The chairman of the House Veterans' Affairs Committee is accusing Washington Monthly magazine of publishing "blatantly false" statements that seem aimed at dismissing the healthcare scandal at the Department of Veterans Affairs, in a story that was published with the guidance of someone with direct links to the VA.
The VA may have benefited from a favorable editorial hand at Washington Monthly, according to emails obtained by the Washington Examiner's media desk. Those emails show senior editor Phillip Longman, who was appointed to the VA's Commission of Care in 2015 by Senate Minority Leader Harry Reid, D-Nev., acted as a consultant for the more than 8,000-word expose, titled "The VA Isn't Broken, Yet."
Longman's relationship with the VA isn't disclosed until the 76th paragraph of a story that contains 81.
House VA Committee Chairman Jeff Miller, R-Fla., characterized the article as "propaganda," and accused the publication of trying to "minimize" the VA's wait-time scandal. The congressman also said the magazine is guilty of publishing "completely false statements about the nature and severity" of the agency's woes.
The report alleged that the VA isn't "broken," and suggested the scandal is actually a nefarious plot hatched by billionaire brothers Charles and David Koch. The article also stated that demagogues had blown the issue of long wait-times out of proportion.
"In most VA facilities, wait times for established patients to see a primary care doc or a specialist were in the range of two to four days … For the VA system as a whole, 96 percent of patients received appointments within thirty days," Washington Monthly's Alicia Mundy wrote.
A report prepared in 2014 by the VA's Office of Inspector General found that there was indeed widespread dysfunction.
"Inappropriate scheduling practices are a nationwide systemic problem. We identified multiple types of scheduling practices in use that did not comply with [Veterans Health Administration's] scheduling policy. These practices became systemic because VHA did not hold senior headquarters and facility leadership responsible and accountable for implementing action plans that addressed compliance with scheduling procedures," the federal watchdog said in a report dated August 26, 2014.
"In May 2013, the then-deputy under secretary for health for operations management waived the FY 2013 annual requirement for facility directors to certify compliance with the VHA scheduling directive, further reducing accountability over wait time data integrity and compliance with appropriate scheduling practices," the report added. "Additionally, the breakdown of the ethics system within VHA contributed significantly to the questioning of the reliability of VHA's reported wait time data. VHA's audit, directed by the former VA secretary in May 2014 following numerous allegations, also found that inappropriate scheduling practices were a systemic problem nationwide."
Washington Monthly editor Paul Glastris, who edited the story, maintained that the story's point was not to dispute that wait-times have been a problem for the federal agency.
"Our story acknowledges and confirms the scheduling problems the IG details and links directly to the IG report. But we also compare the VA's performance to that of the rest of the non-VA health care system," he told the Examiner.
He then pointed to a section of the article that reads:
Across facilities, veterans waited an average of just six and half days from their preferred date of care to see a primary care doctor. As a point of comparison, consider that a private survey taken at the time by the consulting firm Merritt Hawkins showed that in fifteen major medical markets across the country, non-VA patients seeking a first-time appointment with a family practice doctor had to wait an average of 19.5 days. Access is much more limited in most rural areas. Though precise comparisons are not possible due to data limitations (unlike the VA, most private health care providers aren't required to make their performance numbers public), a recent study by the RAND Corporation has found that, given certain reasonable assumptions, "wait times at the VA for new patient primary and specialty care are shorter than wait times reported in focused studies of the private sector."
"Wait times aren't a fundamental VA problem — they're a fundamental health care problem. While the IG report and reporting in the Arizona Republic found real problems in Phoenix, the figures we cite from a comprehensive VA audit and link to in the piece … point to a system that is not crippled and often outperforms the private sector," the Washington Monthly editor said.
On the issue of Longman's involvement in the story's publication, Glastris said it's much ado about nothing. And while the story refers to Longman as a "senior editor," Glastris characterized the VA Commission on Care member's role at the magazine as a "part-time staffer."
"Phil was not the editor of the story. I was. Phil was consulted at various times on the story and contributed ideas and information to the author … and me, consistent with his role as a part-time staffer at the magazine," he told the Examiner.
The article also challenged Miller's claim that his team found 40 veterans had died while waiting for treatment at a VA hospital in Phoenix.
"Miller claimed as many as 40 veterans could have died while waiting for care," Mundy reported, referring to remarks that the congressman made on April 9, 2014. "This latter charge ... was later shown to be unsubstantiated. An exhaustive independent review of patient records by the VA inspector general uncovered that six, not forty, veterans had died experiencing 'clinically significant delays' while on waiting lists to see a VA doctor, and in each of these six cases, the IG concluded that 'we are unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans.'"
"In other words, the reality behind the headlines had little, if any, more significance than the fact that people die every day while waiting for an appointment to see their tax accountant or lawyer," Mundy added.
Miller maintained, however, that Mundy's characterization of this issue was "simply not true," and cited the IG as proof.
The 2014 IG report said, "From our review of [the Phoenix VA Health Care System's] electronic records, we were able to identify 40 patients who died while on the [Electronic Wait List] during the period April 2013 through April 2014."
"As a result of using inappropriate scheduling practices, reported wait times were unreliable, and we could not obtain reasonable assurance that all veterans seeking care received the care they needed," it added.
Investigators said they could not "conclusively assert" that any of the deaths were caused by long wait times. Still, the idea that long wait times contributed to the death of several veterans is not far-fetched, according to Dr. John D. Daigh, the assistant inspector general for healthcare inspections.
"Would you be willing to say that wait lists contributed to deaths of veterans?" Rep. David Jolly, R-Fla., asked in a congressional hearing.
"No problem with that," Daigh answered. "The issue is cause."
USA Today also reported in 2014 that, "Delays in endoscopy screenings for potential gastrointestinal cancer in 76 veterans treated at Department of Veterans Affairs hospitals are linked to 23 deaths."
But Glastris said the article's reporting on the 40 veterans at the Phoenix VA is more nuanced that Miller's characterization.
"The IG report itself debunks that claim. After an exhaustive investigation the IG found 40 patients who died while on the list, but only 28 instances of clinically significant delays. Of those 28, only six individuals died, and none could be shown to have died because of the delays," the editor said.
The IG report explained: "During our review of EHRs, we considered the responsibilities and delivery of medical services by primary care providers (PCPs) versus specialty care providers (such as urologists, endocrinologists, and cardiologists). Our analysis found that the majority of the veteran patients we reviewed were on official or unofficial wait lists and experienced delays accessing primary care—in some cases, pressing clinical issues required specialty care, which some patients were already receiving through VA or non-VA providers."
"For example, a patient may have been seeing a VA cardiologist, but he was on the wait list to see a PCP at the time of his death. While the case reviews in this report document poor quality of care, we are unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans," it added.
And to the issue of Daigh's testimony, Glastis maintained that the story is accurate.
"[W]hatever one thinks of Miller, the IG was not off base, and nor was our story," he said, adding, "Daigh said that wait times could have contributed to deaths, but that 'The issue is cause.'"
The Washington Monthly report also stated conclusively that there was "no fundamental problem at the VA with wait times, in Phoenix or anywhere else."
The IG found in an investigation of 73 VA facilities 51 separate cases of scheduling problems.
For Miller, claims that the VA scandal had been overblown are ludicrous.
"[T]here was a fundamental problem at VA with wait times and delayed care, and that is the reason the Commission on Care exists," he said, referring to the group that Longman was appointed to last year. "I find it ridiculous that I have to waste time pointing these sorts of details out."
Washington Monthly's claims regarding the Phoenix VA were repeated almost verbatim by Mother Jones' Kevin Drum.
"[T]here was no evidence that [the Phoenix VA] problem was widespread; there was no evidence that it caused any deaths; and there was no evidence that care had been compromised," the Drum wrote.
Miller, who addressed his concerns this week to the Commission on Care, told group's chairwoman, "You can't solve problems by denying they exist. Further attempts to minimize the VA scandal are quite simply a slap in the face to the many veterans who suffered from it."
"It's unfortunate that some Commission on Care members aren't familiar with these simple concepts. Please do not allow their ignorance and or bias to influence the important work you are doing."
This story has been updated with comment from Washington Monthly. This story also claimed originally that the Washington Monthly article did not disclose Longman's ties to the VA. This is incorrect.