A new scandal threatens to engulf the New Mexico Veterans Affairs (VA) medical center. Doctors want to know why the VA is fiddling with appointments over a year old to make them appear as though they’re new, according to internal emails obtained by The Daily Caller News Foundation.
On Nov. 20, Dr. Lana K. Wagner sends an email at 8:56 a.m. to other doctors and the acting chief of staff at the facility regarding a mysterious problem. Requests for appointments dating from over a year ago, called consults, are suddenly disappearing due to being cancelled.
“It is distressing to find out that many of the studies that we ordered have not been performed. It is horrifying to think that these patients are going to fall through the cracks because these consults are being cancelled,” Wagner writes in the email. “Surely we are not cancelling these >1yr old consults in order to make is seem that care is not being delayed.”
Wagner sent out the email to try and get to the bottom of why the center is devoting resources to cancelling consults instead of trying to complete them.
Confirming this is not an isolated issue, Dr. Aaron M. Pierce writes back at 9:13 a.m. and says he too is experiencing similar problems. In Pierce’s case, the consults cancelled are also over a year old, prompting him to ask, “Is there something particularly important/relevant about a consult still being open after a year?”
“Regardless, I am getting frustrated at having to respond to these inappropriately completed consult notifications,” Pierce says.
Acting chief of staff James Goff responds at 9:24 a.m. to the email thread and says that “We have a major issue with open consults greater than and we are going through a facility wide herculean effort to resolve many old consults.”
“Do not shoot the messenger- get smart about the process,” Goff adds.
What exactly Goff means by his email is unclear, although he recommends the doctors meet with Henry Lin, vice chair of the Veterans Affairs Department of Internal Medicine, to better understand the process.
As described by the doctors, the VA regularly cancels consults and re-enters them into the appointment database. Once re-entered, the clock is reset. Consults which are over a year old then appear to be completely new.
This exact process has occurred elsewhere in the VA. An inspector general report in 2014 found that staff at two different facilities erased consults over 90 days without review by clinical staff. After the 2014 waitlist manipulation scandal broke, the inspector general in a separate report recommended for the Interim Undersecretary for Health to “conduct a systematic assessment of the processes each VA medical facility used to address unresolved consults…[and] ensure that if a medical facility’s processes are found to have been inconsistent with VHA guidance on addressing unresolved consults, action is taken to confirm that patients have received appropriate care.”
A report from the Government Accountability Office (GAO) determined that out of 150 consults reviewed, 122 failed to meet 90-day timeliness requirements.
In an interview, Debra Draper, the GAO’s director of health care, says, “VA has not required medical centers to document how they’re closing out consults, so, often consults are closed and there’s no apparent reason for why the consult was closed, and in some of those cases the veterans never received care.”
Sonja Brown, New Mexico VA’s chief of voluntary service and public affairs operations, responded to TheDCNF request for comment, saying:
The New Mexico VA Health Care System is committed to providing timely access to veterans as determined by their clinical needs. To be clear, no consults are being inappropriately cancelled. For example, in some cases, consults are sometimes cancelled at the request of a patient, or when no longer clinically indicated. Not every type of clinic appointment has the same urgency, or the same medical risk to the patient in the event of delay. Steps are being taken to address the specific concerns raised by the doctors in the email messages you provided. These steps can not only result in revealing any problems in the scheduling process, but also may clear up any misperceptions about that process. We will continue to provide safe, high-quality, personalized, and timely care for all eligible veterans.
The House Veterans’ Affairs Committee is currently looking into the emails, but notes the VA needs to be fully upfront about its consult-closing practices and hold responsible officials accountable.
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