New Details of Delays at Phoenix VA

The VA has not taken corrective action to address problems in urological care, despite learning of them five months ago

Phoenix VA Health Care Center / AP
January 30, 2015

The Phoenix veterans’ hospital does not have accurate data on nearly a quarter of patients in need of urological care, according to a new report by the inspector general.

"In approximately 23 percent of the total cases reviewed, we frequently found approved authorizations for care, notations that authorizations were sent to contracted providers, and often scheduled dates and times of appointments with [non-Veterans Affairs] urologists."

"However, in these instances, we found no scanned documents verifying that patients were seen for evaluations and, if seen, what the evaluations might have revealed," the report says. "This finding suggests that [the hospital] has no accurate data on the clinical status of the patients who were referred for urologic care outside of the facility."

While the review is "ongoing," these preliminary findings suggest that delays "could potentially be putting patients at risk for being lost to follow-up," and create "a backlog of unnecessary secondary authorizations, further delaying care."

Part of the issue with urological care is staffing, according to the report. The Phoenix facility is reportedly "understaffed," making it difficult "to keep up with many of the administrative tasks required to process authorizations."

The Department of Veterans Affairs (VA) hired 300 new employees last year.

Genevieve Billia, a spokesperson for the agency, said in a statement that the 300 employees "include nurses, physicians, physician assistants, allied health professionals, and clinical administrative staff."

The agency "will look to hire additional clinical support staff there under authorities and funding provided by the Choice Act," Billia said.

Even with the additional employees, one VA official told the Washington Free Beacon that the system continues to "experience increased workload and demand for services."

To deal with the demand, the agency has identified more than 1,000 clinical and support positions within the Phoenix Health Care System, which they intend to fill over the next two years, and construction for additional building space is already underway in two Arizona cities.

A spokesperson for the agency did not elaborate on which, if any, of the changes were specific to the urological department.

Since April 2014, the Phoenix VA Health Care System has faced intense scrutiny after a CNN investigation revealed that 40 veterans died waiting to receive care.

While operational changes have been made, the latest IG report raises questions about the agency’s efforts to address problems at the Phoenix hospital in a timely manner.

The problems in urological care at the Phoenix VA were first identified in a broad inspector general’s report roughly five months ago.

That report evaluated wait times throughout the Phoenix system, and highlighted three cases in which veterans faced challenges in gaining access to urology services.

One veteran had an appointment to see a VA urologist, but urology staffers canceled the appointment and, according to investigators, no one attempted to contact the patient to reschedule.

The veteran was diagnosed with metastatic prostate cancer and admitted to hospice, where he died two months later.

These problems raised concerns among investigators, and they announced plans for a separate investigation that would focus specifically on urology care.

A statement provided by the department suggests they have done little to address the issue.

A VA spokesperson told the Free Beacon that the agency was working to improve access to medical care and that the latest report gives them a chance to correct these problems early.

"This interim report from the Office of Inspector General (OIG) gives us the opportunity to address these issues identified during their January 12 site visit now rather than waiting until the review and final report are complete," the spokesperson said. "VA and Phoenix VA Health Care System (PVAHCS) are developing action plans now to track each issue identified in the interim report. The plans will include completion timelines and specific offices for those plans."

When asked why the agency did not take corrective actions after the first report's findings regarding the urology department, the spokesperson did not respond.

Congressional aides said the delay is inexcusable.

A top staffer on the House Veteran Affairs Committee told the Free Beacon, "It is absolutely shocking and very disturbing that VA has known about problems in the Phoenix urology department since at least August of 2014, yet made no effective effort to address them."

"The department clearly has some explaining to do regarding how it could leave such gaping problems unaddressed, especially given the scrutiny on the Phoenix VA Health Care System," he said.