The Veterans Affairs Office of Inspector General (OIG) has released the interim report of their ongoing review at the Phoenix Health Care System (HCS), identifying the allegations they have substantiated to date; for veterans like me it is tough reading even though I’ve never used the VA healthcare system. Older veterans who intend to read it might consider their blood pressure first.

Not only was the Phoenix VA healthcare scheduling system grossly mismanaged, but it and others also included several systematic schemes designed to hide the true level of poor performance.You may wonder why. If, as the buck passers say, the VA just did not have the funds necessary to meet the performance standards, what is there to gain by lying about it, gaming the system, and in many cases keeping names off all waiting lists so those veterans may never receive care at all?  You’re certainly not helping the veterans. Unfortunately, I believe the answer is contained in a single telling sentence in the OIG report, “The Phoenix HCS leadership understated the time new patients waited for their primary care appointment listed in their FY 2013 performance appraisal accomplishments, which is one of the factors considered for awards and salary increases.”

That is the way the OIG sends messages, what they are saying to the criminal investigators is, “Hey, look at this!”  I know because I worked for Army OIG for three years.

Policies prevent the IG from expressing the outrage some investigators surely felt when writing this interim report.Part of the special IG training involves remaining objective even when faced with gross negligence, incompetence, and/or apparent criminal conduct. We were charged with sticking to the facts and letting the appropriate command structure deal with the administrative corrections, discipline, or criminal charges, but no amount of training can make you un-human so we were allowed a little vent in the privacy in the team room to get to help us move on. In most cases it was limited, something akin to, “what in the world do they think they are doing?”

Here are some of the gory details. There were 1,400 veterans waiting to receive a scheduled primary care appointment on Phoenix electronic waiting list (EWL). At the same time, there additional 1,700 veterans who were waiting for a primary care appointment but were not on the EWL.  So those waiting off the books actually outnumbered those officially waiting for care.

“The time these 1,700 veterans wait for appointments prior to being scheduled or added to the EWL will never be captured.” Until that happens, the reported wait time for these veterans has not started. “Most importantly, these veterans were and continue to be at risk of being lost or forgotten in Phoenix HCS’ convoluted scheduling practices. As a result, these veterans may never obtain their requested or required primary care appointment.”

The report used by enrollment staff to notify Primary Care Coordinators or schedulers that a newly enrolled veteran has requested an appointment during the enrollment process listed 1,138 veterans who were waiting for an appointment an average of 200 days. However, only 53 of those veterans were actually on the EWL. The remaining 1,085 patients were not on the EWL. Consequently, their wait time prior to being scheduled or added to the EWL would potentially never be captured in any VA data.

It’s not just Phoenix, the OIG’s preliminary work has already revealed a number of scheduling schemes (the term from the OIG report) that are in use throughout VA health operations and under investigation. It goes on to discuss four of those schemes in detail – in my opinion the one thing they have in common is their purpose and I’ll say it even if the IG can’t, the obvious purpose is hide problems and mismanagement and qualify for raises, promotions, and bonuses on the backs of the veterans.

The next step for the Executive Branch is to identify those directly responsible and those whose management failure allowed this to become epidemic and take the appropriate action. The buck has to stop somewhere. What in the world do they think they are doing?  

Marty Richman, CWO4, U.S. Army (Retired)