Veterans die after being placed on VA Hospital’s secret waiting list

[Forever_frost]

At least 40 U.S. veterans died waiting for appointments at the Phoenix Veterans Affairs Health Care system, many of whom were placed on a secret waiting list.

The secret list was part of an elaborate scheme designed by Veterans Affairs managers in Phoenix who were trying to hide that 1,400 to 1,600 sick veterans were forced to wait months to see a doctor, according to a recently retired top VA doctor and several high-level sources.

For six months, CNN has been reporting on extended delays in health care appointments suffered by veterans across the country and who died while waiting for appointments and care. But the new revelations about the Phoenix VA are perhaps the most disturbing and striking to come to light thus far.

Internal e-mails obtained by CNN show that top management at the VA hospital in Arizona knew about the practice and even defended it.

Dr. Sam Foote just retired after spending 24 years with the VA system in Phoenix. The veteran doctor told CNN in an exclusive interview that the Phoenix VA works off two lists for patient appointments:

There’s an “official” list that’s shared with officials in Washington and shows the VA has been providing timely appointments, which Foote calls a sham list. And then there’s the real list that’s hidden from outsiders, where wait times can last more than a year.

Deliberate scheme, shredded evidence

“The scheme was deliberately put in place to avoid the VA’s own internal rules,” said Foote in Phoenix. “They developed the secret waiting list,” said Foote, a respected local physician.

The VA requires its hospitals to provide care to patients in a timely manner, typically within 14 to 30 days, Foote said.

According to Foote, the elaborate scheme in Phoenix involved shredding evidence to hide the long list of veterans waiting for appointments and care. Officials at the VA, Foote says, instructed their staff to not actually make doctor’s appointments for veterans within the computer system.

Instead, Foote says, when a veteran comes in seeking an appointment, “they enter information into the computer and do a screen capture hard copy printout. They then do not save what was put into the computer so there’s no record that you were ever here,” he said.

According to Foote, the information was gathered on the secret electronic list and then the information that would show when veterans first began waiting for an appointment was actually destroyed.

“That hard copy, if you will, that has the patient demographic information is then taken and placed onto a secret electronic waiting list, and then the data that is on that paper is shredded,” Foote said.

“So the only record that you have ever been there requesting care was on that secret list,” he said. “And they wouldn’t take you off that secret list until you had an appointment time that was less than 14 days so it would give the appearance that they were improving greatly the waiting times, when in fact they were not.”

Foote estimates right now the number of veterans waiting on the “secret list” to see a primary care physician is somewhere between 1,400 and 1,600.

Doctor: It’s a ‘frustrated’ staff

“I feel very sorry for the people who work at the Phoenix VA,” said Foote. “They’re all frustrated. They’re all upset. They all wish they could leave ’cause they know what they’re doing is wrong.

“But they have families, they have mortgages and if they speak out or say anything to anybody about it, they will be fired and they know that.”

Several other high-level VA staff confirmed Foote’s description to CNN and confirmed this is exactly how the secret list works in Phoenix.

Foote says the Phoenix wait times reported back to Washington were entirely fictitious. “So then when they did that, they would report to Washington, ‘Oh yeah. We’re makin’ our appointments within — within 10 days, within the 14-day frame,’ when in reality it had been six, nine, in some cases 21 months,” he said.

In the case of 71-year-old Navy veteran Thomas Breen, the wait on the secret list ended much sooner.

“We had noticed that he started to have bleeding in his urine,” said Teddy Barnes-Breen, his son. “So I was like, ‘Listen, we gotta get you to the doctor.’ “

Teddy says his Brooklyn-raised father was so proud of his military service that he would go nowhere but the VA for treatment. On September 28, 2013, with blood in his urine and a history of cancer, Teddy and his wife, Sally, rushed his father to the Phoenix VA emergency room, where he was examined and sent home to wait.

“They wrote on his chart that it was urgent,” said Sally, her father-in-law’s main caretaker. The family has obtained the chart from the VA that clearly states the “urgency” as “one week” for Breen to see a primary care doctor or at least a urologist, for the concerns about the blood in the urine.

“And they sent him home,” says Teddy, incredulously.

Sally and Teddy say Thomas Breen was given an appointment with a rheumatologist to look at his prosthetic leg but was given no appointment for the main reason he went in.

The Breens wait … and wait … and wait …

No one called from the VA with a primary care appointment. Sally says she and her father-in-law called “numerous times” in an effort to try to get an urgent appointment for him. She says the response they got was less than helpful.

“Well, you know, we have other patients that are critical as well,” Sally says she was told. “It’s a seven-month waiting list. And you’re gonna have to have patience.”

Sally says she kept calling, day after day, from late September to October. She kept up the calls through November. But then she no longer had reason to call.

Thomas Breen died on November 30. The death certificate shows that he died from Stage 4 bladder cancer. Months after the initial visit, Sally says she finally did get a call.

“They called me December 6. He’s dead already.”

[Forever_frost]

Sally says the VA official told her, “We finally have that appointment. We have a primary for him.’ I said, ‘Really, you’re a little too late, sweetheart.’ “

Sally says her father-in-law realized toward the end he was not getting the care he needed.

“At the end is when he suffered. He screamed. He cried. And that’s somethin’ I’d never seen him do before, was cry. Never. Never. He cried in the kitchen right here. ‘Don’t let me die.’ “

Teddy added his father said: “Why is this happening to me? Why won’t anybody help me?”

Teddy added: “They didn’t do the right thing.” Sally said: “No. They neglected Pop.”

First hidden — and then removed

Foote says Breen is a perfect example of a veteran who needed an urgent appointment with a primary doctor and who was instead put on the secret waiting list — where he remained hidden.

Foote adds that when veterans waiting on the secret list die, they are simply removed.

“They could just remove you from that list, and there’s no record that you ever came to the VA and presented for care. … It’s pretty sad.”

Foote said that the number of dead veterans who died waiting for care is at least 40.

“That’s correct. The number’s actually higher. … I would say that 40, there’s more than that that I know of, but 40′s probably a good number.”

CNN has obtained e-mails from July 2013 showing that top management, including Phoenix VA Director Sharon Helman, was well-aware about the actual wait times, knew about the electronic off-the-books list and even defended its use to her staff.

In one internal Phoenix VA e-mail dated July 3, 2013, one staffer raised concerns about the secret electronic list and raised alarms that Phoenix VA officials were praising its use.

“I have to say, I think it’s unfair to call any of this a success when Veterans are waiting 6 weeks on an electronic waiting list before they’re called to schedule their first PCP (primary care physician) appointment,” the e-mail states. “Sure, when their appointment is created, it can be 14 days out, but we’re making them wait 6-20 weeks to create that appointment.”

The e-mail adds pointedly: “That is unethical and a disservice to our Veterans.”

Last year and earlier this year, Foote also sent letters to officials at the VA Office of the Inspector General with details about the secret electronic waiting list and about the large number of veterans who died waiting for care, many hidden on the secret list. Foote and several other sources inside the Phoenix VA confirmed to CNN that IG inspectors have interviewed them about the allegations.

VA: ‘It is disheartening to hear allegations’

CNN has made numerous requests to Helman and her staff for an interview about the secret list, the e-mails showing she was aware of it and the allegations of the 40 veterans who died waiting on the list, to no avail.

But CNN was sent a statement from VA officials in Texas, quoting Helman.

“It is disheartening to hear allegations about Veterans care being compromised,” the statement from Helman reads, “and we are open to any collaborative discussion that assists in our goal to continually improve patient care.”

Just before deadline Wednesday, the VA sent an additional comment to CNN.

It stated, in part: “We have conducted robust internal reviews since these allegations surfaced and welcome the results from the Office of Inspector General’s review. We take these allegations seriously.”

The VA statement to CNN added: “To ensure new Veterans waiting for appointments are managed appropriately, we maintain an Electronic Wait List (EWL) in accordance with the national VHA Scheduling Directive. The ability of new and established patients to get more timely care has showed significant improvement in the last two years which is attributable to increased budget, staffing, efficiency and infrastructure.”

Foote says Helman’s response in the first statement is stunning, explaining the entire secret list and the reason for its existence was planned and created by top management at the Phoenix VA, specifically to avoid detection of the long wait times by veterans there.

“This was a plan that involved the Pentad, which includes the director, the associate director, the assistant director, the chief of nursing, along with the medical chief of staff — in collaboration with the chief of H.A.S.”

Washington is paying attention

The Phoenix VA’s “off the books” waiting list has now gotten the attention of the U.S. House Veterans Affairs Committee in Washington, whose chairman has been investigating delays in care at veterans hospitals across the country.

According to Rep. Jeff Miller, chairman of the House Committee on Veterans’ Affairs, what was happening in Phoenix is even worse than veterans dying while waiting for care.

Even as CNN was working to report this story, the Florida Republican demanded the VA preserve all records in anticipation of a congressional investigation.

In a hearing on April 9, Miller learned even the undersecretary of health for the VA wasn’t being told the truth about the secret list:

“It appears as though there could be as many as 40 veterans whose deaths could be related to delays in care. Were you made aware of these unofficial lists in any part of your look back?” asked Miller.

“Mr. Chairman, I was not,” replied Dr. Thomas Lynch, assistant deputy undersecretary, Veterans Health Administration.

Congress has now ordered all records in Phoenix, secret or not, be preserved.

That would include the record of a 71-year-old Navy veteran named Thomas Breen.

http://myfox8.com/2014/04/23/veterans-die-after-being-placed-on-va-hospitals-secret-waiting-list/

[Scott Mc]

Lived between two Vietnam vets a few years back. They both said the VA is where you go to die.

[Country cracker]

It sucks that people that sacrifice the most for our country get shit on the most

[Forever_frost]

Lived between two Vietnam vets a few years back. They both said the VA is where you go to die.

Yep but don't worry, the VA type care is now available for everyone. I had a hernia repaired back when the news broke that the VA was infecting vets with HEP and HIV because they weren't cleaning their surgical tools. I told them if I leave with a disease, they're all going to die before I do.

Open communication is important to a relationship.

[coley]

My dad went to the va last year for his neck being sore over a year ago. After multiple visits over 8 months his neck started to swell, finally a doctor told him he had cancer (stage 4). And then several more months went buy before they would start his treatments. Aftertreatment started one of his doctors asked why he waited so long to start because his cancer had showed up on a scan he did almost a year earlier. He had just found out three months prior.

[Forever_frost]

More than 1.5 million medical orders were canceled by the Department of Veterans Affairs without any guarantee the patients received the treatment or tests they needed, the Washington Examiner has found.

Since May 2013, veterans' medical centers nationwide have been under pressure to clear out 2 million backlogged orders for patient care or services.

They were given wide latitude to cancel unfilled appointments more than 90 days old. By April 2014, the backlog of what the agency calls “unresolved consults” was down to about 450,000.

What happened to other 1.5 million appointments is something that no one, including top officials at the veterans’ agency, can answer.

A review by the Government Accountability Office of the process VA used to close old consult orders found that poor documentation in patient files and the lack of independent verification made it impossible to know whether patients got care they needed before their medical orders were canceled.
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“We found they closed consults but there was no evidence as to why it was closed,” Debra Draper, health care director for the GAO, told the Examiner.

“By not having that independent verification or any other controls, there isn’t any way of knowing whether they were appropriately closed out,” Draper said.

“You don’t know whether people received the care or if they received it in a timely manner. There’s no audit trail. There’s no way to know whether they were appropriately closed,” she said.

The Examiner reported in February that the VA did a mass purge of backlogged medical orders that cleared 40,000 unresolved appointments in Los Angeles beginning in 2009 and 13,000 in Dallas during a one-week period in September 2012.

VA officials have since refused to say how widespread is the practice of canceling orders by labeling them “administratively closed” or how many unfilled consult orders were eliminated nationwide.

VA officials have also given conflicting statements about the issue to the media, Congress and the agency's own inspector general.

VA is under pressure to eliminate the long waits patients face when they need potentially life-saving medical tests.

A Veterans Affairs fact sheet released in April said 23 patients at VA medical facilities nationwide with gastrointestinal cancers died after they could not get the colonoscopies or other tests that had been ordered within the deadlines in agency policy. Those tests could have detected the cancers in their early stages, when they are most treatable.

The total number of deaths linked to delayed care from other medical disorders was not revealed.

At least 40 patients in the Phoenix VA health system may have died as a result of delayed care, according to an investigation by the House Committee on Veterans Affairs and reports by the Examiner and other news media outlets.

At a hearing in April, committee chairman Jeff Miller, R-Fla., ordered records at the Phoenix facility to be preserved, while the agency’s inspector general probes allegations that two sets of appointment logs were kept to hide long wait times for medical care.

Allegations that almost 60,000 overdue medical orders were purged in Phoenix to cover long wait times also have been raised by whistleblowers.

It’s not clear how long the VA has been mass-closing backlogged orders for tests and other procedures.

The Los Angeles purge began in 2009, when hospital administrators were under orders from Washington to reduce the backlog of unfilled consults, according to Oliver Mitchell, a whistleblower who formerly worked as a scheduling clerk in the Los Angeles facility's radiology department.

Mitchell filed separate complaints to the inspector general and the U.S. Office of Special Counsel in 2009 alleging thousands of tests were canceled.

Both complaints were closed after investigators did a cursory review and received assurances from VA officials that all patients who needed care got the ordered procedures.

In Dallas, the 13,000 cases were administratively closed in about a week in September 2012.

A consult is an order for follow-up care from a medical provider ranging from a diagnostic test such as a colonoscopy to an order for transportation to a medical facility.

In 2012, officials at the VA headquarters in Washington tried to build a database to track consult orders. But the database proved to be useless because of poor record keeping and the lack of standard procedures for tracking and filling the orders, Draper told the House veterans committee in April.

In May 2013, a directive was sent to medical centers across the country to clean up the records and clear out outdated and unfilled orders that were no longer needed.

Before an order was closed, the case was supposed to be reviewed to ensure the treatment was no longer required.

But an ongoing review by GAO found lax procedures and the lack of independent verification left VA unable to prove that all patients got the care they needed before the appointment was closed.

At one facility reviewed by GAO, patients in three of the 10 cases examined did not get the ordered procedures before their consults were closed.

At another, 18 consult orders were canceled on the day the facility was required to have the cases resolved.

GAO reviewed three of those cases and “found no indication that a clinical review was conducted prior to the consults being discontinued.”

Some of the 1.5 million backlogged consults were probably closed appropriately, Draper told the Examiner.

In some cases, the patient received the test but the verification was not correctly entered into the patient’s file. In those cases, closing the consult order would be appropriate.

Some of the closed consults were administrative tasks, such as transportation orders, and in others the medical procedure was no longer required because the patient’s treatment plan had changed or the patient died.

But there is no way to tell how many of the orders were appropriately filled or canceled, Draper said. A large proportion were simply “administratively closed” without any sign the appropriate review was done or the patient ever received the needed care that had been ordered, she said.

VA officials refused to be interviewed for this story.

They have issued a variety of statements in the past both acknowledging and denying mass cancellations of backlogged consult orders.

In response to Mitchell's whistleblower complaint, VA officials in Los Angeles told the inspector general they were ordered by Dr. Charles Anderson, then national radiology director at VA, to “mass purge all outstanding imaging orders” that were more than six months old.

An internal VA memo from Dallas in September 2012 said medical staff would “aggressively address this backlog of unresolved consults and reduce the number to an acceptable level.”

However, after the Examiner reported on the Los Angeles and Dallas purges, Robert Petzel, under secretary for health at VA, said only a few hundred cases in the Los Angeles facility had been administratively closed.

Petzel also said he had never heard the 40,000 figure cited by the Examiner, which was initially raised during a congressional hearing a year earlier.

The same day, Dr. Dean Norman, chief of staff for the VA Greater Los Angeles Healthcare System, said in an agency blog post that several hundred old orders had been closed in Los Angeles after careful administrative review.

“At no time were ‘group’ close-outs of imaging studies completed,” Norman said.

The one consistency in VA’s explanations has been that cases were closed only after careful, individual reviews, and that no patient who needed care was denied care.

Draper said that is not a claim VA can back up.

Reviewing cases individually, as GAO did, is tedious and time-consuming, Draper said. It is unlikely such a careful analysis could have been done on 13,000 cases in Dallas in about a week, much less 1.5 million cases nationally in a year, she said.

GAO is still investigating the large-scale closing of unfilled consult orders and its findings should be published this summer.

The VA inspector general is also conducing an investigation into allegations first raised by the Examiner of the Los Angeles and Dallas mass purges.

After the Examiner's story was published, Republican Reps. Kevin McCarthy of California and Dan Benishek of Michigan asked for in an internal agency investigation.

Benishek is chairman of the House Veterans' subcommittee on health and a former VA surgeon.

A similar request was sent by Rep. Pete Olson, R-Texas.

Petzel responded in an April 9 letter to Benishek that the inspector general would handle the investigation. Petzel did not respond to questions on the accuracy of the Examiner's reports or if the mass-purge practice was being used at other VA medical facilities.

“It’s unacceptable,” Benishek said of the response he’s gotten from the VA. “It’s a 'CYA' philosophy.”

Prior investigations by the GAO and inspector general found hospital administrators had an incentive to show steep declines in appointment backlogs. Performance reviews and bonuses are tied in part to meeting agency goals for reducing patient wait times.

GAO also identified several ways local facilities manipulated appointment lists to show it was meeting agency rules for wait times.

Sharon Helman, the director of the Phoenix VA health system, got a $9,345 bonus last year.

Draper said the bonus incentives and weak oversight make it easy for VA hospitals to manipulate their statistics.

“There are incentives that may encourage bad or unwanted behaviors,” she said. “There are weak system designs that really allow for manipulation if that’s what’s desired.”

http://washingtonexaminer.com/veterans-affairs-officials-purged-1.5-million-unfinished-medical-orders/article/2547921?utm_campaign=Fox+News&utm_source=foxnews.com&utm_medium=feed

[Gasser64]

Its like theyre actively trying to kill vets

[line-em-up]

Its like theyre actively trying to kill vets

Something I've been saying for 15 years and people just look at me like I'm nuts.

[Forever_frost]

I really think they are. When you take out those sworn to defend the country, you outlaw firearms and then push socialism and common core, who do you have left that remembers what the constitution is?

[Gasser64]

Plus vets have military knowledge that would be very useful to revolutionaries

[Forever_frost]

DHS already called us domestic terrorists.

[KBScobravert]

I just listened to Sen (VT) Bernie Sanders tell Rachael Maddow that the VA offers comparable care to the open market....right after acknowledging that the VA is SOCIALIZED MEDICINE and that the only people complaining about it are doing it because the Republican party does not approve of socialized medicine. He made it a solid point to correct himself that the complaints in Phoenix now are allegations and that it so far.

[Forever_frost]

If the VA handed out vouchers that would permit us to seek care in the community and bypass the VA completely, no one would go to the VA.

[Forever_frost]

This case just beggars belief. They deliberately let people die, covered it up and now are destroying evidence despite the order of Congress.

Via WFB:

Whistleblowers say officials have been destroying evidence at the Phoenix Veterans Affairs hospital where at least 40 patients died from delays, despite requests from Congress to preserve records.

Dr. Katherine Mitchell came forward to the Arizona Republic with records that show the hospital was using a secret list to hide the long wait times veterans faced. According to the Republic, Mitchell sent the documents to the paper after receiving a call from a coworker that evidence was being destroyed.

“I had no doubts they were capable of destroying evidence, or altering evidence,” she told the Republic. “So there I am, a 47-year-old doctor with two degrees, trying to figure out where to hide stuff.”

“I spent my whole professional life wanting to be a VA nurse, and then a VA physician,” she continued. “[But] the insanity in the system right now needs to stop, and whatever I can do to accomplish that, I will.”

News investigations have revealed at least 40 veterans died while waiting for treatment at the Phoenix VA Health Care System. According to whistleblowers, hospital leadership was aware of the secret lists, which were used to hide the long wait times from officials in Washington.

http://weaselzippers.us/184797-breaking-whistleblower-says-phoenix-va-hospital-officials-destroying-evidence-in-deaths-of-vets/