Just last week, top leaders including VA Secretary Eric Shinseki and President Obama were wondering aloud whether the VA’s problems were limited to a few bad actors. Now, they don’t have to wonder. Messing with schedules to hide long wait times for veterans seeking medical care is “systemic” in the VA’s health-care system, according to a new report from the VA’s Office of Inspector General. And those “scheduling schemes” are placing veterans at risk.
The new report’s official judgment should resolve any doubt about how deep and widespread these issues are. As of Wednesday, when the report was released, the Office of Inspector General’s (OIG) investigation had expanded to 42 separate VA facilities.
Increased calls for political action came swiftly in the report's wake and focused on VA Secretary Shinseki.
“I haven’t said this before, but I think it’s time for Gen. Shinseki to move on,” Sen. John McCain said in an appearence on CNN Wednesday.
Rep. Jeff Miller, chairman of the House Veterans’ Affairs Committee, responded to the report with a statement that said Shinseki should “resign immediately.”
Less than a week ago Rep. Jeff Miller was calling for Shinseki to stay at his post until the OIG completed its investigation, but he changed course after reviewing the interim report’s findings. In his statement Miller called Shinseki a “good man who has served his country honorably,” but said that he seemed “completely oblivious to the severity of the health care challenges facing the department” and that it was “time for him to go.”
In addition to Miller, four other lawmakers also called on Shinseki to resign after the report was released, adding to the more than 50 members of Congress who have called for him to step down since the scandal broke last month. At least two new Democratic senators joined the chorus Wednesday, suggesting that more members of the president’s party are turning against his appointee in the wake of the OIG’s findings.
Though the VA’s problems have been clear for some time, it has been harder to gauge the full consequences and extent of the widespread delays. In the OIG’s report, the impact of the scheduling manipulation can actually be measured in individual veterans affected and days spent waiting for medical treatment.
Wednesday’s interim report focuses on the Phoenix VA where the scandal first broke after a whistleblower revealed widespread scheduling fraud in the facility and dangerous treatment delays for veterans.
In Phoenix, 1,700 veterans in line for medical care were kept off of official records and placed on secret waiting lists. On average it took 115 days, over three months, from the time veterans first reported to the VA until they had their first primary care appointment. Of the 226 veterans reviewed by the OIG for their report, 84% waited more than 14 days—the maximum wait time set by the VA—before they saw a medical provider.
To hide those delays, the employees in Phoenix used the same methods detailed in leaked memos provided by the Central Texas VA whistleblower who spoke with The Daily Beast. And, as the OIG’s own report suggests, their motivation for cheating the records was likely the same—to score high marks on performance evaluations and qualify for bonus pay.
According to the OIG, the most common scheduling trick used to hide delays was changing veterans’ “desired dates” for medical appointments. On Tuesday, before the OIG’s report was released, The Daily Beast gave a detailed account of the “desired date” scheme in an exclusive story based on leaked official documents and testimony from a whistleblower who says that scheduling manipulation remains rampant at the Central Texas VA where they work.
Changing veterans’ desired appointment dates for medical care may have been the most common method used to game the system in Phoenix. But it wasn’t the only one. The OIG report lists four separate “scheduling schemes” used by VA employees to manipulate veterans’ appointments and hide delays.
The pressure to meet the VA’s performance measures likely led to the proliferation of “scheduling schemes,” like those detailed by the IG. Each of those scheduling tricks helped the VA’s director, who presided over a facility where veterans waited months for care, earn high marks and bonus pay.
Addressing performance measures in the report, the OIG writes: “The Phoenix HCS leadership significantly understated the time new patients waited for their primary care appointment in their FY 2013 performance appraisal accomplishments, which is one of the factors considered for awards and salary increases.”
But patient wait times is not just one of many co-equal factors considered for bonuses. It’s worth 50%, half of the overall bonus.
The OIG lays out a thorough account of how fraud was perpetrated in Phoenix but it doesn’t explain how and why a culture of deception took root. And, as the OIG acknowledges, the new report report on Phoenix is only the latest entry in a large file containing detailed warnings about wait time issues in the VA. Since 2005, the OIG has produced 18 separate reports on treatment delays, hidden wait times and problems in the VA scheduling system.
Phillip Carter—a former top Pentagon official who’s now a senior fellow at the Center for a New American Security, studying veterans’ issues—believes that while the IG report and other investigations may new light shed on old problems, larger issues are still unresolved.
“There are systemic issues with the VA’s allocation of medical resources generally that run much deeper than Sec. Shinseki and his leadership of the VA,” Carter said, “and lay partly at the feet of Congress for neglecting this issue so long too.”
“However,” Carter added “accountability rests with the Secretary, and these issues arguably should have been fixed during Sec. Shinseki’s tenure.”
Editor's Note: This story will be updated as new information becomes available.