New Department of Veterans Affairs Secretary Robert McDonald has hardly had time to get comfortable in his office before being put on the defensive by fresh revelations of longstanding agency efforts to hide or downplay patient deaths and treatment delays.
The VA inspector general issued a little-noticed report last week slamming the mass cancellation of more than 1,500 patient appointments in one day at a Georgia VA medical center to meet agency-imposed goals on reducing reported backlogs. More than 600 patients whose medical appointments were canceled did not receive the care that was ordered.
The Washington Examiner has reported since February that VA launched a nationwide purge of backlogged medical orders — called "consults" by the agency — that cleared more than 1.5 million appointments nationwide with no guarantee patients received care that had been ordered.
On Friday, the Atlanta Journal-Constitution reported that as many as 47,786 veterans died while their applications for medical benefits were stuck in an electronic backlog.
Almost 850,000 veterans who sought medical benefits online, as VA encouraged them to do, were left in bureaucratic limbo by July 2012 because the agency was not processing their applications, the newspaper reported.
And in a letter released Monday, McDonald apologized for misleading statements made in an agency report and congressional testimony in April downplaying its admission that at least 23 patients died of gastrointestinal cancers after unacceptable delays in getting colonoscopies or other screening tests.
McDonald inherited an agency in turmoil when he was confirmed by the Senate in July. His predecessor, Eric Shinseki, resigned as VA secretary in May amid growing scandals over falsified appointment lists created to hide long delays veterans face when seeking health care.
Administrators at VA health facilities nationwide were using phony appointment logs to make it appear that agency deadlines were being met, a key factor in their performance reviews and the awarding of merit bonuses.
For 10 years, investigations by the IG and the Government Accountability Office had identified manipulation of patient waiting times to hide backlogs.
Since the latest scandal on falsified wait times erupted in April, the IG has confirmed the “systemic” falsification of patient records and is now investigating similar practices in at least 92 facilities nationwide.
The new report on the mass closing of backlogged medical orders involves the VA medical center in Dublin, Ga.
On April 25, 2014, hospital administrators improperly “batch closed” 1,546 consult orders to meet an agency-imposed May 1 deadline to clear the backlog, the IG found.
Of those, 648 were for patients who were waiting for a medical appointment at the time the order was closed.
The Examiner reported in February that VA mass-purged medical orders in Los Angeles and Dallas to make it appear years-long backlogs were being cleared.
In a follow-up story in May, the Examiner confirmed more than 1.5 million consults were cleared without any guarantee the patients received the medical treatment that had been ordered.
VA began a nationwide effort in May 2013 to close consult orders that were more than 90 days old.
While mass closures of consults are permitted by VA rules, they are supposed to be individually reviewed to ensure the patient got the needed care.
A GAO investigation cited by the Examiner in May found poor documentation and a lack of independent verification made it impossible to determine whether patients received the ordered treatments.
The Atlanta investigation published Friday cited internal VA documents and whistleblower statements involving the failure of an initiative launched in 2010 encouraging veterans to use an online portal to apply for medical benefits.
But instead of speeding the approval process, the applications received no action, which delayed access to care, according to the AJC.
By July 2012, there were 848,699 unprocessed applications in the system, according to an internal VA analysis cited by the newspaper.
Whistleblowers warned of the growing problem. But instead of fixing it, top VA administrators chose to ignore it because their own performance reviews were tied to the success of the system, according to the AJC.
VA officials “manipulated data to achieve results linked to these goals instead of focusing on fixing the problems,” the AJC reported.
In a response posted on the VA’s public blog site, Stephanie Mardon, acting chief business officer with the Veterans Health Administration, called the AJC report “misleading.”
VA records show 216,736 online applications for medical care were pending as of May 15, 2014, not the 848,699 cited by the AJC, according to Mardon.
She attributed the difference largely to requests for medical records or services other than applications for medical care.
Of those seeking care, about half of the applications are missing information that is required for processing, according to Mardon.
As to the 47,786 veterans who died with pending applications, about 75 percent of them were not applying for health benefits, the VA blog stated.
In April, VA released a report admitting that 23 patients died of gastrointestinal cancers after unacceptable delays in receiving a colonoscopy or similar procedure.
The deaths were identified in a review of 250 million medical orders since 1999, according to the report and subsequent testimony from VA officials.
Miller challenged the numbers after learning in July that all 23 patients died since August 2010. A 24th death has also been confirmed.
In his letter to Miller, McDonald said the results of two separate studies regarding unresolved consults and potential harm to patients were conflated, which resulted in “a stunning lack of clarity in the oversight and communication of this work.”