Employees of the infamous Phoenix VA hospital continue to manipulate wait-time data to make it appear patients are treated promptly, and some of them are still dying unnecessarily as a result.
The new inspector general (IG) report makes clear that little has changed in the problems that made the Phoenix facility ground zero in the scandal that triggered the resignation of a VA secretary. It sparked promises in the White House of wholesale reforms at VA and a change in the department’s seriously dysfunctional management culture.
The IG report’s account of continuing problems at Phoenix was confirmed by the hospital’s chief of specialty care, who told The Daily Caller News Foundation he had reported hundreds of examples of appointments being wrongfully canceled to the hospital’s director, but nothing changed.
The report released Tuesday reviewed 2015 records and, “determined that untimely care from PVAHCS (the Phoenix hospital) may have contributed to the death of 1 patient” who “never received an appointment for a cardiology exam that could have prompted further definitive testing and interventions that could have forestalled his death.”
The review looked at patients who were waiting for appointments when they died, and appointments that were mysteriously cancelled. Most of the deaths were unrelated to slow care, it found, but the cancellations were a widespread violation of VA policy.
“In 2015, PVAHCS staff inappropriately discontinued consults,” it said. “We analyzed 30 consults canceled from January through March 2015, and found that the Chiropractic Service staff responsible for scheduling inappropriately canceled all 30.”
Another IG report released last week found that a second Phoenix patient died because the VA kept him waiting for treatment for lung cancer after it was diagnosed.
Phoenix VA’s Chief of Specialty Care Clinics Kuauhtemoc Rodriguez told TheDCNF that, “as for scheduling of appointments, primary care has deleted at least 1,600 that I’m aware of, that were reported to Ms. Deborah Amdur and the associate and deputy facility director.” Amdur was then the facility’s director.
“I personally handed her a deleted list of 300 patients who were removed by primary care supervisors in order to meet national metrics. There are people who are supervisors in primary care still today who ran the secret wait-lists. Not one of them has been punished,” Rodriquez said.
The VA chose Amdur to help the hospital recover from the scandal the same month a previous IG report revealed extensive evidence that she had overseen data manipulation in her last job. Amdur resigned from the Phoenix job unexpectedly after only a few months, and VA replaced her with another director with a flawed record.
Tuesday’s IG report said appointments were canceled either with no explanation, after making inadequate attempts to contact the patient, or because of paperwork errors. By canceling appointments, workers were able to give the impression that not as many people were waiting for care.
“As of July 2016 … the facility had nearly 38,000 total open consults” because “staff had not scheduled patients’ appointments in a timely manner … and staff did not properly link completed appointment notes to the corresponding consults.”
In August 2015 there were “more than 22,000 individual patients had 34,769 open consults.” Nearly 5,000 people were waiting for appointments more than a month after the date the doctor recommended.
The IG said the improper cancellations included taking patients off lists when they were waiting for VA approval to see a non-VA doctor.
Rodriguez claimed VA officials at Washington headquarters concocted a plan to ping-pong patients back on forth between waiting-for-approval-to-see-private-doctor and waiting-for-government-doctors list. Each time that happened, the official number of days the patients were recorded as waiting was reset to zero.
“This will produce skewed access data because it will portray consults as having been seen sooner because they’ll be repeatedly shuffled between Vendor-VA,” he said, referring to it as “recycling consults.”
The IG also assessed allegations that Phoenix staff were keeping a second system of appointment records to keep wait times out of the reporting metrics that Congress and others could see, and which can affect cash performance bonuses for VA staff.
Investigators reviewed a printed list and said it was simply used “to record their attempts to contact the patients.” Rodriguez claimed that they reviewed the wrong thing, and that Post-It notes and, in some departments, Microsoft Outlook calendars were used to keep off-the-books records.
Rep. Jeff Miller, chairman of the House Committee on Veterans’ Affairs, said in a statement that, “the work environment in Phoenix is marred by confusion and dysfunction. VA’s performance in Phoenix and across the nation will never improve until there are consequences up and down the chain of command.”
In response to the report, the Phoenix VA said it would develop “a process to review charts of deceased patients with open consults to determine if there was a delay in scheduling the requested care, and if so, how that delay might have impacted the outcome,” and “monitor compliance with national and local consult management policies.”
“Though we have made irrefutable progress, there is still much work to be done,” VA Deputy Secretary Sloan Gibson said in a statement.
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