Dennis Wagner and Paul Giblin

The Republic | azcentral.com

Acting Secretary of Veterans Affairs Sloan Gibson visited the Phoenix VA Center on Thursday.

Gibson%27s visit came a day after his agency said it had contacted nearly all 1%2C700 Arizona veterans left off a wait list for care.

Department of Veterans Affairs medical centers nationwide have misrepresented or manipulated patient scheduling for more than 57,000 former military personnel, according to a preliminary analysis of data released Monday by the agency, and about 64,000 more were not even on its electronic waiting list for doctor appointments they requested.

The VA Health Care System also announced an array of major reforms, including an administrative hiring freeze, increased transparency and the cancellation of bonuses to employees who meet a goal for scheduling doctor appointments.

The data release by acting VA Secretary Sloan Gibson further verifies wrongdoing uncovered in Phoenix and shows that dysfunctional practices permeate the agency's medical system and jeopardize health care for 9.3million enrolled veterans.

Audits at 731 VA facilities showed widespread confusion about record-keeping practices and pressure at some locations for schedulers to "utilize unofficial lists or engage in inappropriate practices in order to make wait times appear more favorable."

Auditors said they found improper scheduling at about three-quarters of the facilities examined and inappropriate wait lists at 70 percent. Fewer than half of the scheduling clerks reported proper usage of the VA's computerized appointment database. Roughly one in 10 of the employees responsible for making appointments did so incorrectly.

The entire VA health-care system has about 6million appointments in its scheduling system at any given time. Authorities are in the process of contacting more than 90,000 veterans affected by the snafus, or who otherwise may face unwarranted delays in getting care.

In a news release, Gibson said, "It is our duty and our privilege to provide veterans the care they have earned through their service and sacrifice. ... We must work together to fix the unacceptable, systemic problems in accessing VA health care.

"Today, we're providing the details to offer transparency into the scale of our challenges, and of our system itself. I'll repeat — this data shows the extent of the systemic problems we face, problems that demand immediate actions."

President Barack Obama last week appointed Gibson to replace Secretary Eric Shinseki, who resigned amid the mushrooming scandal. During a visit to Phoenix on Friday, Gibson announced he would open the VA to scrutiny, demand accountability and overhaul scheduling practices and standards.

On Monday, Gibson seemingly launched his reform campaign, announcing more than a dozen major initiatives in a news release. Among them:

Removing a 14-day scheduling goal. Auditors determined that the two-week standard was "unattainable" due to a shortage of medical professionals, yet employees were motivated to game the system so they could reap cash bonuses. "New rules will eliminate incentives to engage in inappropriate scheduling practices or behaviors," the announcement said.

Establishing new patient surveys. Gibson directed the Veterans Health Administration to immediately begin developing a new patient satisfaction measurement program to provide real-time, location-by-location information.

Holding administrators accountable. Personnel actions will target top administrators in VA facilities where audits have identified misconduct. An independent, external audit of systemwide VHA scheduling practices will be performed. "Where appropriate, VA will initiate the process of removing senior leaders," the news release said.

Imposing an administrative employment freeze. The VA will suspend hiring at VA headquarters and the nation's 21 regional health-care offices, filling only critical positions approved by the secretary.

Increasing medical staffing. At the same time, the department will accelerate the hiring of doctors, nurses and other staffers. "VA's first goal is to get veterans off wait lists and into clinics ... to ensure (they) receive the care they have earned through their service."

Increasing openness. Twice monthly, the VHA will post regular updates to wait-time data released Monday.

Gibson also announced he is sending an additional "front-line" team to Phoenix to immediately rectify problems with patient backlogs, appointment scheduling and record-keeping.

The VA found that 1,715 veterans in the Phoenix VA Health Care System and 1,115 in Prescott's Northern Arizona Health Care System have been waiting for initial appointments for 90 days or more. Meanwhile, 1,075 in Phoenix and 139 in Prescott were found to not be on the official waiting list for first appointments.

Although the VA tempest started in Arizona, data also indicate wait times have been manipulated even more egregiously in other locations.

When the two practices of keeping patients off wait lists are combined, Phoenix had the nation's 11th-highest total of veterans sidetracked in the system, with nearly 2,800. Atlanta had 7,300, Gainesville, Fla., 7,000, Nashville 5,000 and Sacramento 4,000.

As a result of the nationwide audits, the Prescott VA medical facilities have been flagged for further review and investigation, the report said.

"Any instance of suspected willful misconduct is being reported promptly to the VA Office of Inspector General," it said. "Where the OIG chooses not to immediately investigate, VHA leadership will launch either a fact-finding or formal administrative investigation."

Prescott's VA medical center was among the nearly 250 sites identified as needing further review.

Timely service for existing patients at Phoenix VA clinics ranked among the worst nationally no matter how it was measured, according to the report. About 11 percent of patients who had appointments were scheduled more than 30 days after they were booked. That was tied with facilities in Fresno, Calif., and Reno for the second-worst showing in the country.

The Prescott and Tucson facilities fared better in that category. For Prescott, 5 percent of existing patients waited more than 30 days. In Tucson, just 1 percent waited that long.

Sen. John McCain, R-Ariz., described the overall revelation as a "disgrace" and added, "Finding that staff engaged in widespread falsification of data to improve performance metrics and secure bonuses, this audit confirms that VA's problems stretch far beyond what President Obama last month called an 'issue of scheduling.'"

Sen. Bernie Sanders, I-Vermont, chairman of the Senate Committee on Veterans' Affairs, said: "Incompetent administrators and those who have manipulated wait-time data should be dismissed at once. Senator McCain and I have agreed on legislation to let the VA do just that.

"It is equally important, however, to understand that the reason certain VA facilities around the country have long wait times is because they lack an adequate number of doctors, nurses and other medical practitioners. The legislation, which I hope will be on the floor in a few days, would help the VA hire — in an expedited manner — the professional staffing that is needed to address long wait times."

Rep. Ann Kirkpatrick, D-Ariz., a member of the House Committee on Veterans' Affairs, said facilities flagged as "problematic" should undergo more intense audits, "including the one in Prescott that serves so many of our northern Arizona veterans."

"I ask the inspector general to engage immediately with the Prescott VA to investigate wrongdoing and determine if a criminal investigation is needed," she said.

Veteran groups said the latest investigative findings offer statistical proof for traumatic experiences described by ex-military personnel who visit VA facilities daily.

"This is not just 'gaming the system,'" said Daniel Dellinger, the American Legion's national commander. "It's Russian roulette, and veterans are dying because of the bureaucracy."

"This audit is absolutely infuriating and underscores the depth of this scandal," agreed Paul Rieckhoff, founder and chief executive with the Iraq and Afghanistan Veterans Association. "Our vets demand action and answers."

The VA furor began behind the scenes late last year when Dr. Sam Foote, then a physician in the Phoenix VA Health Care System, filed a complaint with the VA Office of Inspector General alleging that hospital administrators were falsifying patient access records to secure bonus pay and promotions.

Foote and other whistle-blowers identified a handful of tactics used by VA staffers to conceal delays in patient care. One tactic removed first-time doctor appointments from the agency's official electronic waiting list. Other techniques included altering the starting date for an appointment and eliminating some appointments by cancellation.

The concern that patients were dying while waiting for appointments became public in early April when Rep. Jeff Miller, R-Fla., chairman of the House Committee on Veterans' Affairs, mentioned it during a hearing and The Arizona Republic published a detailed article on Foote's allegations.

The controversy already has had significant national impact. The House and Senate committees have conducted hearings and are planning more. Shinseki and a top aide, Undersecretary Robert Petzel, resigned. Susan Bowers, the Southwest regional VA health- care director, was forced to retire early. Sharon Helman, director of the Phoenix VA medical center, was placed on administrative leave with two top aides and could be fired.

The inspector general continues investigating reports of wait-time misrepresentations at more than 40 locations nationwide. An interim report issued last week said investigators already have confirmed systemic "instances of manipulation of VA data that distort the legitimacy of reported wait times." It said those "deficiencies" had caused veterans to experience "lengthy waiting times and the negative impact on patient care."

Veterans organizations nationwide have convened town halls and demanded VA reforms. Committees on veterans affairs in both houses of Congress have conducted hearings, including one Monday evening, and are planning additional sessions. In addition, House and Senate members have proposed legislation to increase accountability and to expand the availability of private medical care for veterans when VA services are not readily available.

Republic reporter Rob O'Dell contributed to this article.