Officials from the Department of Veterans Affairs used paper waiting lists and manipulated electronic scheduling data at as many as 93 VA medical facilities across the country, but investigators found no conclusive evidence that the resulting delays in care caused any veteran deaths at the VA’s hospital in Phoenix, Arizona.
The Phoenix VA hospital has been at the epicenter of the scandal involving so-called secret waiting lists and deliberate gaming of the scheduling system by senior VA managers who attempted to cover up evidence that some veterans had been waiting for months to receive care. But while the final report by the VA’s Office of Inspector General, released today, confirmed the existence of “nationwide systemic” problems with scheduling practices and controls, investigators could not link those practices to patient deaths in Phoenix.
“While the case reviews in this report document poor quality of care, we are unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans,” the report states.
Since the scandal first made headlines last spring, the VA’s inspector general office has received 445 allegations of scheduling manipulation across the VA medical system. As of August, the IG has opened 93 investigations across the nation into scheduling manipulation and falsified wait times. So far, investigators have found at many VA medical facilities schedulers used the next available date as the desired date for appointments, senior managers directed schedulers to cancel or change appointments, paper waiting lists were used instead of VA’s main electronic health record system, consults were changed without proper clinical review and clinic utilization rates were altered to make the facilities appear to be meeting utilization goals.
Richard Griffin, VA’s acting inspector general, said in a statement accompanying the final report that the investigations at the 93 medical facilities are ongoing and are being coordinated with the Justice Department.
In an exclusive interview with FedScoop, VA Chief Information Officer Stephen Warren said the agency has taken several steps to fix the outdated scheduling component of VA’s EHR system, including turning on an auditing function that will provide a basic understanding of who is doing what on the system.
An internal VA review identified 11 issues related to scheduling that need to be fixed, and Warren’s team has so far finished work on five while “the rest are in the pipeline for solutions to be tested in the field and then deployed,” he said.
The VA inspector general also called on Warren’s team to activate auditing for the scheduling system. It took them about four days to do that nationwide. “There is some basic level of knowledge of who does what,” Warren said, pointing out that auditing is not the silver bullet that can stop all wrongdoing when it comes to individuals intent on manipulating the schedule. The added piece dealt with new fields to track who changed what and when. “That’s now all captured and available to the audit team,” he said.
Meanwhile, both VA and the Defense Department this week announced the launch of major contracting efforts to upgrade and modernize their respective electronic health record systems. Analysts, however, have been critical of both agencies for abandoning efforts to create a joint EHR and choosing instead to pursue separate modernization contracts.
“VA’s problems festered because administration officials ignored or denied the department’s challenges at every turn,” House Veterans’ Affairs Committee Chairman Rep. Jeff Miller, R-Fla., said in a statement. The president, Miller said, should “order the department to cooperate with the congressional committees investigating VA, and force DoD and VA to work together to establish a joint electronic health record integrated across all DoD and VA components.”