "We need new leadership who will demand accountability to fix these problems," Udall said in a statement.
Rep. Jeff Miller, R-Fla., chairman of the House Veterans Affairs Committee; Rep. Howard "Buck" McKeon, R-Calif., chairman of the House Armed Services Committee, and Arizona's two Republican senators, John McCain and Jeff Flake, also called for Shinseki to step down. Miller and McCain also said Attorney General Eric Holder should launch a criminal investigation into the VA.
Miller said the report confirmed that "wait time schemes and data manipulation are systemic throughout VA and are putting veterans at risk in Phoenix and across the country."
President Barack Obama found the findings "extremely troubling," his spokesman, Jay Carney, said.
"As the president said last week, the VA must not wait for current investigations of VA operations to conclude before taking steps to improve care. 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," Carney said in a statement.
Shinseki called the IG's findings "reprehensible to me, to this department and to veterans." He said he was directing the Phoenix VA to immediately address each of the 1,700 veterans waiting for appointments.
Reports that VA employees have been "cooking the books" have exploded since allegations arose that as many as 40 patients may have died at the Phoenix VA hospital while awaiting care. Griffin said he's found no evidence so far that any of those deaths were caused by delays.
VA guidelines say veterans should be seen within 14 days of their desired date for a primary care appointment. Lawmakers have called that target unrealistic and said basing employee bonuses and pay raises on it is outrageous. The 14-day waiting period encourages employees to "game" the appointment system in order to collect bonuses based on on-time performance, the IG report said.
The inspector general described a process in which schedulers ignored the date that a provider or veteran wanted for an appointment. Instead, the scheduler selected the next available appointment and used that as the purported desired date.
"This results in a false 0-day wait time," the report said.
Thomas Lynch, an administrator at the Veterans Health Administration, an arm of the VA, said the quality of VA health care compares favorably with that in the private sector.
Still, Lynch said a bonus system based on meeting the 14-day goal has had an unintended, negative effect.
"Our performance measures have become our goals, not tools to help us understand where we needed to invest resources," he told the House Veterans Affairs Committee late Wednesday. "We undermined the integrity of our data when we elevated our performance measures to goals."
The IG's report said problems identified by investigators were not new. The IG's office has issued 18 reports to George W. Bush and Obama administrations as well as Congress since 2005.
Griffin said investigators' next steps include determining whether names of veterans awaiting care were purposely omitted from electronic waiting lists and at whose direction and whether any deaths were related to delays in care.
He said investigators at some of the 42 facilities "have identified instances of manipulation of VA data that distort the legitimacy of reported waiting times." The IG said investigators are making surprise visits, a step that could reduce "the risk of destruction of evidence, manipulation of data, and coaching staff on how to respond to our interview questions."
Justice Department officials have already been brought into cases where there is evidence of a criminal or civil violation, Griffin said.
Dr. Samuel Foote, a former clinic director for the VA in Phoenix who was the first to bring the allegations to light, said the findings were no surprise.
"I knew about all of this all along," Foote told The Associated Press in an interview. "The only thing I can say is you can't celebrate the fact that vets were being denied care."
Foote took issue with the finding by the inspector general that patients had, on average, waited 115 days for their first medical appointment.
"I don't think that number is correct. It was much longer," he said. "It seemed to us to be about six months."
Still, Foote said it is good that the VA finally appears to be addressing some long-standing problems.
"Everybody has been gaming the system for a long time," he said. "Phoenix just took it to another level. ... The magnitude of the problem nationwide is just so huge, so it's hard for most people to get a grasp on it."
The report Wednesday said 84 percent of a statistical sample of 226 veterans at the Phoenix hospital waited more than 14 days to get a primary care appointment. A fourth of the 226 received some level of care during the interim, such as in the emergency room or at a walk-in clinic, the report said.
In a related matter, Griffin said investigators have received numerous allegations of mismanagement, inappropriate hiring decisions, sexual harassment and bullying behavior by mid- and senior-level managers at the Phoenix hospital. Investigators were assessing the validity of the complaints and their effect, if any, on patients' access to care, he said.