Top managers at the Department of Veterans Affairs have been held “accountable” for preventable patient deaths, falsified records and long backlogs in care.

What that means is not clear.

Even the fate of Sharon Helman, director of the Phoenix veterans' hospital that is ground zero in the latest scandal involving secret waiting lists, is uncertain.

Acting VA Secretary Sloan Gibson said Wednesday he is "confident" Helman remains on the agency's payroll, despite an announcement last month that suggested she was being fired.

"Removal from federal service, I am told, is the appropriate technical term, and that seems pretty clear," Gibson said when asked directly whether Helman was fired. "This is not a VA euphemism. It is the practice."

Getting rid of any federal employee takes time because of civil service laws and procedures, Gibson said.

"What we have done on those personnel actions is everything the law allows us to do in order to remove a person from federal service," he said.

"Employees of the federal government in the process of a personnel action continue on the payroll of the federal government during the process of that action. So, (it's) not a VA issue. It's what the law is," he said.

Gibson also said he does not know whether the VA has recovered Helman's $9,345 performance bonus for the 2013 fiscal year.

Helman and two of her top deputies are the only VA officials to be removed from their jobs in the scandal over secret waiting lists to hide backlogs in care that erupted in June, Gibson said.

Former Veterans Affairs Secretary Eric Shinseki said last month that he had “initiated the process for the removal of the senior leaders of the Phoenix VA medical center.”

He did not say who they were or whether they were fired.

A week earlier, Shinseki “exercised his authority to rescind” Helman's bonus, saying it had been paid “due to administrative error.”

VA has been caught playing similar word games regarding accountability of agency managers in the past.

In congressional hearings, Shinseki and his deputies repeatedly used phrases like “dismissed,” “removed” or “no longer in their positions” to describe what happened to hospital administrators and regional directors in charge of facilities where patients needlessly died.

But further investigation revealed many of those people have been allowed to resign or retire, keeping any federal pensions to which they are entitled.

Others have simply been transferred to other positions, sometimes in the same facility where the deaths occurred. Still others received only written reprimands or no punishment.

No one has been publicly fired. Shinseki resigned May 30.

Rep. Jeff Miller, R-Fla., is fed up with the euphemisms and what he considers the lack of any meaningful accountability at VA.

Miller, the chairman of the House Veterans Affairs Committee, is the sponsor of a House-passed bill that would give the veterans' secretary more power to fire or demote poor-performing members of the Senior Executive Service, the upper rung of management.

“The steady and tragic stream of preventable deaths, patient safety incidents and revelations of widespread corruption at the Department of Veterans Affairs that have essentially gone unpunished calls into question whether VA leaders even know the meaning of the word ‘accountability,’ ” Miller told the Washington Examiner.

“When pressed on the lack of consequences for VA employees who preside over negligence and mismanagement that harms veterans, department officials have pointed to non-disciplinary actions, such as employee transfers, resignations and retirements, or bureaucratic slaps on the wrist, such as temporary written warnings, in a disingenuous attempt to create the illusion of accountability,” Miller said.

“Such semantic sleights of hand are insulting to the families struck by VA preventable deaths and patient safety incidents, veterans seeking care at the department as well as the taxpayers who fund VA’s operations,” he said.

Veterans were dying on Shinseki's watch long before allegations surfaced in April of secret waiting lists used in Phoenix to hide the long wait times patients face.

Meeting agency deadlines for delivering timely care is a critical component in determining performance bonuses to high-level administrators.

Shinseki said in March that six senior executives had been “dismissed” in the prior two years for unacceptable performance. Though he provided no details, a memo from VA to Miller's committee illustrates the source of his frustration.

Three senior executives who were still in their first-year probationary period were “removed” for performance issues, according to the memo.

One of them remained a top manager with the agency in a General Schedule 15 position, the highest level below the federal Senior Executive Service.

The memo does not describe the circumstances of the removal or say what happened to the other two.

Three non-probationary senior executives were also removed. One remained as a GS-14 and another was temporarily reinstated by the Merit Systems Protection Board, but “this person is no longer employed by VA,” the memo states.

It does not identify anyone by name or say what happened to the third non-probationary employee.

Eight senior executives resigned or retired while facing potential discipline.

More telling is what happened in individual cities.

In Atlanta, at least three patient deaths from suicide or drug overdose were linked in an inspector general’s investigation to widespread mismanagement.

VA officials later said seven employees were punished and two retired.

But at least five of those employees received only written reprimands and kept their jobs at VA. Atlanta VA director James Clark retired, keeping more than $31,000 in bonuses.

In Columbia, S.C., six patients died of colorectal cancers linked to long waits for colonoscopies and other screening tests.

No senior managers were disciplined, though three resigned under the threat of discipline, Robert Petzel, former under secretary of health at VA, said during a congressional hearing earlier this year.

Robert Petzel, former under secretary of health at VA, was announced to be resigning the day after a heated Senate Veterans Affairs Committee hearing in May. Petzel had announced his plans to retire last year. (AP image)

Petzel himself became VA's ultimate symbol for holding people accountable when Shinseki announced in May that Petzel resigned the day after a heated Senate Veterans Affairs Committee hearing.

Shinseki’s statement failed to mention that Petzel had announced his plans to retire last year and that his replacement had already been named by the president.

In Pittsburgh, at least five patient deaths in 2011 and 2012 were linked by the inspector general to mismanagement and poor maintenance.

Hospital director Terry Gerigk Wolf received a performance bonus of nearly $13,000 in 2011 and a perfect performance evaluation in 2012.

Michael Moreland, the regional medical director whose district included Pittsburgh, received a $63,000 Presidential Distinguished Rank Award bonus in 2013, a few days after the IG report was released.

Moreland retired last year. Wolf was placed on paid administrative leave this month, three years after the initial outbreak, pending “completion of administrative actions,” the VA announced.

The chief of staff in Augusta, Ga., where three patients deaths were linked to delayed care, resigned under threat of discipline in 2013.

But hematologist Dr. Luke Stapleton remained on the VA hospital's payroll in a different job, according to the Augusta Chronicle.

The strongest language about any VA manager being held accountable for failure was Shinseki’s assertion about Helman, and the agency’s statement that her bonus would be revoked.

Whether that can be done is questionable.

During a September 2013 House committee hearing, Petzel was asked whether he had taken action to revoke Moreland’s bonus in light of the inspector general’s finding of mismanagement in Pittsburgh.

Petzel said it could not be done.

“The bonuses were awarded for the performance as we knew it when it was occurring then and, as I understand it, we cannot retract or take back those bonuses,” Petzel said.

In announcing plans to revoke Helman’s bonus, VA officials said it was issued because of an administrative error.

However, Helman's boss, regional director Susan Bowers, told KPHO-TV in Phoenix the bonus was awarded because of Helman's outstanding performance.

“She received the bonus for a highly successful rating,” Bowers said.

Carol Bonosaro, president of the Senior Executives Association, which represents SES employees at the VA and other federal agencies, agreed with Petzel’s assessment that a bonus cannot be rescinded.

Debra Roth, the association’s lawyer, told the Examiner she is not familiar with a similar case in which an agency has sought to rescind a bonus, so has not researched the issue fully.

Bonosaro said the effort to take back Helman’s bonus is a dangerous precedent. She also is concerned the pressure to fire top VA managers could lead to the wrong people being targeted.

“When someone has been determined to be accountable for what happened, of course we don’t disagree with accountability,” Bonosaro said.

“It’s just that an awful lot right now is based on allegations, and that’s not the way the civil service works,” she said.