INVESTIGATIONS

Inspectors rip Phoenix VA boss' previous hospital

Report says Amdur called for an inspection after learning of scheduling manipulation

Dennis Wagner
The Republic | azcentral.com
Deborah Amdur, former boss of a VA facility in Vermont, was named director of the Phoenix VA Health Care System in November 2015.

The new boss at Phoenix's beleaguered VA Medical Center was in charge of a similar facility in Vermont where investigators last year uncovered rampant manipulation of patient appointments and falsification of wait times, according to a VA Inspector General report this week.

Deborah Amdur, director of the Phoenix VA Health Care System since last fall, previously held an identical position at a hospital in White River Junction, Vt., where an inspection conducted under her watch uncovered dishonest scheduling at the outset of a national crisis over failed care for veterans.

A VA Office of Inspector General report this week documents numerous tactics in Vermont that resemble practices exposed by whistleblowers and media in Phoenix, which set off the scandal two years ago.

The report contains a summary of interviews with Amdur, though it does not identify her by name. That summary says Vermont VA staffers told Amdur of improper appointment methods in May 2014, weeks after The Arizona Republic reported that patients in the Phoenix hospital had died awaiting care. The White River Junction report says Amdur became "really alarmed" and immediately ordered a fact-finding mission by her chief of quality management. She also requested an Inspector General probe and removed two scheduling managers from their supervisory positions.

Nevertheless, the damaging Vermont report raises questions as to whether Amdur was aware of scheduling practices in the hospital and, if not, why not.

Timeline: The road to VA wait-time scandal

"While I was director at the White River Junction VA, we were working on reorganizing our scheduling processes to centralize all appointment scheduling activities when internal questions from staff were raised about our scheduling practices," Amdur said in a written statement Thursday. "I immediately asked the VA’s Inspector General to come in and investigate. As information from the investigation was revealed, we made changes immediately."

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"I’ve always believed that taking immediate action is the right thing to do, and that helped us immensely when I was at WRJ," she said. "I carry that same belief with me at the Phoenix VA and encourage staff to come forward to leadership when they find things they think might not be correct. I’ve rewarded staff publicly for identifying improvement opportunities and work to ensure that all staff are aware and trained when a process is improved."

White River Junction facility

Amdur became director at the Carl T. Hayden VA Medical Center in Phoenix in November 2015, months after the Washington Times reported that she had "misled" a member of Congress about contaminated medication given to a veteran at the Vermont hospital.

Amdur previously had become director of the White River Junction facility in January 2013. According to the OIG report, employees already were routinely "gaming" patient scheduling records and data. For example, staffers were trained to enter false dates in the system, and faced discipline for making "errors" if they recorded accurate dates.

Manipulation of appointments, mismanagement, retaliation and other failures at the Phoenix VA Health Care System led to the replacement of hospital administrators, nationwide performance audits, criminal probes, the resignation of former VA Secretary Eric Shinseki and passage of a $16.3 billion VA reform bill.

PREVIOUSLY: Deaths at Phoenix VA hospital may be tied to delayed care

The Vermont hospital inspection report released this week says veterans in White River Junction struggled with delays of eight months or more in some medical areas, and reducing patient waits became a such a priority that employee evaluations hinged in part on success.

'Gaming' patient schedules

One technique described in the report involved simply entering the veteran's appointment date as the "desired date" even if that patient asked or needed to be seen much sooner. As a result, records falsely indicated veterans had no delays in care. More than half the schedulers in White River Junction recorded zero wait times for appointments over a two-year period.

Another strategy involved not officially logging a patient's appointment until it could be filled within 14 days. Those processes mirrored improper scheduling methods uncovered in Phoenix and dozens of other locations. Inspectors also found that the hospital's mental-health providers did not schedule any appointments with patients, as required by policy. Instead, all veterans needing treatment were steered into a walk-in clinic "so that the 14-day metric for new patients in mental health was not a concern."

The OIG report says if Vermont VA employees failed to follow the manipulation guidelines, other staffers would enter the computer system later to alter the dates and data.

It is unclear to what extent the falsification and delays affected veterans. While the report found that "no specific patient harm had been identified," employees reported multiple deaths and other adverse consequences. One medical chief told inspectors the "pressure of having good access numbers" forced providers to cut appointments so short they could not perform full body exams. As a result, the chief said, she found cancer in "at least 10 patients whose cancer had not been found during earlier VA visits."

VA watchdog sits on wait-time investigation reports for months