Waitlist manipulation is rampant in Department of Veterans Affairs medical facilities across Louisiana and Illinois, according to a devastating new set of reports released by the VA inspector general Thursday.

Although the IG discovered flagrant violation of appointment practices, management insisted to investigators they never told staff to manipulate wait times, and employees denied ever receiving explicit instructions to fiddle with appointment dates.

The reports’ consistent findings render statements from management and employees suspect. One possible explanation for the inconsistency is that employees may be reticent to blow the whistle, given the department’s history with whistleblowers. A second is that the practice has been so normalized and viewed as standard fare in training that some employees didn’t even consider the procedure to be manipulation.

Investigators found that in the New Orleans/Baton Rouge VA health care system in Louisiana, a staff member recalled that during his training all the way back in 2008, management told him to treat the patient’s desired appointment date as the next date available in the scheduling software, known as the Veterans Health Information Systems and Technology Architecture (VistA). Since employees were trained from the beginning with this procedure, continued reminder from management was unnecessary.

Again in 2010, this same employee was instructed to “use the next available date as the patient’s desired date in VistA when scheduling appointments for patients,” but he did not remember the name of his trainer. This instruction was repeated by new management in 2014, according to an email the employee showed investigators.

This procedure was the exact same procedure used by staff in Florida VA facilities.

A nurse from Baton Rouge said she received her process training all the way back in 2000. Investigators found similar stories across Louisiana VA medical facilities, though the director of the Southeast Louisiana health care system explicitly denied telling anyone to manipulate times to remain within the 14-day appointment guidelines. She also stated that “There were no consequences for employees if patients were not being scheduled within the 14-day standard.”

In Shreveport, investigators watched and took careful notes as a medical support assistant scheduled an appointment.

“He used a method of finding the first available date in VistA, ‘backing out’ of the VistA appointment grid, then entering the ‘next available date’ as the ‘desired date,’ which reflected that there was no wait time,” the report stated. “We brought to his attention that this manipulated the wait time and asked him about why he used that method. He stated that it was the way he was taught when he first became an MSA.”

A common theme among employees is that they did not really consider fiddling with the schedule to be “manipulating” wait times, but supervisors certainly seemed to be at least somewhat aware of clever appointment rescheduling practices.

“If he booked a patient over 14 days in the future, he would get an email from his supervisor to redo the appointment schedule so it would show that the appointment date was less than 14 days from the desired date,” the report continued.

Whether or not any explicit instructions were delivered from management, employees clearly understood that serious pressure existed to stay within the 14-day limit for appointments.

At the Hines medical center in Illinois, one witness told investigators that nurses regularly made use of scheduling logs on the surgical floor that included sensitive patient information, such as last names and partial Social Security numbers.

“She believes this method caused excess delay in pain treatments because the log was not visible, but was locked in a drawer instead of being placed in an approved computer system,” the report noted. “The logbook was maintained by two nurses (one of whom is Witness 14 below). In approximately March 2014, when wait time investigations became known, the logbook was taken out of use and ‘shredded.'”

An employee at the VA medical center in Danville, Illinois, reported that supervisors would send “nasty-grams” about patients with wait times over 30 days. It was understood from these emails that employees needed to match “the desired date and appointment date in VistA to reduce the wait time to zero.”

“MSA1 called this the blacklist because she felt if the changes were not made there would be repercussions by management,” said the report.

The inspector general will continue rolling out reports over the next several months on waitlist manipulation.

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