Deaths resulting from delay of care at VA hospitals is an issue that has been very much in the news recently. Reports from whistleblowers show that not only have American veterans died while waiting for appointments and care, but that VA hospitals have concealed that fact and used deceptive appointment lists to improve their reported efficiency and efficacy.
However, the long delays in care from the government-administered health system are nothing new. For many years, veterans and their families have shared stories of absurd wait times, telephone tag games, bureaucratic run-arounds, inadequate care even after an appointment finally happens, lack of funding, poor facilities and endless other tales of woe at the hands of the VA. Sadly, even the death of veterans who were awaiting appointments or care is a previously known phenomenon, as The Daily Banter reports today.
The Phoenix story has lit a media fire under the issue of veterans’ access to care, but more than a year ago, the GAO reported on the same practices being alleged in Phoenix, and in a subsequent Congressional hearing, V.A. officials testified about deaths related to the long wait times.
One of the most disturbing details of the report is the fact that the use of fraudulent wait lists was not only in practice prior to 2012, but that they were known and reported on by the Government Accounting Office. A report from the office dated December 2012 made clear that wait times were being adjusted and lied about on official records, essentially the same deception as in the "secret list" stories published in the last few weeks.
During our site visits, staff at some clinics told us they change medical appointment desired dates to show clinic wait times within VHA’s performance goals. A scheduler at one primary care clinic specifically stated that she changes the recorded desired date to the patient’s agreed-upon appointment date in order to show shorter wait times for the clinic. A provider at a specialty care clinic at another VAMC said providers in that clinic change the desired dates of their follow-up appointments if a patient cannot be scheduled within the 14-day performance goal.
In a House hearing in 2013, the specific issue of deaths occurring as a result of delayed care was raised to Dr. Thomas Lynch, Assistant Deputy Under Secretary for Health Clinical Operations and Management. Lynch was asked directly by Congressman Mike Coffman (R-CO) if he was aware of any deaths. He responded:
"With respect to what had occurred in Columbia and Augusta, we are aware that there were some clinical disclosures made and that there were veterans who had died with a disease process that could potentially have been related to consult delay."
That is a clinical and evasive way of saying, yes, he was made aware of deaths that were "potentially" the result of delays. Rep. Coffman, however, made it specific. From The Daily Banter:
“Well, yeah, I think you have via the internal documents here, and you are actually fairly specific,” Coffman said. “It is in May that it, in fact, the delay in treatment did cause the death of a veteran in South Carolina, and another date in May—another internal document, last year, May 15, speaks to the Dorn facility, speaks to another death due to delay in care, so I think that clearly there are, by your own internal documents, there are issues concerning the quality of care related to timeliness and, unfortunately, the loss of life unnecessarily of veterans, and that is particularly alarming.”
There is a comprehensive accounting of the report and the hearing at the Banter's website. Truth Revolt's reading of the report yields an additional point. In the conclusion, the report states "unreliable wait time measurement has resulted in a discrepancy between the positive wait time performance VA has reported and veterans’ actual experiences." This is obviously a sad and gross understatement, especially jarring in light of all the recent revelations.
Among the report's recommendations:
To better facilitate timely medical appointment scheduling and improve the efficiency and oversight of the scheduling process, we recommend that the Secretary of VA direct the Under Secretary for Health to take actions to ensure that VAMCs consistently and accurately implement VHA’s scheduling policy, including use of the electronic wait list, as well as ensuring that all staff with access to the VistA scheduling system complete the required training.
To improve timely medical appointment scheduling, we recommend that the Secretary of VA direct the Under Secretary for Health to develop a policy that requires VAMCs to routinely assess clinics’ scheduling needs and resources to ensure that the allocation of staffing resources is responsive to the demand for scheduling medical appointments.
If only this had been done, perhaps Thomas Breen and others would be alive today.