WASHINGTON — The inspector general of the Department of Veterans Affairs said Monday that potential criminal cases related to the department’s nationwide patient wait-list scandal are being reviewed by federal prosecutors.
The IG is investigating 69 VA facilities for criminal, civil and administrative wrongdoing after revealing late last month that scheduling abuses implemented to mask long wait times for health care are systemic within the veteran health care system, Acting Inspector General Richard Griffin said during a hearing before House lawmakers.
Earlier in the day, the scope of the crisis became more apparent when the VA released its own audit showing more than 57,000 veterans have been waiting more than three months for care appointments. The audit blamed a lack of providers and an “overly complicated” scheduling process for the breakdown in timely care at 731 hospitals and clinics nationwide.
“I think it comes down to accountability of senior leadership out in these facilities,” Griffin said before the House Veterans’ Affairs Committee. “Once somebody loses their job or is criminally charged, that will be the shot heard around the system.”
The IG has discovered that in many cases, staff would game the system by giving veterans the first available appointment date — up to six months in the future — despite their requests for an earlier visit and then mark the appointment as the desired date, which would then appear in the VA computer system as no wait, Griffin said.
Staff also would schedule patients for visits months into the future, then cancel the appointment two weeks before and reschedule for the same date so it appeared to fall within the VA’s goal of 14-day wait times, he said.
The IG and Department of Justice are now discussing whether such practices rise to the level of criminal activity, Griffin said.
“You have to work your way back up the supervisory chain to find out who put out that order, and that’s what we are having to do,” he said. “Maybe if people do start getting charged, maybe somebody will say, ‘I don’t want to take the fall for somebody farther up the food chain who told me to do this.’”
The VA audit released Monday showed that about 70 percent of the 731 VA facilities reviewed used off-the-books patient waiting lists at least once, and management pressured staff in some cases to manipulate appointments to make waits appear shorter, the audit confirmed.
The VA rushed out the audit under pressure from Congress and veteran groups. The findings provide the first detailed look — at least from the department’s own perspective — at patient wait times at individual facilities since allegations in April that up to 40 patients died awaiting care at a Phoenix VA hospital.
Philip Matkovsky, assistant deputy veterans affairs under secretary for health for administrative operations, apologized to the public and to veterans during testimony Monday night before House Veterans’ Affairs Committee and said the audit marked a turning point for the department.
“We saw this as the opportunity, the opportunity for us to do a reset,” Matkovsky said.
Last year, the department began requiring that veterans receive care within two weeks of asking for an appointment, and it used the goal to evaluate employee performance. Those who kept waits within that time frame were given awards and bonuses, the VA inspector general found.
Matkovsky said the VA has now discontinued the scheduling goal and stopped using it as a personnel performance measure.
The audit released Monday found the goal was partly responsible for the deep problems within the department.
“Meeting a 14-day wait-time performance target for new [patient] appointments was simply not attainable given the ongoing challenge of finding sufficient provider slots to accommodate a growing demand for services,” according to the audit.
It found that department leaders failed by expecting staff to meet the appointment goal without understanding the potential effects on hospitals and clinics that serve 6.5 million beneficiaries annually.
“Findings indicate that in some cases, pressures were placed on schedulers to utilize inappropriate practices in order to make waiting times … appear more favorable,” the audit found.
Still, the VA audit claims that the vast majority of veterans — about 90 percent to 99 percent — receive care within 30 days of booking appointments.
Across the board, wait times for new veteran patients greatly exceeded those for established patients, it found.
For example, a VA hospital in Philadelphia now has 426 veterans who have been waiting more than three months for a first visit. Those patients must wait 43 days on average for primary care, while returning patients wait about three days.
The statistics drew some skepticism from House lawmakers, who said the VA statistics have been continually changing, and reports from their districts of veterans waiting for care were sometimes much higher than the numbers shown in the audit.
“If you can't rely on the data … is the alternative to go in and do a case-by-case analysis?” Rep. Doug Lamborn, R-Colo., said. “How do we get to the bottom of it when the records or the reports are unreliable?”
Matkovsky said the newest VA statistics are more accurate than past reports.
“As we improve the integrity of our reporting,” he said, "the patient wait times may get worse."
Wait times are already painfully long, said some of the veterans who gathered at a VFW post near Baltimore on Monday night to relate experiences with the VA healthcare system to VFW’s national leaders. Their stories, along with more accounts gathered at a similar meeting Monday in Kansas City, will be compiled and submitted to Congress and the White House, VFW officials said.
Steven Klein, 55, a retired Army master sergeant who badly injured his back in 2005, was told he’d have to wait months for a specialist appointment. Baltimore was identified Monday in the VA’s self audit as having among longest wait times for new patients seeking primary care, although it did not rank among the top 10 worst hospitals for patients in need of specialty care.
“I went down to the VA hospital in Baltimore, and they told me they couldn’t fit me in for five months,” he said. “If it hadn’t been for my wife’s health insurance, I would have been in pain for those five months.”
The extra cost of using his wife’s insurance was worth it, he said, because he was able to see a doctor within days and quickly have surgery for what turned out to be five herniated spinal discs.
Klein said he’s been satisfied with his VA primary care doctors, but when time is of the essence, the system breaks down.
“If I need a specialist, I’ll use my wife’s insurance,” he said. “At the VA in downtown Baltimore, you’re gonna wait.”
Stars and Stripes reporter Chris Carroll contributed to this report.