HIBBING, Minn. – A group of former employees of a Veterans Affairs outpatient clinic in Hibbing says they were ordered to backdate medical appointments for veterans to make it look like the vets were getting seen within 14 days of their desired date when the waits were actually as long as six to eight weeks.

Speaking publicly for the first time, six former clinic employees told the Star Tribune they were told to falsify the appointment records by Sterling Medical Associates, the private company operating the clinic, in order to make it appear that the clinic was delivering on a mandate to see and treat patients quickly.

One former clerk, Bobbi Jo VonAlman, said she was ordered to change the schedule despite her protests.

"You went back and remade the appointment to make it look like it was within 14 days," she said. "They said there was nothing wrong with it. They just wanted to make their numbers look good."

A VA inspector general investigation in June was unable to substantiate any allegations of past scheduling irregularities. Both Sterling and the VA said last week there is no evidence of current tampering, and Sterling denies ever ordering any schedule tampering.

Senior leaders from the Minneapolis VA have made monthly visits to the clinic.

"We have not identified issues with scheduling practices at the Hibbing Clinic during these visits," the VA said in a statement.

The former employees maintain that the backdating orders stopped only in late April, when investigators found that the VA medical system, which serves almost 9 million veterans nationwide every year, was maintaining secret waiting lists and delivering insufficient care. A May report from the VA's inspector general described inappropriate scheduling as "systemic," and VA Secretary Eric Shinseki was forced to resign amid the controversy.

The latest accusations emerging in Hibbing come just days after the new national leader of the VA, Bob McDonald, vowed to establish customer-friendly reforms and to make the VA more accountable nationwide.

The apparent problems at the Hibbing clinic suggest how difficult it can be to reform an agency of 340,000 employees, the second-largest in the federal government.

Desired dates

Former clinic employees said they were given a list of 20 to 25 veterans seeking medical help every two weeks and ordered to delete the actual date the vet was seen if it was more than 14 days past the desired date. They said they were told to replace it with a date that made it appear to be an earlier appointment. It was a routine process, they said, known as "clearing the access reports."

Six former employees at the Hibbing clinic, including nurses and clerks, said representatives from the Minneapolis VA offered tutorials on how to schedule vets correctly, and that a VA staffer made annual visits to ensure that the process was followed. Every employee who had the ability to make appointments, known as "turning on the key," was required to take the training.

But they were ordered to continue changing the records after Sterling took over in 2013, they said.

When one clerk protested to an interim manager, the employees said, the manager contacted higher-ups in Sterling and reported back that the practice was to continue.

"We knew the VA rules, we knew what we weren't supposed to do," a former nurse said. "So when we were told to do something and when we questioned them we were told, 'Just do it.' "

VonAlman, the former clerk, said she e-mailed a former manager at the Hibbing clinic after seeing the initial news reports this spring on the VA's scheduling scandal.

"I said, 'This is exactly what we were doing. Changing those desired dates,' " VonAlman said. "The manager said, 'I better watch the news.' "

VonAlman said she repeatedly raised concerns about how the Hibbing clinic was run to officials at the VA in Minneapolis but she never heard back. She left the clinic in April, calling the work environment "absolutely hostile. Horrible."

Nurses also said they were ordered to periodically "scrub" vets scheduled for annual appointments to make way for a backlog of other patients waiting to be seen.

VonAlman said she was ordered to scrub one vet who had been scheduled a week and a half before his annual appointment was actually due. The next available appointment would have been at least six weeks out. She said she refused.

As part of a far-reaching probe after the VA scandal erupted, federal investigators came to Hibbing and interviewed employees about the scheduling practice. Employees who were interviewed told the Star Tribune that they were asked only if the problem was occurring at the time, not whether it had happened in the past. The whole process took less than 10 minutes, they said.

Scheduling issues were part of larger problems with how the clinic was run, the former employees said. One nurse said she resigned rather than work under the conditions imposed by Sterling. One mandate, the employees said, was to decrease patient times with medical care providers from 45 minutes to 30 in order to fit more appointments into the day.

The nurse said she feared losing her license because of the increased potential for a botched case. The higher number of patients meant she often had to work late into the night to return telephone messages from earlier in the day.

"It was getting to be unsafe," the nurse said. "I wasn't going to put my license on the line anymore."

The VA and Sterling said in a statement that the term "scrub" is often used incorrectly. A patient care team may "scrub" a schedule if they are looking ahead at schedules for patients who may not need or want a visit with a provider.

The VA said independent surveys show Hibbing patients say they are very satisfied with the services and care provided by the clinic. Cincinnati-based Sterling's five-year contract for the clinic was awarded in March 2013, and there are no plans for the VA to take over its operation.

After an anonymous call was made about the scheduling concerns to a VA whistleblower hot line, an inspector general investigation was conducted in June, but agents said the allegations could not be substantiated. Senior executives of the Minneapolis VA have visited with clinic staff and leadership monthly.

"Minneapolis VA leadership has provided careful oversight of both our hospital-based clinics and community-based outpatient clinics and their scheduling practices," said Minneapolis VA Health Care System Chief of Staff Dr. Kent Crossley.

Vets complain

The scandal that has engulfed the VA this year focused on improprieties at some of the country's 151 large VA hospitals. But the VA also operates 820 community clinics like the one in Hibbing, which provides outpatient and primary care to vets in a tiny office space nestled between a church and a Mexican restaurant in a shopping mall on the outskirts of town.

The Hibbing VA Clinic serves about 3,400 enrolled vets from four counties in northern Minnesota. Sterling Medical is reimbursed $62.02 per veteran per month by the VA, with additional reimbursements for such things as mental health services.

One local county veterans services officer logged more than two dozen complaints about the clinic after Sterling took over. This summer, U.S. Rep. Rick Nolan, who represents the area in Congress, held a veterans forum in Hibbing, which was dominated by complaints about service.

Nolan said at the time he saw improvement in Sterling's performance. Asked about the most recent allegations, Nolan, through his office, said he is aware of the new concerns and would continue to monitor the situation, particularly since Congress has given the new VA secretary broader authority to act quickly on irregularities.

Mark Brunswick • 612-673-4434