An investigation into the scheduling practices of the Veterans Affairs Medical Center San Diego and its community outpatient clinics revealed that the data for the length of a patient’s wait time was often manipulated.
In a summary of the investigation, released March 30, the VA Office of Inspector General found medical support assistants at the medical center altered or incorrectly scheduled patients’ desired date — the date a patient requests to be seen — so it would fall as close as possible to the actual appointment date, in effect making it appear as if there was no wait time. Many assistants reported that they were directed to do so by their medical administrative official.
According to Veterans Health Administration Directive 2010-027, under no circumstances can a desired date be manipulated, even if the patient accepts another appointment date because of lack of availability on the desired date.
But emails from a program analyst and claims from medical assistants said that they were directly told to violate the policy to ensure that wait times were less than 14 days. Three emails directing the manipulation of desired dates were found from a program analyst to medical support assistants in an investigation into VA Mental Health in 2013.
The emails showed that the program analyst directed assistants to call veterans with wait times over 14 days and ask if they’d prefer an earlier date of appointment. If they declined, the desired date was to be changed to the current appointment date, as a veteran was indicating that that date was the preferred date, in violation of the directive.
The medical assistants also alleged that the medical administrative officer told them to manufacture zero-day wait times by canceling or rescheduling appointments and that one employee was tasked with changing desired dates to reflect shorter wait times. If they failed, it would be reflected in their evaluations, preventing promotions and bonuses, according to one of the complainants.
One veteran attempted to commit suicide in 2014 because he was unable to see his medical provider due to multiple cancelled appointments. The inspector general’s office investigated the claim and found scheduling data showed that in 2013, 13 to 14 percent of the veteran’s appointments were cancelled with less than a day’s notice. In 2014, the number rose between 24 to 27 percent.
The investigation began after two complaints alleging the misconduct were made to an office of inspector general hotline in May of 2014. Many of the medical support assistants verified this in interviews by the inspector general’s office, testifying that their medical administrative officer directed the manipulation.
The Veterans Administration Medical Center San Diego director said he was surprised by the investigation’s findings after a briefing on the results. In its investigation, the office of inspector general interviewed the medical center director, 16 current and former medical support assistants and several other VA employees.
In 2014, about 1,700 veterans were victims of a schedule fixing ploy in Phoenix; several other VA facilities across the nation were similarly affected. About 40 veterans died as a result of the Phoenix scheme.
Democratic U.S. Congressman Scott Peters, whose District 52 includes much of central San Diego County, released the following statement after the findings were released:
“I’m disappointed and angry,” he said, “to learn the very type of VA malfeasance that I’ve railed against, that I’ve fought to eradicate, was happening here in San Diego. I’m particularly saddened to hear that another horrible wait-time cover-up contributed to a suicide attempt – which shows how desperately this veteran needed the help that was delayed by someone’s desire to put a sunny face on a dark problem. “Congress was rightly shocked into action after learning of ‘schedule fixing,’ most notably in Phoenix but also in other regions. How anyone could think it was better to cover up that veterans in need weren’t getting the care they’d earned, rather than speak up, is appalling and an egregious abuse of trust. “I know SDVA has acted to address these problems, and I commend them for taking the findings and recommendations made by the inspector general seriously. I will, however, follow up… to find out how it is that any of the people found responsible still have a job at the VA.” – KUSI