Fort Collins Agent Orange Town Hall Meeting, December 5

VA Internal Survey Released Today Reveals Scandal Worse Than First Thought

From USA Today (reporters Gregg Zoroya and Meghan Hoye)

Internal VA documents show the depth of fraudulent scheduling, manipulation of data and in some

cases intimidation of staff to hide delays in medical care to veterans in the 6-million patient national system.

Auditors found at least one appointment scheduler at 109 VA medical centers who said wait times for veterans had been falsified, according to a USA TODAY analysis of internal VA survey data made public Tuesday. To keep evidence of delayed care out of the VA's official electronic tracking system, secret lists were maintained at 110 facilities, the analysis shows.

Workers at the Department of Veterans Affairs outpatient clinic in Wilmington, N.C., told auditors they "were fearful of retaliation" if they did not manipulate appointment data.

At the Edward HInes Jr. VA hospital in Hines, Ill., near Chicago, "staff felt they would be subject to disciplinary action" if appointment records were not changed, one report shows.

Managers instructed or "encouraged" schedulers to falsify appointment data at such VA medical facilities as those in Leeds, Mass.; Jacksonville, N.C.; Virginia Beach and Cleveland, according to the documents.

The audit by the VA's Veterans Health Administration was ordered earlier this year by then-VA Secretary Eric Shinseki. The results were provided to President Obama on May 30, the day Shinseki resigned.

The Senate on Tuesday confirmed Obama's nomination of former Procter & Gamble CEO Robert McDonald as Shinseki's successor. McDonald, 61, of Cincinnati, was approved on a 97-0 vote to replace Acting VA Secretary Sloan Gibson, who took over after Shinseki resigned.

Auditors interviewed more than 3,200 employees at more than 700 clinics and hospitals to gather their findings.

A broader investigation underway by the VA Inspector General and the Justice Department is scheduled to be completed next month. Gibson has testified in Congress that "several supervisors" are being investigated in connection with potential criminal charges.

The VA issued a statement late Tuesday saying it is seeking disciplinary action against six employees working at a hospital in Cheyenne, Wyo., and at an outpatient clinic in Fort Collins, Colo., for manipulating appointment data.

One of the six is a regional director; others include the director of the Cheyenne hospital and the chief of staff there. The VA said it is seeking to have two of the six fired. The agency said it found evidence that supervisors personally manipulated data, instructed subordinates to do so and withheld accurate information from higher officials.

Internal investigations found that clinic or hospital chiefs may have manipulated appointment data in order to look better on performance evaluations upon which their bonuses were based.

"As these new details make painfully obvious ...some VA executives are so driven in their quest for performance bonuses, promotions and power that they are willing to lie, cheat and put the health of the veterans they were hired to serve at risk," said Rep. Jeff Miller, R-Fla., chairman of the House Committee on Veterans' Affairs.

The internal audit made public Tuesday shows that schedulers who said they did not manipulate data worked at medical centers that reported the longest wait times, according to official VA data.

Fort Collins VA Clinic Experience

Fort Collins (CO) VA Outpatient Clinic

Today I related to the American Legion Crisis Action meeting here in Fort Collins my most recent
appointment experience. Previously, I'd been disappointed only with the long delay arranging an initial primary care appointment (I'm 100% service connected) after we moved to Colorado. I didn't think much about it and subsequent experiences, both with health care and appointments, were perfect; nice folks, superb care, attractive facility, short waiting time...everything great. Good reason to move to Fort Collins!

But a real problem hit in June. I'd been in the Palo Alto (CA) VA War Injury & Illness Study Center for several days of extensive tests, with more problems identified. I was discharged with instructions to seek an appointment with my primary care within two weeks. Doing so, I left a message with the Fort Collins VA Clinic recorder - no live person free to answer the phone, I guess. Gave the details of the request and waited.

Eight days later, not having heard anything, I called again, only to have to leave a message on their machine again. The next day I was called (June 26) and we discussed my request to see my primary care.

I related my recent VA hospitalization in California, mentioned I'd also just had shoulder surgery three days earlier, repeated my issues with heart disease, cancer, spinal cord injury, diabetes, 100% service connected and other stuff. The scheduler explained that I saw my primary care twice a year and so the next appointment should be in September.

Just in case he didn't understand or I'd not been clear, I repeated everything, especially the Palo

Alto VA orders to see my local VA primary care in two weeks (which would be late June into early July.) Just in case I didn't understand, the scheduler then repeated that my next appointment should be in September.

"Okay," I said. I certainly didn't want to "bump" anyone needing care more urgently, and the next available appointment offered me was again, September. I told the clerk that because I felt I needed care more promptly than that, I'd seek it through non-VA means. I repeated I didn't want to bump anybody from ahead of me at the VA. We finished our call.

Three months. A long time for a vet already rated "catastrophically disabled" and 100% service connected by the VA to wait for an appointment to see his primary care provider. An especially long time given the VA Palo Alto discharge instructions to see the primary care provider within a couple weeks. An especially long time given the twice-repeated summary of the reasons behind the appointment request, and also because the primary care had referred me to Palo Alto's War Injury and Illness Study Center and follow-up with him was necessary.

Admittedly, I was passive, unassertive, letting the appointment clerk make his decisions without my pushing, but carefully waiting to see what the outcome would be. How quickly would I be seen or how long would my appointment be put off? I was already alarmed because my first call to their appointments recorder had been eight days earlier. Eight days passed and I heard nothing until I called a second time, and then a day passed before we connected. Nine days, with the first request left on their answering machine apparently lost and never acted on.

Today, relating my situation to the team of VA specialists helping the American Legion conduct their Veterans Crisis meeting, the VA gentleman from Cheyenne typed my info into his laptop (on line with the VA) and offered me three choices for appointments next week. No big deal – when did I want to come in? What time of day was most convenient?

Wonderful! But I don't understand why I was tossed a 90-day delay with my earlier request, but today, before relating my situation in detail but simply saying I wanted to have an appointment,  was offered numerous possibilities anytime next week.

I do know the ninety day delay was bad enough that it could have left some vet dead. No non-vet would ever tolerate such a delay elsewhere in the medical community. Discussing it with VA managers today was unburdening but nobody took notes, nobody said it was something that wouldn't happen again, nobody said it was something to fix, everybody was polite.

I was told to mention it to my primary care when I see him next week. That's all.

I see no reason situations like this won't repeat, especially with confused, depressed, stoic or passive veterans who quietly accept whatever's offered in terms of appointments, scope of care, ancillary services, things which can be quite important to life and limb! The patient's role is to ask for help from the VA and explain the need.

In its ninety-day response, VA proved dangerously inadequate in my most recent experience. At least in this instance and in this place, VA's process depended on a patient to push past an appointment clerk for proper telephone triage appropriate for the urgency to be acted upon. VA cannot count on patients to push the system, and doesn't take well to them doing it, either.

Superb VA Care Today in Cheyenne

Today, as with nearly every other day I've entered VA hospitals since 1992, I have had excellent

care from physicians, dentists and allied health professionals. I met with a variety of administrative functions on different issues, and was treated respectfully and with sincere concern for my issues.

There's plenty to say about the VA. Not all of it is bad, and neither is it all good.

Today, in Cheyenne, this veteran found it excellent and I'm grateful to be their patient. Just as I have been since my first visit. 100% satisfied and grateful.

WTC

President Obama Issues Statement on Veterans' Health and Benefits:

The White House, Washington D.C. –

For their service and sacrifice, warm words of thanks from a grateful nation are more than warranted, but they aren't nearly enough. We also owe our veterans the care they were promised and the benefits that they have earned. We have a sacred trust with those who wear the uniform of the United States of America. It's a commitment that begins at enlistment, and it must never end. But we know that for too long, we've fallen short of meeting that commitment. Too many wounded warriors go without the care that they need. Too many veterans don't receive the support that they've earned. Too many who once wore our nation's uniform now sleep in our nation's streets.                                                                                                                                        PRESIDENT BARACK OBAMA, MARCH 19, 2009

Dear Mr. President,

Why does the Department of Veterans Affairs obstruct Agent Orange exposure claims by inventing a VA-unique definition of exposure, by which no veteran of any war, of any service, in any circumstance could ever qualify?  Clearly, the redefinition by Veterans Health Administration was to prevent claims from succeeding.

Why does VA redefine exposure in an unscientific manner, challenged by other federal agencies and health experts, when that definition isn't used even elsewhere in the VA itself? Why permit VA to use a unscientific definition of such a fundamental term, when no juried publication would ever touch such work? Why did VA's own National Center for Ethics in Healthcare avoid dealing with the criminal and ethical questions such redefinition raises?

Why does the Veterans Health Administration game patient wait times by keeping veterans out of their hospitals? Are you and Secretary Shinseki aware that VA games their own system by blocking qualified veterans' disability claims for years, and constructing a three to five year additional delay through the VA Board of Veterans Appeals? What happened to your promises of 2009, and the VA's obligation to be "veteran-friendly" and non-adversarial? Would you ask America to wait five years for us to put on our uniforms to report for duty? 

Clearly, your Administration has waited five years to consider our situation, and the wait continues. Perhaps a solution will arrive, but it will likely interest our survivors more than us. Do you expect us to draw comfort from the words of VA's Chief Consultant of Post Deployment Health who, when asked if claims could be considered before veterans died, answered, "We all die."

How can you permit the Veterans Benefits Administration to order Agent Orange exposure claims denied with the excuse that that Agent Orange is harmless? Has your Office of General Counsel read the Yale Law C-123 finding? Has VA any intention of obeying the law without a court order to do so?

Why does VA refer complex medical and scientific issues to the National Academy of Sciences Institute of Medicine and pay only for arguments and testimony against the veterans' claims, but spend or offer nothing in support of the veterans' perspective? The VA obviously develops a scheme to prevent disability claims and is dedicated to funding that view in IOM meetings, and leaves it to the veterans' resources to argue their case. VA outspending the veterans works for the VA, but not the veterans. This isn't science. And it dishonors all involved.

God bless the United States. 

Respectfully,

FOR THE C-123 VETERANS ASSOCIATION:

Wes Carter, Chair
Fort Collins, Colorado

VA Difficulties Mount: More Medical Centers Report Deceptions in Patient Care

Reporter: Greg Zoroya
The VA Cancer Spreads Nationwide:

Note:  This Blogmaster is a patient at Cheyenne VA and has since the first found their care excellent in every way. What concerns me most is the date of the original discovery of the Cheyenne problems and the several months delay in action by the Secretary. As shown yesterday, the individual's conduct, if as alleged, was serious enough to get him out of the hospital immediately...that is what should have been done in 2013 with associated investigation to insure the problem went no further. No action was taken...and the problem went so very much further!

Secretary Eric Shinseki on Friday placed on administrative leave a nurse in a Wyoming medical center after seeing an e-mail containing explicit directions on how to "game" the system and hide long delays in treating veterans for medical and mental health issues.

Shinseki earlier this week promised "swift and appropriate" action if wait-time records were falsified as a widening scandal over treatment delays brought congressional action.

The nurse, David Newman, works at the Cheyenne VA Medical Center, which was investigated late last year by the Department of Veterans Affairs Office of Medical Inspector in connection with allegedly falsified wait-time records at a VA clinic in Fort Collins, Colo.

An e-mail dated June 19, 2013, that appears to be drafted by Newman, a Cheyenne Medical Center telehealth coordinator, explained how to alter records to show that veterans saw doctors within a 14-day goal established by the VA.

C-123 Veterans Announce Agent Orange Town Hall Meetings

Partnering with the Vietnam Veterans of America. representatives of the C-123 Veterans Association

are now available to present the popular Agent Orange Town Hall meetings throughout the United States. Addressing the full range of Agent Orange concerns and benefits, our Association presents an additional element of exposure topics, including a bit more scientific focus on routes of exposure.


The meetings, free to the public and with light refreshments provided, will also include the latest VA's War Injuries and Illness Study Center, where their poly-exposure expertise has been so important to veterans, especially those with multiple war exposures.

The Agent Orange Town Hall meetings have been organized for nearly two years under the auspices of the Vietnam Veterans of America, the objective being to acquaint veterans and the public with the lingering issues of this Vietnam-war era military herbicide which still causes such grief to America's veterans, as well as allies from South Korea, Australia and the former Republic of South Vietnam.

VVA's web site posts announcements of these talks, presented by many affiliated veterans' organizations in each of the fifty states, and which have proven so popular. The VVA site also posts meeting materials for organizers, and links to vital materials from the Department of Veterans Affairs and the VVA itself, especially the informative VVA Guide to Agent Orange Self Help.

Town Hall Meetings are pointedly non-political...information about Agent Orange and its impact on America's veterans and
their families is the only agenda item. And that information is changing all the time, with new perspectives from the VA, the medical community and veterans themselves.

The C-123 Veterans Association anticipates its next Town Hall Meeting to be July 19 in Cheyenne, Wyoming, in partnership with the city's three Veterans of Foreign Wars posts, and with input from the Wyoming Veterans Commission and the Cheyenne Veterans Affairs Medical Center (note: participation by other agencies such as the VA does not imply their sponsorship or content approval, but only their wish to help inform their veterans and answer questions on any topic of interest.)

Other organizations wishing to conduct Town Hall Meetings under the sponsorship of the Vietnam Veterans of America are asked to coordinate with the VVA through Mokie Porter in the national office. 1-800-882-1316 ext. 146 (mporter@vva.org) For information about the C-123 Veterans Association Town Hall Meeting, please contact W. Carter at wes@c123cancer.org

Fort Collins VA Clinic Also Falsified Vet's Records – USA Today

(Blogmaster's Note: I am a patient at the Fort Collins VA Clinic, transferring my care there from Portland last year. I have absolutely no complaints regarding delays, quality of care nor qualify of compassion. As a retired hospital administrator, Air Force retiree and chair of a veterans organization, I'm quite critical of shortfalls. In months here in Fort Collins, have seen none of the issues reported below. This USA Today report stands on its own. I have met Phoenix reporter Dennis Wagner and trust his journalism completely. Thus, today's story leaves me confused and disappointed. This story was also published in the AF Times, Army Times and Navy Times. In a related story, Congressman Mike Coffman R-CO) has demanded an immediate Inspector General investigation into the Fort Collins deceptions.)

Gregg Zoroya, USA TODAY: VA investigation of one of its outpatient clinics in Colorado reveals how ingrained delays in medical care may be for an agency struggling to rapidly treat nearly 9 million veterans a year amid allegations that dozens have died because of delays.

Clerks at the Department of Veterans Affairs clinic in Fort Collins were instructed last year how to falsify appointment records so it appeared the small staff of doctors was seeing patients within the agency's goal of 14 days, according to the investigation.

A copy of the findings by the VA's Office of Medical Inspector was provided to USA TODAY.

Many of the 6,300 veterans treated at the outpatient clinic waited months to be seen. If the clerical staff allowed records to reflect that veterans waited longer than 14 days, they were punished by being placed on a "bad boy list," the report shows.

"Employees reported that scheduling was 'fixed,' " the findings say.

After enduring a year of criticism that the VA took too long to deliver earned compensation to disabled veterans, a new wave of attacks is building over slow medical care.

Department officials revealed last month that 23 deaths of veterans were linked to delayed cancer screenings dating back four years. More recently, a retired doctor, Sam Foote, alleged that 40 other veterans died because of treatment delays at a VA hospital in Phoenix. VA officials say there's no evidence so far to support those claims, but the hospital administrator was placed on leave pending an investigation by the agency's inspector general .

Sally Eliano, an Arizona woman, complained that her 71-year-old father-in-law, a Navy veteran, died after delays at the VA hospital in Phoenix in the treatment of bladder cancer.

The Medical Inspector's probe in the Fort Collins case could not confirm that patients had been harmed "due to the lack of specific cases evaluation."

A key allegation by the whistle-blowing retired doctor in Phoenix is that staff members manipulated records to hide delays. The same practice was found by the VA Office of Medical Inspector at the clinic in Fort Collins.

While investigators found that VA policies were violated, local medical leaders concluded that the violations were less intentional than the result of confusion and no disciplinary action was taken, says a VA statement released Saturday. Retraining and weekly audits were implemented, the statement says.

The VA in 2013 revamped some of its tracking procedures to better gauge wait times for nearly 100 million medical appointments each year at 151 hospitals and 820 clinics.

The agency found that only 41% of new VA medical patients were seen within 14 days last year, down from 90% reported in 2012 under an old, now-abandoned measurement method.

The VA found it wasn't doing so well with first-time mental health appointments, either. The agency reported in 2011 that 95% of new mental health patients were seen within 14 days, but the new tracking system found the rate in 2013 was 66%.

Mike Davies, the VA director of access, says the revised system for tracking new-patient appointments has finally provided accurate measurements on wait times. He says the department's commitment to track every single appointment is far more stringent than industry standards.

"I don't think there's any other health-care system that does this," Davies says.

He says the VA now can better determine what additional resources it needs to make sure veterans are treated more rapidly.

As a result of what happened at Fort Collins — the Medical Inspector's investigation was completed in December — the VA has done four site inspections to see whether timely treatment standards are being met, Davies says.

They found "other instances of misunderstanding" wait-time tracking requirements, "but we have not found any widespread patterns of misunderstanding," Davies says.

But federal investigators say that despite these efforts, the VA health-care system remains plagued by delays in treatment and opportunities to cover them up.

"Data has to be reliable to be useful," says Debra Draper, who directs an investigative staff for the Government Accountability Office. "So if you've people going in there and doing all kinds of things (to change the data), it really is not reliable."

Draper has led investigations into VA health care problems for years and says the agency has been struggling to accurately assess wait times for decades.

Draper says a key problem is a lack of oversight by top VA officials. The Fort Collins problems, for example, came to light only after a whistle-blower stepped forward.

Numbers of outpatient visits are spiraling, in large part because of an aging veteran population and young combat survivors suffering multiple medical and psychological issues.

At Fort Collins and the nearbyVA Medical Center in Cheyenne, Wyo. — which oversees seven clinics, including the one in Fort Collins — officials complained they didn't have enough doctors or supporting staff.

The result is jobs are left undone, VA investigators found. Staff required to follow up with veterans to schedule necessary appointments often didn't have time.

Investigators found that nearly half the clinic's 6,000 veteran patients did not have necessary medical appointments scheduled.

"Many of the (clerks) reported significant stress when trying to explain to veterans why they cannot make earlier appointments for them," the report says. "By entering (false data), the wait time for that patient appears to be zero days. ... The wait times were actually much longer."

Contributing: Dennis Wagner of The Arizona Republic

Amazing Day at Cheyenne VA Regional Center

Friday I visited the Cheyenne, Wyoming VA Regional Center. The hospital was simply superb...an eighteen-bed facility, and smiles everywhere with terrific care as I went to Pharmacy, Occupational Medicine, the Lab, Benefits, Dental, the Exchange, the coffee shop, Travel. The terrific care even extended to the VA police who came to the rescue with a jump start once we discovered our headlights had been left on (oops!) for ten hours! 

Less satisfactory was the time with Benefits. I was there to learn more about the VA's position vis-a-vis Agent Orange exposure and claims denials that our C-123 veterans experience.

The benefits lady tried to be as helpful as possible, and was as patient with my inquiries as could be expected. No complaints at all there! What proved disappointing, however, were the amazing answers I got to my inquiries about why the claims are denied.

She pulled up quotes from denied claims, and read to me from them, "Regulations do not permit..." and the rest of the boilerplate language provided by Veterans Health Administration for Compensation and Pension to insert in the denials.

I asked, "But what are those regulations?" She pointed to the parts she'd just read back to me and said, "Right there. It says there are regulations, so there are." She continued her explanation, "Except for Vietnam, and some troops along the DMZ in Korea, and some veterans who served in Thailand, no other Agent Orange claims are permitted." She was kind, but seemed to be challenging, "What part of this denial can't you read? It says right there in the denial 'regulations do not permit,' so, somewhere and somehow, they do not permit. And that's that."


She couldn't find any regulation (because there isn't any) and she wouldn't even look at the Federal Register p. 21355 dated 8 May 2001. Concluding our visit, she repeated, "VA regulations clearly forbid C-123 Agent Orange claims and raters have to go by those regulations, not the Federal Register, or letters or doctors' opinions."


Do you get it? The claim denial SAID there were regulations, so that was her proof. Not the fact that VA has no such regulations, but that VHA said to tell the veteran "regulations do not permit." That sounds like adult talk for a kid's "Just because."