Newly obtained internal Department of Veterans Affairs emails show that Central Texas VA doctors were directed to alter their scheduling requests for critical medical screenings in an attempt to make wait times appear shorter than they really were.
Printouts of the emails were mailed to the American-Statesman this week by an anonymous VA employee and echoed allegations made earlier this month by former VA physician Dr. Joseph Spann, who said orders to enter false request dates came from the radiology department at Temple’s Olin Teague Veterans Medical Center. Spann verified the authenticity of the emails. VA officials didn’t respond to a request for comment.
“The orders are out there to be found, many orders were routinely cancelled by the Chief of Imaging to hide waiting times,” wrote the latest VA whistleblower in a letter to the American-Statesman accompanying the documents. “We all know (Spann) is telling the truth.”
The new round of allegations came as the VA inspector general issued a blistering report Wednesday that concludes “inappropriate scheduling practices are systemic throughout (the VA).”
The inspector general interim report centered on allegations at the Phoenix VA medical center, where a former doctor claimed that officials maintained a secret waiting list to hide long wait times and that dozens of veterans died while awaiting care. Investigators found that while the facility claimed veterans waited an average of 24 days for an initial primary care appointment, the true average wait time was 115 days. The report didn’t determine if any veteran deaths were related to delays in care, nor did it assign blame to specific employees or administrators, something it might do in a final report in August.
The inspector general’s office is investigating 42 VA medical centers around the country, including the Austin Outpatient Clinic, the North Central Federal Clinic in San Antonio and the Waco Veterans Affairs Medical Center.
Those are the three facilities where VA employee Brian Turner claimed scheduling clerks were instructed to “cook the books” on wait time data. After the American-Statesman revealed Turner’s claims on May 8, VA inspectors launched their investigation in Central Texas. According to an inspector general letter to U.S. Rep. Lamar Smith, R-San Antonio, VA Secretary Eric Shinseki personally ordered the probe of the Texas facilities.
The inspector general probe is expected to be far more comprehensive than the internal review of Spann’s allegations, which local officials conducted after his claims went public. Last week, local officials announced they had found no evidence of the scheme he described.
The internal emails however, paint a different picture.
In an email dated Nov. 1, 2011, a radiology technologist in Temple directed doctors throughout the Central Texas VA health care system to use a false requested appointment date: “Please use the date desired for screening mammography exams as the 2nd of January,” wrote James Anderson. “The first available slots for screening mammograms is January the 12th.”
An hour and a half later, the chief of staff for the system, Dr. William Harper, wrote back: “You cannot do this!!!! This is essentially fraud. The desired date is what it is and if we don’t meet the standard then we will work to improve. You have to put down a reasonable desired date and we should be asking the patient what their desired date is.”
The VA grades facilities and top administrators on their ability to see patients close to their desired appointment date. Spann alleged that VA leaders encouraged fraudulent appointment data because it was tied to the bonuses they receive. Local VA officials have called any scheduling problems a “training issue” that didn’t originate with local leadership.
In another chain of emails from Nov. 5, 2011, Spann complains that he was directed to change the requested date for an abdominal ultrasound on a patient with “escalating midepigastric pains.” Another medical provider responded, “It doesn’t help if you insist on a desired date that doesn’t meet their 30-day criteria. (Chief of Radiology Dr. Gordon) Vincent just cancels the order. End of story.”
A July 2011 document shows that Vincent canceled a liver ultrasound appointment request for a patient with cirrhosis and asked that it be reordered for a later date.
Turner was the first to publicly reveal data manipulation in Texas, and he said a key part of the scheme was to leave veterans off of the VA’s electronic wait list, which is supposed to track patients who are waiting more than 90 days for an appointment, but which could also reveal lengthy wait times.
The Phoenix report found the same scheme and determined that Arizona officials kept 1,700 veterans off of the electronic list.
Investigators linked that wait list manipulation to bonuses for executives.
“A direct consequence of not appropriately placing veterans on (electronic wait lists) is that the Phoenix (VA) 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,” wrote Richard Griffin, the VA’s acting inspector general, in the Phoenix report.
The report led U.S. Rep. Jeff Miller, R-Fla., chairman of the House Committee on Veterans Affairs, to join the chorus of calls for Shinseki’s resignation.
“Shinseki is a good man who has served his country honorably, but he has failed to get VA’s health care system in order despite repeated and frequent warnings from Congress, the Government Accountability Office and the IG,” Miller said in a statement.
State Sen. Leticia Van de Putte, D-San Antonio, who chairs the Texas Senate veterans affairs committee, said she is working with the Texas Veterans Commission and Texas Veterans Land Board to set up a veterans hotline, on which state workers would help veterans “navigate the VA’s complicated system and get the medical appointments they need.”
From: Anderson, James C
Sent: Tuesday, November 01, 2011 8:01 AM
Subject: Screening Mammography Exams
Please use the date desired for screening mammography exams as the 2nd of January. The first available slots for screening mammograms is January the 12th.
From: Harper, William F.
Sent: Tuesday, November 01, 2011 9:34 AM
To: Anderson, James C; CTXDocs
Cc: Vincent, Gordon S; Eggers, James O.
Subject: RE: Screening Mammography Exams
You cannot do this!!!! This is essentially fraud. The desired date is what it is and if we don’t meet the standard then we will work to improve. You have to put down a reasonable desired date and we should be asking the patient what their desired date is.
William F. Harper, MD, FACP
Chief of Staff
Central Texas Veterans Health Care System