Veterans Administration employee: 'They wanted me to cook the books'

NEW RIVER, ARIZ. -- Three years ago Edward Laird, a 76-year-old Navy veteran, noticed two small blemishes on his nose. His doctor at the Veterans Affairs hospital in Phoenix ordered a biopsy, but month after month, as the blemishes grew larger, Laird couldn't get an appointment. Laird filed a formal complaint and, nearly two years after the biopsy was ordered, got to see a specialist — who determined that no biopsy was needed. Incredulous, Laird successfully appealed to the head of the VA in Phoenix. But by then, it was too late. The blemishes were cancerous. Half his nose had to be cut away.

"Now I have no nose and I have to put an ice cream stick up my nose at night so I can breathe," Laird said. "I look back at how they treated me over the years, but what can I do? I'm too old to punch them in the face."

The Phoenix VA Health Care System is under a U.S. Justice Department investigation for reports that it maintained a secret waiting list to conceal the extent of its patient delays, in part because of complaints such as Laird's. But there are now clear signs that veterans' health centers across the United States are juggling appointments and sometimes manipulating wait lists to disguise long delays for primary and follow-up appointments, according to federal reports, congressional investigators and interviews with VA employees and patients.

The evidence suggests a VA system with overworked physicians, high turnover and schedulers who are often hiding the extent to which patients are forced to wait for care.

The 1,700 hospitals and clinics in the VA system now handle 80 million outpatient visits a year. Veterans Affairs Secretary Eric Shinseki promised to solve growing problems with patient access when he took over in 2009, and he has been successful in some respects: Iraq and Afghanistan veterans are using VA health care at rates never seen in past generations of veterans, and a growing number of Vietnam veterans are receiving VA care as they age.

The agency reports it also made substantial progress in reducing wait periods last year, 93 percent of the time meeting its goal of scheduling outpatient appointments within 14 days of the "desired date."

But several VA employees have said the agency has been manipulating the data.

"The performance data the VA puts out is garbage — it's designed to make the VA look good on paper. It's their 'everything is awesome' approach," said Dr. Jose Mathews, chief of psychiatry at the VA St. Louis Health Care System. "There's a 'don't ask, don't tell' policy. Those who ask tough questions are punished, and the others know not to tell."

Mathews was put under administrative investigation in September after he alleged that long wait times led to poor patient care and what he said were two preventable deaths. He said a suicide attempt by a veteran was covered up after a VA psychiatrist failed to provide follow-up treatment.

Several VA schedulers have told investigators that agency staffers were "gaming the system" by making it appear that appointments set for weeks or months in the future were "desired dates" requested by veterans. In fact, they said, veterans grudgingly accepted future appointments because they felt they had no other choice.

Appointment requests were falsified

"We found people that were told to change the [appointment] dates to make it look like it was in line with VA guidelines," said Debra Draper, who was part of a team from the Government Accountability Office that interviewed 19 appointment schedulers at four VA medical centers in 2012. The team found that more than half failed to correctly record the appointment date patients requested.

VA officials say that manipulation of wait lists has occurred only in isolated cases. VA hospitals since 2004 have consistently ranked higher in customer satisfaction surveys than their counterparts in the private sector, they note, with more than 90 percent of patients offering positive assessments of their care.

"As we know from the veteran community, most veterans are satisfied with the quality of their VA care, but we must do more to improve timely access," Shinseki said Friday as he announced the resignation of the VA's undersecretary for health, Dr. Robert Petzel.

But veterans and current and former agency employees interviewed last week described a dysfunctional bureaucracy in which turnover is high, the number of doctors is insufficient, and patients may be left dangling when facing life-threatening problems.

"The evidence is there. They're never going to be able to hide it," said Brian Turner, a veteran who worked as a scheduling clerk in VA facilities in Austin and San Antonio.

Waited two months for an MRI

Navy veteran Walter Burkhartsmeier, 73, had to wait two months to get an MRI exam at a VA facility in Seattle for shooting pains down his left arm. Eighteen months passed before someone read the MRI results — which showed bony projections on his spinal cord that put him at risk of paralysis.

In Texas, Carolyn Richardson, 70, said a VA doctor last year ordered "immediate" chemotherapy for her husband, Army veteran Anson "Dale" Richardson, 66, but a two-month delay robbed him of the chance to fight the throat cancer that killed him Nov. 4.

In Phoenix, Thomas Breen, 71, a Navy veteran with a history of bladder cancer, waited two months last fall for a follow-up appointment at the VA facility there after discovering blood in his urine. His family finally took him to a private hospital that diagnosed him with terminal bladder cancer. He died Nov. 30.

Six days later, a clerk from the VA in Phoenix called Breen's daughter-in-law, Sally Barnes-Breen, to schedule an appointment.

"No. You are too late, sweetheart," Barnes-Breen said she told the clerk. "He's dead."

In Nevada, Sandi Niccum, 78, a blind Navy veteran, was forced to wait five hours for emergency room treatment at a VA facility in North Las Vegas last year. Niccum, who was weeping and pounding the floor with her cane because of intense pain, died less than a month later after a large mass was found. A VA investigation did not link the care delay to her death, but faulted the facility for the wait.

In Durham, N.C., two employees were put on administrative leave last week after an internal review found irregularities in appointments.

Some VA employees have said they faced reprisals after they resisted instructions to manipulate appointment books.

Lisa Lee, a medical support assistant at the VA facility in Fort Collins, Colo., said she was transferred and later put on two-week administrative leave when she objected to supervisors' instructions to manipulate appointments. "They wanted me to cook the books, and I didn't do it," Lee said. "You're supposed to do your work and shut up."

After Lee was transferred, a VA supervisor in June wrote an e-mail to the Fort Collins staff instructing them to manipulate veterans' appointment requests in order to meet the 14-day directive. In the e-mail, the official, David Newman, wrote: "Yes, it's gaming the system a bit. But you have to know the rules of the game you are playing, and when we exceed the 14-day measure, the front office gets very upset, which doesn't help us."