As controversy swirls around the Veterans Administration over deaths caused by delayed care, an investigation by the Dayton Daily News found that the VA settled many cases that appear to be related to delays in treatment.
A database of paid claims by the VA since 2001 includes 167 in which the words "delay in treatment" is used in the description. The VA paid out a total of $36.4 million to settle those claims, either voluntarily or as part of a court action.
The VA has admitted that 23 people have died because of delayed care, and is facing accusations that hospital administrators are gaming the system to conceal wait times, including using a "secret list" at the VA in Phoenix.
Robert Petzel, undersecretary for health care at the VA, resigned Friday, the day after he and agency head Eric Shinseki were grilled by the Senate Committee on Veterans Affairs. Many have called for Shinseki's resignation, as well.
It's unclear in the data analyzed by the newspaper how many of the cases match the VA's definition of delayed care. But there are numerous examples, including in Dayton, where claimants allege substandard care related to lags in treatment.
The Dayton VA in 2009 paid out $140,000 for a 2006 claim that was described as "Failure/Delay in Admission to Hospital or Institution; Medication Administered via Wrong Route; Failure to Order Appropriate Test."
A pending $3.5 million claim from March 2013 was filed by a man who says delayed treatment of his wife's cervical cancer resulted in her death in March 2012. The names of the veteran and her widower were redacted.
"I'm not personally aware of any deaths that were attributed to a delay in receiving care at the Dayton VA Medical Center," said Dayton VA spokesman Ted Froats.
More than 100 payments go out every year to resolve claims that veterans died due to mishaps by VA medical centers, according to an investigation conducted in partnership between this newspaper and WSB-TV in Atlanta.
The number of dead veterans could total more than 1,100 from 2001 through the first half of 2013 -- including 16 at the Dayton VA Medical Center and 11 at the Cincinnati VA -- according to records obtained via Freedom of Information Act.
These are instances in which the family of a veteran claimed that a death occurred after something went awry and the VA paid money to resolve the issue.
Dayton VA officials would not comment on specific cases, but did issue a statement:
"Unlike many private hospitals, in the rare instance where a situation has interfered in a patient's medical care, we sit down with the veteran to discuss what happened and notify the veteran of his or her right to file a tort claim," it says. "As with any other aspect of our facility, we believe that transparency is the best method for handling any potential conflict."
'Mad as hell'
Ohio American Legion Service Director Suzette Price said this newspaper's findings were tragic, but not surprising.
"When you've got veterans that are mistreated, it's wrong," she said. "I think the whole system needs an overhaul."
Price and the American Legion's national office believe the place to start is with the resignation of Department of Veterans Affairs Secretary Shinseki, especially after allegations came to light that veterans were dying at some medical centers because of delayed wait times.
Shinseki testified before a Senate committee on veterans affairs Thursday. He said the allegations "make me mad as hell" and promised action if an investigation by the VA inspector general finds wrongdoing. But he evaded calls to step down.
"I came here to make things better for veterans," he said.
Sen. Sherrod Brown, D-Ohio, sits on the veterans affairs committee and said he has faith in Shinseki, to whom he spoke last week.
Brown characterized heat put on the VA as partisan and political attacks on a health care system so massive -- providing 85 million patient visits a year -- that it will inevitably make mistakes.
"We know there have been problems in Dayton, at the VA center there over the years," he said. "Much of that is corrected, but the size of the VA tells me that there are always going to be some problems. We've got to continue to work on it to perfect it."
'A whole different mentality'
Concerns about dangerous delays for care and VA officials gaming the system are not new, and are not isolated to Phoenix.
The U.S. Government Accountability Office in December 2012 released a review of the Dayton VA Medical center as well as VA hospitals in Montana, California and Washington, D.C. It found errors by schedulers at every hospital.
"During our site visits, staff at some clinics told us they change medical appointment desired dates to show clinic wait times within VHA's performance goals," the report says.
The VA responded that it would revise its scheduling policy by November 2013, but that it is hampered by staffing shortages among schedulers because of turnover due to high stress and low starting pay.
An April 9 GAO report issued after a review of select VA centers across the country noted that approximately 2 million outpatient referrals were unresolved for more than 90 days in 2012.
Inspectors found that three of 10 gastroenterology referrals they reviewed at one medical center had left veterans waiting 140 to 210 days. Four of 10 physical therapy referrals at another medical center took 108 to 152 days "with no apparent action taken to schedule an appointment for the veteran."
U.S. Rep. Brad Wenstrup, R-Cincinnati, sits on the House VA committee. He also is a veteran and a physician.
He said the VA could learn from private providers who put priority on processing patients. Private hospitals can do 10 colonoscopies in the time it takes the VA to do three, he said.
"It's just a whole different mentality," he said. "I think we have to change if we're going to see all of our veterans who deserve to be served and be seen."
'It's seriously flawed'
Ohio's six VA medical centers had a combined 54 malpractice payouts related to deaths since 2001. The Dayton VA Medical Center had the most, though Cleveland's two medical centers had 22 combined. One case settled in 2003 for $200,000 involved hospitals in both Dayton and Cleveland.
Price with the American Legion said her agency conducts audits of medical centers. The most recent was in Cleveland, and it started with a town hall meeting at which veterans complained about access to care.
The Legion investigated and found the VA was struggling with the software it uses for scheduling appointments.
"One of the biggest issues they had was the appointment software," she said, adding that this "absolutely" has contributed to some of the delay-of-care issues seen across the country.
"It's flawed," she said. "It's seriously flawed."
Payouts at the Dayton VA related to deaths since 2001 total nearly $2 million. They range in size from $70,000 to $300,000. The most recent was a May 2012 payment for $140,000 for apparently failing to properly diagnose a patient.
Separate records obtained by this newspaper list all the claims made against the Dayton VA since the beginning of 2011 -- including those that weren't settled or paid -- as well as more details on payments made.
The largest settlement in those records was for $85,000 for the family of a veteran who died in June 2010 after his heart monitor leads apparently became disconnected and workers allegedly failed to check on him and respond to an alarm signaling that the leads were disconnected.
Another claimant is asking for $3.5 million, alleging his wife's death in March 2012 was the result of the hospital's delayed treatment of her cervical cancer.
Records include two deaths for which the VA's regional attorneys denied payment. In one case from 2012, a man claimed his grandson died six hours after a cardiac stress test, allegedly due to an allergic reaction to an injection he received before the test. The grandfather was seeking $400,000.
Another denied case was filed in 2009 by a woman who claimed physicians misdiagnosed her husband with pneumonia. Six months later he was found to have lung cancer; three months after that he died, the widow claims. She was seeking $250,000.
If the VA settles a claim, it may be for much less than what the filing demands. The VA settled a $500 million claim for $8,000. That veteran was allegedly abused by a CT technician.
Another veteran sued for $509,360 after doctors performed kidney stone surgery on the wrong kidney. He settled for $35,000.
The response to this newspaper's FOIA request to the national VA came with a four-page statement noting the Veterans Hospital Administration is one of the largest health care providers in the United States and is "committed to ensuring the health care services we provide are Veteran-centric, transparent, safe and of high quality."
"Given the inherent risks associated with health care deliver, however, VHA -- like all health care providers -- does occasionally experience unexpected adverse outcomes in a small percentage of cases."
Shirley Ribak, a retired Air Force Reserve Colonel who also retired from a job providing quality assurance at the Dayton VA, said a culture change is needed across the VA. She said top administrators set up well-intentioned goals, but then offer incentives to meet those goals that unintentionally encourage people to game the system.
"I believe in their heart they (administrators in Washington) were trying to do the right thing," she said. "They had good intentions, but people should not be rewarded for those accomplishments. That's their job."
The VA paid $91.2 million last year in financial settlements and awards in response to malpractice claims. A nationwide Cox Media Group investigation in November found that payouts peaked in 2012 and totaled $845 million over the past decade.
Experts say these payouts were not completely out of line with private-sector health systems, but they came as criticism mounted over performance bonuses, pay raises and transfers for employees -- some of whom oversaw mistakes and failures at medical centers.
U.S. House Speaker John Boehner, R-West Chester Twp., said he expects the House this month to consider the VA Management Accountability Act, which would give Shinseki -- who Boehner is not calling on to resign -- authority to remove senior executives.
"If you look at recent VA preventable deaths, patient safety incidents and backlog increases, department senior executives who presided over negligence and mismanagement are more likely to have received a bonus or glowing performance review than any sort of punishment," says a description of the bill on the website of the House Veteran Affairs Committee.
Brian Kollars contributed to this report.