Gregg Zoroya

USA TODAY

Delaying medical care to veterans and manipulating records to hide those delays is "systemic throughout" the Department of Veterans Affairs health system, the VA's Office of Inspector General said in a preliminary report Wednesday.

"Our reviews at a growing number of VA medical facilities have thus far provided insight into the current extent of these inappropriate scheduling issues throughout the VA health care system and have confirmed that inappropriate scheduling practices" are widespread, the report said.

Investigators with the Inspector General's Office also said their probe into charges of delays in health care at a VA hospital in Phoenix shows that the care of patients was compromised.

Late-night testimony Wednesday by a top VA official before Congress amounted to a confession that the agency had lost its focus over the years, paying more attention to meeting performance standards than treating patients.

"I think that there is a potential that we have lost true north. I think we need to focus on our mission: treating veterans," says Thomas Lynch, an assistant deputy under secretary, referring to a tough 14-day treatment goal that investigators said VA schedulers repeatedly manipulated records to get around.

Lynch said that for years, investigators from the VA Office of Inspector General found evidence of schedulers "gaming" medical appointments to hide delay.

"We were told that the scheduling system was challenged," Lynch testified. "But we discounted the (inspector general) reports and patient concerns as exceptions, not the rule. We could and should have challenged those assumptions."

The inspector general probe released Wednesday found that 1,700 veterans who are patients at the Phoenix hospital are not on any official list awaiting appointments, even though they need to see doctors. Some 1,138 veterans in Phoenix had been waiting longer than six months just to get an appointment to see their primary doctors, investigators found.

"These veterans were and continue to be at risk of being forgotten or lost in the (Phoenix hospital's) convoluted scheduling process. As a result, these veterans may never obtain a requested or required clinical appointment," the report said.

The Inspector General's Office said it is working with the Justice Department to determine if crimes occurred in how patients were handled.

Reaction to the report was swift with more calls for VA Secretary Eric Shinseki to resign, this time from Rep. Jeff Miller, R-Fla., chairman of the House Veterans' Affairs Committee, and Sen. John McCain, R-Ariz.

"It's time for him (Shinseki) to go," Miller said.

One of the strongest reactions Wednesday came from Sen. Patty Murray, D-Wash., a member of the Senate Veterans' Affairs Committee, who said Shinseki must immediately "put an end to what appears to be a pervasive culture of lying, cheating mismanagement" at the VA.

Lynch conceded in testimony late Wednesday that the "VA needs to work hard to re-establish trust and confidence among veterans."

As news of the findings broke, the number of lawmakers calling on Shinseki to step down totaled 37 in House, including 11 Democrats; and a dozen Senators, among them four Democrats, according to data collected by Military Times.

The embattled VA chief described what investigators found as "reprehensible" and immediately directed staff to rapidly care for the 1,700 veterans waiting to see doctors.

White House press secretary Jay Carney said President Obama had been briefed on the findings and found them "extremely troubling." He said Obama continues to push for immediate steps to correct delays in care.

William Thien, national commander of the Veterans of Foreign Wars, called for mass firings of "every employee and supervisor who knowingly gamed the reporting system."

The Disabled American Veterans service group, which has 1.2 million members, continued to stand by Shinseki while calling for more funding to expand medical resources at the agency.

Paul Rieckhoff, executive director of Iraq and Afghanistan Veterans of America (IAVA), which has about 270,000 veterans on its e-mail list, called the interim report "damning and outrageous. It also reveals the need for a criminal investigation."

"Even before this report came out, IAVA members were losing confidence in Secretary Shinseki and President Obama," Rieckhoff said.

The Inspector General's Office was called in to investigate following allegations by a retired VA doctor in Phoenix who said medical personnel kept secret lists of veterans whose appointments had been delayed. The physician alleged that up to 40 veterans had died awaiting care.

"Our reviews have identified multiple types of scheduling practices that are not in compliance with policy," the report said.

Evidence is mounting that delays in patient care are more systematic than Shinseki has indicated.

Investigators said they are now looking into 42 medical facilities in connection with health care delays, the number rising sharply from 26 last week and 10 the week before that.

In Phoenix, investigators found "multiple lists" that may be the basis for "secret" waiting lists that the doctor, Sam Foote, alleged had been created.

The investigators said that while health care quality was affected, they were not yet reporting findings on whether patients were harmed by the delays.

Investigators said that since launching the probe, they have received "receive numerous allegations daily of mismanagement, inappropriate hiring decisions, sexual harassment and bullying behavior by mid- and senior-level managers at this (Phoenix) facility."

At the time Shinseki asked the office to investigate the Phoenix facility, he placed the hospital administrator and two top officials there on administrative leave. Shinseki said he did so at the request of the inspector general.

The Inspector General's Office said the problems it is finding are not new. It has issued 18 reports dating to 2005 documenting delays in treating veterans at some of the agency's 150 hospitals and 820 clinics and detrimental health impact these delays have had on these patients.

"It appears that a significant number of schedulers are manipulating the waiting times of established patients," the report said.

The Inspector General appeared to draw a direct link between delays in health care and the bonuses of about $9,000 and salary increases that hospital officials receive as a result of their performance appraisal.

Investigators said by not providing patients with necessary scheduled appointments – as happened with the 1,700 veterans – the wait-time performance of the hospital looked better that it actually was.

"(Hospital) leadership significantly understated the time new patients waited for their primary care appointment in their FY 2013 performance appraisal accomplishments, which is one of the factors considered for awards and salary increases," the report said.'

Asked whether bonuses might have driven hospital administrators to manipulate wait time records, Lynch, a high-ranking VA doctor, told Congressmen, "I think that's possible."

Conclusions about whether patients died as a result of waiting for care or were otherwise harmed were not included in the report because further investigation is necessary, death certificates studied and medical records analyzed.

The report outlined problems found at other hospitals, evidence that supported the Inspector General Office's conclusion that the manipulation of records and delay of patient care are systemic at the VA, the nation's largest health care system serving nearly 9 million veterans.

One of the schemes to hide wait times involved scheduling supervisors who reviewed reports concerning cases where patients were waiting longer than 14 days. In those instances, supervisors instructed schedulers "to review these reports and 'fix' any appointments greater than 14 days." This meant changed dates on files, the investigators said.

In other cases, when doctors sent veterans to a specialist, schedulers merely deleted these appointments -- without checking with the veteran or doctor -- if they were pending for too long, the report said.