Kathy Leatherwood, a nurse and unit manager at the Alaska V.A., said in an interview that she also objected in 2008 to the use of phantom appointments. She said administrators directed her to schedule fake appointments for new patients within 30 days without even notifying the patients. She was then supposed to mark the patient as a “no show” or a cancellation and schedule a real appointment for later, she said. That way, the official record would show the veteran was offered a quick appointment within the required turnaround period.

Ms. Leatherwood said that she, too, went to V.A. administrators to object.

“It’s my name that’s going to be on that chart,” she remembered telling one administrator. The administrator responded that if she was unwilling to carry out the policy, he would find someone who would, she said. When she continued objecting, he threatened to call security if she did not leave his office.

Kathleen Belmonti, who was a nurse there, said in an interview that she, too, was aware of staff concerns about scheduling and management practices.

Cynthia A. Joe, the chief of staff at the Alaska V.A. Healthcare System, said that the facility had never used phantom scheduling and that, while some staff members had raised questions about scheduling practices, no one had protested or faced disciplining after raising concerns.

In court filings detailing the V.A. response to other problems, Dr. Ram Chaturvedi, formerly with the Dallas V.A. Medical Center, said that he began complaining in 2008 about shoddy patient care, including negligence by nurses who had marked the wrong kidney while preparing a patient for a procedure. In another instance, Dr. Chaturvedi said medical personnel had brought the wrong patient to an operating table.

Image Michelle Washington, a psychologist, said her performance was abruptly downgraded. Credit... David Norbut for The New York Times

A supervisor told Dr. Chaturvedi to “let some things slide” because of staffing problems, but he continued writing up complaints. Officials considered him disruptive and fired him in 2010.