Texas VA Hospital Run Like ‘Organized Crime Syndicate’

Veteran Mark Howey waits to ask a question as Sen. John McCain speaks during a forum with veterans regarding lapses in care

Veteran Mark Howey waits to ask a question as Sen. John McCain speaks during a forum with veterans regarding lapses in care / AP

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An award-winning VA hospital in Texas is run like an “organized crime syndicate” with top executives pressuring their staff to hide evidence of delayed appointments for veterans, a whistleblower told the Daily Beast.

The whistleblower said VA directors have a perverse incentive to delay appointments and potentially life-saving treatments because their bonus pay is based on seeing patients in a 14-day window:

“If [VA] directors report low numbers, they’re the outlier. They won’t stay a director very long and they certainly won’t get promoted. No one is getting rewarded for honesty. They pretty much have to lie, if they don’t they won’t go anywhere,” the whistleblower added. Weighted more heavily than other performance measures, the wait time numbers alone “count for 50 percent of the executive career field bonus, which is a pretty powerful motivator.”

Though VA hospitals may be struggling with increasing patient loads and inadequate resources—including too few medical providers—they are punished for acknowledging those problems. The VA’s current system appears to reward executives’ accounting tricks that mask deep structural issues and impede real solutions.

The Daily Beast report is just the latest example of the VA hospitals scandal that is spreading across the country. The VA inspector general is now examining 26 separate facilities to investigate claims of falsified appointments and veterans dying while they waited for treatment.

However, the report also notes that previous inspector general investigations failed to hold anyone accountable in the Central Texas VA health care network:

In 2011, the VA’s inspector general investigated the Central Texas health-care system in response to complaints it had received. The inspector general found that manipulated appointments were widespread and hid significant delays, but the report doesn’t seem to have led to a single VA official being disciplined or officially held responsible for gaming the system.

This internal VA email chain from 2011, provided exclusively to the Daily Beast, clearly instructs medical providers to falsify their schedules in the same manner that was exposed in Phoenix three years later. Though a VA executive warns that the original message is encouraging fraud, by the email’s conclusion two other doctors have written suggesting that it’s a common occurrence. The email was originally sent to every medical provider in the Central Texas VA health-care network.