What The VA’s Self-Audit Missed

So you thought the VA scandal couldn’t get any worse? Well, it just did.

The Department of Veterans Affairs released the results of their Veterans Health Administration internal audit yesterday, which evaluated, and then confirmed, allegations of falsified wait times exposed two months ago. While the initial reports of bureaucratic failure came out of Phoenix, the report shows that the systemic problems are nationwide.

Small reforms might help the situation, but a real legislative overhaul is necessary to fix the degrading VA system.

The Results

The audit, according to the Associated Press, found more than 57,000 veterans waiting 90 days or more for their first medical appointments. An additional 64,000 “fell through the cracks” – not being scheduled any appointments at all.

But how reliable is a report on the VA that was carried out by the VA?

Although these numbers do, to a degree, reflect and confirm reports of falsified wait times (with 13 percent of interviewed schedulers having reported being told by supervisors to falsify wait times to appear shorter) there are clear holes in the report that need to be further investigated. Especially when at least one instance of such practices was identified in 76 percent of VA facilities.

The Problems

The first problem is the faulty execution of the study. The audit planned to interview 10 respondents per facility across 731 facilities, but when it was all said and done, results showed they only saw six people per facility across 596 facilities. This resulted in half the sample size they initially were planning for.

The questionnaire clearly showed that the wording of the questions allowed for murky responses and equally convoluted interpretations instead of asking straightforward questions that would confirm or deny allegations clearly.

Among other problems cited in the site reports, was this: “Employees indicating reluctance to participate in the survey due to fear they would be subject to disciplinary action due to deviation from national policy.”

A fear of subjugation that leads to reluctance of participation often results in selection bias in participants. Therefore, participants would likely be limited to those that were not involved in the actions in question, or those that already wanted to blow the whistle on something.

For these reasons, the VA’s results must be taken with a grain of salt. If true widespread subjective interviewing were to take place from a third party, like the Government Accountability Office (GAO) for example, results may reflect even more alarming levels of gross misconduct from VA leadership.