VA Office of Inspector General Releases Scathing Report of Phoenix VA

The long-awaited Office of Inspector General’s (OIG) report on the Phoenix VA Health Care System (PVAHCS) was released on August 27, 2014 (1). The report was scathing in its evaluation of VA practices and leadership. Five questions were investigated:

1. Were there clinically significant delays in care?
2. Did PVAHCS omit the names of veterans waiting for care from its Electronic Wait List (EWL)?
3. Were PVAHCS personnel not following established scheduling procedures?
4. Did the PVAHCS culture emphasize goals at the expense of patient care?
5. Are scheduling deficiencies systemic throughout the VA?

In each case, the OIG found that the allegations were true. Despite initial denials, the OIG report showed that former PVAHCS director Sharon Helman, associate director Lance Robinson, hospital administration director Brad Curry, chief of staff Darren Deering and other senior executives were aware of delays in care and unofficial wait lists.

Perhaps most disturbing is the OIG finding that scheduling deficiencies are systemic throughout the VA. The OIG is currently investigating 90 VA facilities. The findings prompted Rep. Jeff Miller, House Veterans’ Affairs Committee chairman to comment “We have seen no evidence that the corrupt bureaucrats who created the VA scandal will be purged from the department’s payroll anytime soon. Until that happens, VA will never be fixed,” (2).

Though whistleblowers alleged veterans died while awaiting care in Phoenix, acting Inspector General Richard Griffin did not draw any conclusions about criminal culpability and declared that he was “unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans.” Phoenix whistleblowers Drs. Sam Foote and Katherine Mitchell, said the OIG standard made no sense because 45 examples described in the OIG report showed that delayed care likely resulted in premature deaths or harm to patients’ quality of life. It is the later standard that is usually applied to physicians.

The day prior to the release of the report the Deputy VA Secretary Sloan Gibson was interviewed noting that more veterans are being sent to private doctors for care reducing waiting times (3). "The fundamental point here is, we are taking bold and decisive action to fix these problems because it's unacceptable," said Gibson. It is unclear whether these reports of improved waiting times are any more reliable than the initial denials of prolonged patient waiting times from both the Phoenix VA and VA Central Office.

Richard A. Robbins, MD

Editor

Southwest Journal of Pulmonary and Critical Care

References

1. Office of VA Inspector General. Review of alleged patient deaths, patient wait times, and scheduling practices at the Phoenix VA health care system. Available at: http://www.va.gov/oig/pubs/VAOIG-14-02603-267.pdf (accessed 8/26/14).
2. Wagner D, Lee M. Scathing VA report stirs outcry for accountability. Arizona Republic. Available at: http://www.azcentral.com/story/news/arizona/investigations/2014/08/26/scathing-va-report-stirs-outcry-accountability/14665455/ (accessed 8/27/14).
3. Associated Press. Watchdog report details ‘systemic’ problems at VA facilities. Available at: http://www.foxnews.com/politics/2014/08/26/no-proof-delays-in-care-caused-vets-to-die-va-says/ (accessed 8/25/14). 

Reference as: Robbins RA. VA office of inspector general releases scathing report of Phoenix VA. Southwest J Pulm Crit Care. 2014;9(2):140-1. doi: http://dx.doi.org/10.13175/swjpcc112-14 PDF

Patient Deaths Blamed on Long Waits at the Phoenix VA

This morning the lead article in the Arizona Republic was a report blaming as many as 40 deaths at the Phoenix VA on long waits (1). Yesterday, Rep. Jeff Miller, the chairman of the House Committee on Veterans Affairs, held a hearing titled “A Continued Assessment of Delays in VA Medical Care and Preventable Veteran Deaths.” “It appears as though there could be as many as 40 veterans whose deaths could be related to delays in care,” Miller announced to a stunned audience. The committee has spent months investigating patient-care scandals and allegations at VA facilities in Pittsburgh, Atlanta, Miami and other cities. Miller said that dozens of VA hospital patients in Phoenix may have died while awaiting medical care. He went on to say that staff investigators have evidence that the Phoenix VA Health Care System keeps two sets of records to conceal prolonged waits that patients must endure for doctor appointments and treatment. Sharon Helman, director of Phoenix VA Health Care System, said in a written statement: “We take seriously any issue that occurs in our medical center and outpatient clinics. Therefore, we have asked for an external review by the VA Office of the Inspector General [OIG] ... If the OIG finds areas that need to be improved, we will swiftly address them as our goal is to provide the best care possible to our veterans.”

VA health system workers who asked not to be named because they fear retribution, said patient access data incorrectly show vets are able to see physicians within days when actual waits may be months. Dr. Sam Foote, who retired from the Phoenix VA in December, filed complaints with the VA inspector general seeking investigations of alleged medical care failures and administrative misconduct. In a Feb. 2 letter to the inspector general, Miller, Sen. John McCain and Rep. Ann Kirkpatrick, Foote said the Phoenix system is afflicted by “gross mismanagement of VA resources and criminal misconduct” that produced “systemic patient safety issues and possible wrongful deaths.” According to Foote, VA IG investigators came to Phoenix late last year and verified allegations he’d made in an October complaint, but no action was taken. In an interview, he said patients “were deliberately being held off the lists” to misrepresent the speed of health services for vets, but it remains unknown how many of the deaths may have been preventable. Foote went on to allege hostile working conditions that caused an exodus of quality doctors and nurses, producing backlogs in both primary care and specialty areas. One example was urology, where resignation of several of the staff urologists forced patients to be referred to out-of-state VA centers or private physicians for treatment. Foote described elaborate techniques that were used to mischaracterize system responsiveness, estimating that up to 30,000 patient charts have been altered. He said thousands of new patients must wait up to a year for assignment to primary-care physicians who are overbooked.

Allegations of falsifying wait times or retaliation against whistle-blowers are nothing new at the VA. A Senate hearing in 2011 found similar falsification of wait times (2). Review of the Office of Inspector General’s website revealed multiple instances of similar findings dating back to at least 2002 (3-6). In each instance, unreliable data regarding wait times was cited and no action was taken.

Fear of retaliation was cited by Foote as a reason for retirement and other employees asked that their names be withheld (1). These fears appear to be realistic. Recently, a VA employee was demoted after providing testimony about financial mismanagement at the Phoenix VA (7). In contrast, it appears that VA administrators have little to fear from whistle blowers, the OIG, or Congress. If recent history is any guide, it seems likely that the delays will be blamed on lazy providers and VA administrators will create another layer of bureaucracy ostensibly to solve the problem. However, the outcome will be further repression of any whistle blowers and depletion of already short patient care resources.

Richard A. Robbins, MD

Editor

Southwest Journal of Pulmonary and Critical Care

References

1. Wagner D. Deaths at Phoenix VA hospital may be tied to delayed care. Available at: http://www.azcentral.com/story/news/politics/2014/04/10/deaths-phoenix-va-hospital-may-tied-delayed-care/7537521/ (accessed 4/10/14).
2. Robbins RA. VA administrators gaming the system. Southwest J Pulm Crit Care 2012;4:149-54.
3. http://www.va.gov/oig/52/reports/2003/VAOIG-02-02129-95.pdf (accessed 4/10/14).
4. http://www.va.gov/oig/54/reports/VAOIG-05-03028-145.pdf (accessed 4/10/14).
5. http://www.va.gov/oig/54/reports/VAOIG-05-03028-145.pdf  (accessed 4/10/14).
6. http://www.va.gov/oig/52/reports/2007/VAOIG-07-00616-199.pdf (accessed 4/10/14).
7. Wagner D. VA official in Arizona demoted after her testimony. Arizona Republic. Available at http://www.azcentral.com/news/arizona/articles/20130314va-official-arizona-pedene-demoted-after-testimony.html (accessed 4/10/14).

Reference as: Robbins RA. Patient deaths blamed on long waits at the Phoenix VA. Southwest J Pulm Crit Care. 2014;8(4):227-8. doi: http://dx.doi.org/10.13175/swjpcc050-14 PDF 

Helman Defends Decision to Pull VA Sponsorship of Veterans Day Parade

Sharon Helman, Phoenix VA Director, defended her decision to cancel VA sponsorship of the annual Phoenix Veterans Day Parade in a 4/10/13 email to VA employees. Helman said that VA sponsorship was cancelled because of “…priorities in the organization (specifically access), and heightened awareness over liability concerns which VA Legal Counsel brought forward”. She concluded her letter by warning “… that all media inquiries should be forwarded to Paul Coupaud, Acting Public Affairs Officer”.

VA officials initially said fear of litigation prompted the review of VA support. Last year, a float carrying wounded Veterans in a Midland, Texas, parade collided with a freight train, killing four and injuring 17. Crash victims and their families filed lawsuits in Texas against Union Pacific Railroad and the float owner. The VA was not a defendant, and the VA has not issued any national directives on liability as a result of the tragedy.

In past years, the VA did not contribute cash for the parade. Instead, it served as lead sponsor by providing staging areas at its medical center and allowing Paula Pedene, the former Director of Public Relations at the Phoenix VA, to serve as coordinator. It also provided other support and hosted award events, an essay contest and banquets. Pedene was demoted in the wake of her testimony to the VA Office of Inspector General against former VA administrators. Pedene testified that the Phoenix VA suffered from leadership run amok. She said that agency bosses intimidated employees and created a hostile workplace.

Phoenix VA employees had provided volunteer support on their own time for the Phoenix Veterans Day Parade. No mention has been made of clinical VA employees who participated in parade activities during regular working hours instead of providing care. It is difficult to understand how cancelling sponsorship of the Phoenix Veterans Day Parade will provide increased access to healthcare for Veterans. However, wasting clinical staff time with lengthy and extraneous emails such as the one sent out 4/10/13 or Ms. Helman’s equally lengthy and extraneous weekly e-mails to employees will compromise access. As Helman said in her letter the VA must focus on “bringing additional staff on board” to care for the 81,000 Veterans enrolled at the Phoenix VA. If true, the alleged pattern of abuse, discrimination and retaliation at the Phoenix VA will jeopardize the hiring and retention of the necessary clinical staff to provide Phoenix Veterans access to quality healthcare.

Richard A. Robbins, MD*

*Dr. Robbins was the chief of pulmonary and critical care at the Phoenix VA from 2003-11.

Reference as: Robbins RA. Helman defends decision to pull VA sponsorship of Veterans day parade. Southwest J Pulm Crit Care. 2013;6(4):180. PDF