Houston Veterans Waited for Care After VA Cancelled Appointments

Evidence that VA hospital was falsifying records as recently as February

June 22, 2016

Nearly 100 veterans in Houston waited an average of 81 days for care after schedulers at a Department of Veterans Affairs hospital cancelled their appointments, a watchdog said this week.

The veterans’ wait times appeared much shorter in electronic scheduling records because staffers at the Michael E. DeBakey Medical Center in Houston, Texas were told to designate appointments as cancelled by the patient when they were really cancelled by the facility, according to a VA inspector general report released on Monday.

Investigators learned through a review that two former scheduling supervisors at the hospital and a current director of two of its outpatient clinics told staffers as recently as February to designate appointments cancelled by the clinic as cancelled by patients.

"This report is a prime example of why VA is still mired in dysfunction. The inspector general caught three VA leaders red-handed instructing their subordinates to manipulate wait times," Rep. Jeff Miller (R., Fla.), who chairs the House Committee on Veterans Affairs, told the Washington Free Beacon.

Miller said one of the VA leaders was allowed to retire with full benefits, while the other two still work at the VA.

The watchdog launched an investigation into the medical center after an anonymous tip that leaders were instructing staffers at the hospital and its outpatient clinics to incorrectly record appointments.

The inspector general found that, between July 2014 and June 2015, 223 out of 373 appointments designated as cancelled by the patient in electronic hospital records were in fact cancelled by hospital staffers.

Because the VA measures wait times differently for appointments rescheduled due to clinic cancellations and those rescheduled due to patient cancellations, the action caused nearly 100 veterans’ wait times to be grossly understated in electronic records.

When the clinic cancels a patient’s appointment, the wait time is still calculated from the original clinically-indicated or preferred appointment date. When a patient cancels an appointment, the VA resets the preferred appointment date to the patient’s new preferred date.

Of the 223 falsely designated appointments, 94 were rescheduled beyond the VA’s 30-day wait goal.

These veterans waited an average of 81 days—almost three months—for care, though the hospital’s electronic records showed they waited an average of three days for care.

Investigators also found evidence that staffers did not always use the correct date when scheduling veterans’ appointments, which resulted in waits being understated. The electronic records for 50 appointments understated wait times by 66 days on average. Thirty-eight of these records falsely indicated that veterans waited zero days for appointments.

The Houston VA was one of 112 facilities flagged by the Veterans Health Administration in a system-wide review because of concerns over inappropriate scheduling practices in 2014, after hospital staffers at the Phoenix VA were found keeping secret lists to hide long waits for care. According to findings of that investigation released in March, the watchdog found evidence that Houston VA employees were "zeroing out" wait times by basing preferred appointment dates on available clinic appointments.

"These conditions persisted because of lack of effective training and oversight. As a result, [Veterans Health Administration] recorded wait times did not reflect the actual wait experienced by the veterans and the wait time remained unreliable and understated," the inspector general wrote in the report released Monday.

The watchdog recommended that VA management confer with the agency’s Office of Accountability Review to decide whether any administrative action should be taken. The inspector general also urged managers to provide staff with better training in scheduling procedures and audit scheduling practices.

A spokesman for the Houston VA told the Washington Free Beacon that the medical center started retraining employees in scheduling practices two years ago and has implemented monthly audits of scheduled appointments.

"We are confident that our dedicated schedulers (46 percent of whom are Veterans themselves) now clearly understand the procedures related to scheduling Veterans for appointments," Maureen Dyman, the medical center’s communications director, said in an emailed statement.

Dyman said the investigation "did not substantiate any case of Houston VA Medical Center senior leaders intentionally manipulating scheduling data."

A representative for Concerned Veterans for America, a veterans group advocating for VA reform, said the report "shows that veterans are still at the mercy of ethically challenged VA officials."

"Instructing staff to incorrectly record cancellations is proof-positive of the VA’s desire to avoid accountability for its failure to deliver timely care," said Cody McGregor, the group’s national outreach director and a former U.S. Army sniper. "The corruption and complete disregard inside the VA towards the men and women who sacrificed everything for our country is shameful."

The VA has been criticized by lawmakers and some groups who say the agency has not done enough to reduce veterans’ wait times and punish its employees for misconduct. Last week, VA officials said they would no longer use streamlined firing powers to punish employees for misconduct because of pending legal challenges.

"We are holding people accountable," VA Secretary Robert McDonald said about the decision during a Monday talk at the Brookings Institution. "We have taken advantage of accelerated process for nine senior executive service individuals. What we decided recently is, given that that part of the law has come under constitutional question, we didn’t want to continue to follow that procedure since what we don’t want to do is have a disciplinary process go on and then have it overturned later for a technicality."

"We are using the old procedure. The old procedure is fine," McDonald added.

McDonald came under fire earlier this year for comparing veterans’ waits for care to lines for Disney theme park rides and suggesting wait times are not the best metric of success for the agency. He has since expressed regret for those statements.