Poor Care at Phoenix VA Led to Deaths of Veterans with Cancer

Inspector general: Vets still dying in 2015 due to delays

Phoenix VA Health Care Center
The Phoenix VA Health Care Center / AP
October 16, 2015

Multiple veterans died of cancer after receiving insufficient care at the Phoenix VA hospital, the same VA facility at the heart of the fake waitlist scandal.

A report from the Department of Veterans’ Affairs Office of Inspector General released Thursday outlined the delays experienced by nearly 50 percent of patients referred to the urology service in Phoenix because of "extreme staffing shortages."

Investigators reviewed 3,321 electronic health records between August 2014 and April 2015 and found that 1,484 patients—45 percent—experienced delayed care. Delays involved either not receiving a timely evaluation or not receiving a timely follow-up appointment at the Phoenix urology facility or through so-called "Non-VA Care Coordination."

The report singled out 10 individuals in particular who experienced "significant delays" in care that therefore placed them "at unnecessary risk for adverse outcomes." Half of these patients died.

The majority of these patients received care that delayed the diagnosis of or treatment for prostate cancer. In many cases, appointments were "cancelled by the clinic" for unclear reasons, therefore delaying care. Three of the patients died of prostate cancer, one of bladder cancer, and another of a condition producing blood in his urine.

The inspector general also found the quality of non-urological care to be unacceptable in two of these cases that put the pair of patients at "unnecessary risk for harm."

At least in part, the insufficient care appears to have stemmed from severe staff shortages. The urology department should have had three urologists and three nurse practitioners, according to the report. During a period of two months in 2013, only one part-time urologist was covering the workload of three. Moreover, during a period of four months, one full-time and one part-time urologist were operating the facility without any nurse practitioners.

"As providers left or became unavailable, the [Phoenix VA Health Care System] process was to cancel scheduled appointments, send notification letters of appointment cancellations, and inform patients that they would receive referrals for non-VA care," the inspector general report read.

Fifty-nine percent of the 7,299 urology appointments scheduled between April 2013 and August 2014 were cancelled. Furthermore, not all of the patients whose appointments were cancelled were referred to non-VA urologists.

This is not the first evidence of poor care at the Phoenix VA hospital. The medical facility was at the center of the fake waitlist scandal of 2014 that found hospital staffers using a fake waiting list to conceal the delays veterans faced. At least 40 patients at the facility died waiting for care.

The controversy eventually forced former VA Secretary Eric Shinseki to resign, after which President Obama replaced him with current Secretary Robert McDonald. It also led to the 2014 Veterans Access, Choice, and Accountability Act.

Still, difficulties plague the VA’s network of health care systems. An independent assessment released last month mandated by the 2014 law concluded that the Veterans Health Administration faces "crises in leadership and culture" along with other systematic problems.

Lawmakers have sought to solve the problems at the VA. In July, the House passed the VA Accountability Act of 2015, which would give McDonald the authority to remove or demote a VA employee for poor performance or misconduct.

Obama has threatened to veto the law.