Phoenix VA problems? More than 2 years later, struggles continue, reports say

The independent U.S. Office of Special Counsel says Phoenix's VA hospital "continues to struggle" with delayed care for patients nearly three years after it became the focal point of a national health-care crisis for veterans.

In a letter Tuesday to President Barack Obama and Congress, Special Counsel Carolyn Lerner noted that numerous allegations by another whistleblower at the Carl T. Hayden VA Medical Center had been largely verified by internal reviews.

Lerner cited new findings by the Department of Veterans Affairs' Office of Medical Inspector, as well as an October report by the agencies' Office of Inspector General, that show Phoenix employees continued canceling appointments inappropriately long after the veterans health-care controversy erupted in 2014.

The latest concerns were raised by Kuauhtemoc Rodriguez, chief of specialty care clinics for the hospital at Indian School Road and Seventh Street. While some of his complaints were not substantiated, inspectors late last year corroborated numerous ongoing problems.

In most cases, the inspectors concluded that patients were not harmed as a result of delayed care and improperly canceled appointments. However, the OIG said one veteran, who died awaiting cardiology exams, could have lived with timely testing and treatment.

Key findings in reports

The inspection reports indicate that, more than two years after the VA crisis began, widespread confusion and disagreement persisted among Phoenix employees over appointment-scheduling protocols. Among the key disclosures:

• 215 veterans died awaiting specialty care during the review period, and a fifth of their appointments involved untimely delays. In 76 cases after veterans passed away, their appointment records were changed to "canceled by patient." Inspectors contend the computer entries were not deliberate attempts to conceal veteran deaths while awaiting care.
• During a single week in October 2015, 3,900 appointments were clerically canceled, resulting in at least a dozen patients who "may have experienced harm that could have been prevented." 
• Psychotherapy patients waited an average 75 days for care.
• On an average day, 1,100 patents who sought specialist appointments had been waiting more than a month.

"In case after case since 2014, Phoenix VA whistleblowers have exposed and helped correct serious problems," Lerner said in a news release. "I thank Kuauhtemoc Rodriguez for his courage, and urge the VA to act quickly to address these ongoing concerns."

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Rodriguez had alleged that 35,000 Arizona veterans were waiting for specialist appointments and treatment. He also asserted that hospital administrators directed staff to cancel appointments without review by clinical staff, and that 188 patients died awaiting care.

The medical inspectors' report concluded those claims were "unfounded." However, that finding appears to be contradicted by the OIG report.

For example, Office of Medical Inspector  employees did not substantiate that 35,000 Phoenix patients were waiting for specialist consults, yet the OIG review says, “We determined that, as of August 12, 2015, more than 22,000 individual patients had 34,769 open consults at PVAHCS.”

However, the VA said in a prepared statement that "because the consults were open does not mean that veterans were unable to get care; in most cases an appointment was already scheduled, and the care may have already been provided even though the consult remains 'open' in the system."

Similarly, OMI investigators did not substantiate that 118 patients died while awaiting care. Yet OIG inspectors noted there were "215 individual patients who had open consult requests at the time of their deaths, or had consults discontinued after the date of their deaths.” The 215 included 118 identified by Rodriguez. Finally, the OMI report says inspectors could not substantiate that Phoenix VA discontinued 1,000 vascular appointments without clinical reviews. The next sentence notes that 974 vascular consults were discontinued.

The VA in its prepared statement disputed that there were conflicts between reports. A spokesman for Lerner said the OMI and OIG reports covered somewhat different time periods, which could account for some divergent findings.

VA officials did not comment on discrepancies but stressed that new policies and tools have been employed to overcome delays in specialist appointments. They said the number of consults pending for more than three months has dropped by 64 percent since late 2013 — to just under 100,000 as of August — and only 30 of those were medically urgent.

"VA is undergoing a massive transformation we call MyVA," said Deputy Secretary Sloan Gibson. "We are working hard to provide veterans high quality care where, when and how they need it."

Reactions to whistleblower

Rodriguez said the OMI report was "a means to deflect and water down" as part of a "continuing VA environment that snubs its nose at accountability." Nevertheless, he said, overall findings "show I've been telling the truth the whole time."

After the veterans health-care controversy erupted in Phoenix during 2014, whistleblowers and Congress complained that medical inspectors conducted biased investigations that were designed to exonerate VA officials and denigrate whistleblowers. Those criticisms led to a purported restructuring of the Office of Medical Inspector.

Rodriguez said he is now the target of retaliation, adding, "It's the playbook. … No matter what you disclose in Phoenix VA, they're going to discredit and defame you."

Sen. Chuck Grassley, R-Iowa, chairman of the Senate Judiciary Committee, lauded Rodriguez for coming forward. "Sometimes whistleblowers expose matters of life and death, other times they expose harm against the taxpayers, and sometimes they expose all of the above," Grassley said in a news release. "Kuauhtemoc Rodriguez of the Phoenix VA deserves praise and gratitude for coming forward about problems that cover all of the above."