IG Reports Detail Which VA Facilities Doctored Patient Wait-Times

Two years after whistleblower revelations of manipulated appointment times at the Veterans Medical Center in Phoenix led to findings that the problem was systemic across the Veterans Affairs Department, internal investigations into the matter are finally being released.

The reports, documenting the manipulation of wait-times at VA facilities across 19 states, reveal that in at least seven facilities the dates were falsified per order of supervisors, according to an article in USA Today, which acquired the documents through a Freedom of Information Act request.

The 71 reports are now available for viewing on the department's website. The VA anticipates releasing another half dozen reports at least. It is also completing 30 site-specific investigations that it will release in the coming months, department spokesman James Hutton said.

The reports finally identify VA hospitals and clinics where appointment data was manipulated. In particular, inspector general concluded appointment dates were manipulated in accordance with supervisor instructions in facilities in seven states, including Arkansas, California, Delaware, Illinois, New York, Texas and Vermont.

The investigations were carried out in 2014 after whistleblowers went public with allegations of appointment gaming that resulted in veteran deaths at the Phoenix hospital.

Altogether, 40 VA hospitals and clinics across the U.S. and Puerto Rico were found to be "zeroing out" wait times -- meaning they would adjust the dates to make it appear veterans were getting the appointment dates they desired rather than those that were available.

The manipulation concealed the extent to which facilities were not keeping up with patient demand. In some instances confirmed by the IG agents, wait-times were manipulated as a result of poor training or instruction, though the net results were skewed appointment data in violation of VA procedure.

The department, in anticipation of the reports' release, said last week that it's "important to note that OIG has not substantiated any case in which a [Veterans Health Administration] Senior Executive or other senior leader intentionally manipulated scheduling data."

In about a third of the inspector general investigations, there was no evidence of manipulated appointment data, it said. Of those remaining, investigators substantiated 18 instances of intentional misuse of scheduling systems.

Of those 18 cases, VA says, the Office of Accountability Review found individual misconduct warranting discipline in 12, resulting in 29 employees who were disciplined. VA did not offer a detailed accounting of the actions taken, saying only that they ranged from official admonishment to removal, including three employees who retired or resigned with disciplinary action pending.

Rep. Jeff Miller, a Republican from Florida and chairman of the House Veterans Affairs Committee, on Friday said the inspector general reports "document dysfunction on the part of both the Department of Veterans Affairs and its inspector general."

Miller, who has been the most vocal among lawmakers in demanding VA reform and accountability, slammed the department for sitting on the reports for so long.

"The fact that the IG only released these documents after public pressure from the media as well as Democrats and Republicans in both the House and Senate is proof that it still has much more to learn when it comes to providing the oversight VA needs and the transparency taxpayers deserve," he said. "Nevertheless, the reports outline a host of serious scheduling issues that masked wait times at VA facilities around the country."

At the VA Medical Center in Little Rock, Arkansas, inspectors found that both non-supervisory and supervisory employees manipulating appointment dates in the VA computer system to make it appear patient wait times were significantly lower than they were.

Not only that, but some supervisors "displayed a lack of candor while making statements to [IG] special agents … regarding their knowledge and/or participation in the manipulation of patient waiting times," the report states.

Agents looking into the VA Medical Center in San Diego, California, found employees altering patients' desired appointment date times to show "zero-day wait times," and indicated the change was made on the instruction of a supervisor.

The supervisor, not identified in the report, denied the allegation, though the report cites emails in which employees were told to zero out wait times if patients did not wish to change to an appointment.

At the VA Medical Center in Wilmington, Delaware, agents found employees were "negotiating" with veterans for their appointment desired date instead of simply recording the date they wanted. If they agreed to the date that was also the best available they would be entered into the system and no wait time would be reflected.

The IG found it was not uncommon for employees to negotiate desired dates with patients based on clinic availability.

One supervisor told the IG that negotiated desired dates had to be based on clinic availability even if the date is not the one requested by the veteran. Another said there are times when a desired date is uncertain -- a "gray area" -- the IG report states.

At the VA Medical Center at Audie L. Murphy VA Hospital, San Antonio, Texas, a supervisor acknowledged she "resolved scheduling errors" by changing a veteran's desired appointment date. She also said she may have told other employees to do the same thing, the report states.

Inspectors to the VA Medical Center in Danville, Illinois, found an employee responding to a weekly list of patients with wait times greater than 14 or 30 days between desired and the actual appointment dates by going into the system and reducing the wait time to zero.

"Nobody told her to do this; she just assumed that it should be done," the report states. "[She] felt if such changes were not made, there would be repercussions by management against those which she deemed to be on a black list."

Another employee said she was told to make such changes but couldn't recall who gave her the order. A third worker identified a supervisor who told her that the desired and actual appointment dates must always match, but the supervisor denied giving such instructions, according to the report.

A supervisor with the VA Medical Center in Hines, Illinois, admitted to the IG agent having employees encourage veterans to agree to alternate desired dates closer to those available.

"While arguably practical," the IG wrote, "this violates VHA Scheduling Directive."

At the Community Based Outpatient Clinic in Rochester, New York, the IG found workers and supervisors admitting to using the available date for the desired date.

Supervisors "stated that they trained staff to use the first available date as the desired date because they misunderstood the correct procedure," the report states. The IG also noted that the workers they spoke with were emphatic that managers told them to be upfront with the IG agents and answer questions honestly.

"Many of the employees voiced their opinion that there was no malicious intent by any employee to defraud or mislead anyone regarding wait times," the report states

At the VA Outpatient Clinic in Harlingen, Texas, the report said agents found evidence that an employee "felt pressure from a [VA regional health care system] management official."

And this led the worker, it says, to manipulate the appointment system to keep scheduling numbers within standard.

"We also found evidence indicating that there had been inappropriate training years ago, which carried through into present-day work activities with regard to scheduling," the report states.

Inspectors to the VA Medical Center in White River Junction, Vermont, said they substantiated that facility schedulers inappropriately entered a desired date to match the actual appointment date in order to obtain a zero-day wait time for both new and established patients.

"It was largely corroborated that this manipulation was employed by schedulers at the instruction of a former and current supervisor of the [employees] and with the knowledge of the second-level supervisor," the report said.

-- Bryant Jordan can be reached at bryant.jordan@military.com. Follow him on Twitter at @bryantjordan.