Donovan Slack

USA TODAY

WASHINGTON — The VA suicide hotline is still sending nearly a third of calls to outside back-up centers despite pledges by Veterans Affairs officials to stop the practice last year after a scathing report found the centers had routed veterans to voicemail, an inspector general investigation found.

The VA opened a new call center and hired more staff to answer phones, but as of November, 30% of calls — or 14,600 that month — rolled over to backup centers.

Other concerns identified last year about veteran hold times, training, guidelines and quality assurance also haven’t been fixed, despite VA assurances they would be addressed by the end of September.

“We consider all prior recommendations to remain open as of the publication of this report,” John Daigh, assistant inspector general for health care, wrote in the most recent investigation report issued Monday.

The inspector general also identified new concerns. Investigators found the VA doesn’t keep track of how many veterans attempted or committed suicide after using the hotline so there is no way to tell exactly how effective it is. And when officials learned of suicides, they never reviewed them to see if future intervention procedures could be improved.

VA officials wrote in a response to the report that they agreed with the findings and would implement fixes. Poonam Alaigh, the VA’s acting undersecretary for health, said the hotline is “the strongest it’s ever been since its inception in 2007” and the additional call center, which opened in October, is continuing to staff up.

“This will provide callers with immediate service and achieve zero percent routine rollover to contracted backup centers,” she said.

Since its launch, the crisis line has answered more than 2.5 million calls and dispatched emergency services to callers over 66,000 times. The VA call center was featured in an HBO documentary that won an Oscar in 2015.

When the center’s phone lines reach capacity, new calls automatically roll over to one of four backup centers run by a VA contractor. The inspector general found last year that staffers at the centers did not always pick up calls quickly, were not always trained to the same level as those at the VA call center and some calls were routed to voicemail.

Investigators did not say how many calls ended that way, but at least 20 went to voicemail at one backup center in 2014. That year, roughly 17% of all calls to the VA hotline rolled over to the centers.

After issuing the findings in February 2016, the inspector general continued to receive complaints and so went back and re-examined hotline operations between June and December.

Among the findings:

• Two of four backup centers placed callers into a queue and left them there without routing them to another center if they were unable to answer right away. That meant veterans could be waiting on the line for 30 minutes or longer without ever speaking with someone.

• There is no automated caller ID that records numbers so the VA can follow up to make sure veterans are OK. Instead, operators have to manually enter callers’ numbers and they didn’t always do so correctly.

• There also was no way to record calls, something the agency has since remedied, but at the time of the investigation, there still was no way to listen to those recordings.

• Clinical staff “felt marginalized” in decision-making and said managers measured success by veteran satisfaction, numbers of calls answered and time spent on calls, metrics focused on business and efficiency more than clinical quality.

The inspector general issued a dozen recommendations for improvement, including addressing the concerns raised in the February 2016 report. In December, the VA said it would address those by this month.

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