Declarations by the Department of Veterans Affairs inspector general that delays in healthcare at the agency’s Phoenix hospital did not “conclusively” cause patient deaths is an unrealistic standard that is virtually impossible to meet, according to medical experts.
“Delay of care may not have been the proximate cause of death,” Dr. Gregory Schmunk, past head of the National Association of Medical Examiners, told the Arizona Republic in a story published Wednesday. “But the real question is: Did delay of treatment cause the patient to die earlier than necessary?”
Dr. Gregory G. Davis, current head of the association and chief medical examiner in Jefferson County, Ala., also questioned the standard used in the IG report exonerating the VA for the deaths of at least 20 patients who faced unreasonable delays or substandard care.
“I can’t imagine a circumstance where someone would word it that way,” he said.
Richard Griffin, acting VA inspector general, is under fire for allowing department officials to add a pivotal sentence in the published report on falsification of appointment lists at the Phoenix hospital that essentially absolves the agency in any patient deaths.
“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,” the report said.
Agency officials and much of the news media seized on that sentence. VA released a statement quoting that finding before the final IG report was publicly issued Aug. 26.
That sentence was not in the draft report that the IG sent to agency executives for comment prior to completion of the final version.
The Washington Examiner reported the discrepancy Monday. Griffin confirmed it during a Senate hearing Tuesday.
Congress established the inspectors general program in 1978 to act as independent watchdogs in federal agencies.
The final IG report verified allegations that patient waiting lists were being falsified to hide long delays in care, charges that were first reported to the IG by an agency whistleblower in October 2013.
It also described the practice of maintaining phony waiting lists as “systemic” throughout VA.
The IG’s investigation has spread to 93 VA health facilities nationwide since the allegations were publicly disclosed in April.
The language used by Griffin’s investigators that they could not “conclusively” prove delays in care cause deaths is inconsistent with pathology practices because no mater how long a patient waits for treatment, the underlying cause of death will be the medical condition, the doctors told the Republic.
The newspaper also said Griffin did not identify any previous IG investigative report which listed untimely care as a cause of death.
Griffin also would not discuss why his findings did not address how many patients who died might have lived longer if they had received proper and timely treatment.
The high standard used by the IG to determine whether delays caused deaths was questioned by key members of Congress even before the final report was issued last month.
Rep. Mike Coffman, R-Colo., chairman of the House Veterans’ Affairs subcommittee on oversight and investigation, asked Griffin what standard the IG would be using to assess harm to patients in an Aug. 19 letter.
As the Examiner reported last week, Coffman urged Griffin not to use the “unrealistic” standard requiring 100 percent certainty in weighing whether patient deaths were linked to delays caused by fraudulent scheduling practices at the Phoenix hospital.
The better standard would be that the delays “more likely than not” adversely affected patient care, the standard VA uses when conducting internal reviews, Coffman said.
Coffman also asked whether VA administrators pressured the IG to use the higher standard.
Griffin has repeatedly denied VA executives had undue influence over the final version of the report since the Examiner story last week.
“No one in VA dictated that sentence go in that report, period,” Griffin told the Senate Committee Tuesday.
After the initial Examiner report was published, Griffin issued a statement responding to what he called “media coverage of baseless allegations on independence and integrity over the IG’s report.”
The statement linked to the Examiner story and declared, “there is no basis in fact to support these allegations.”
Griffin’s office has refused to answer detailed questions about its Phoenix investigation submitted by the Examiner.
Last week, the Examiner asked the IG office to describe why it used language saying it could not “conclusively” prove delays caused deaths, and whether that standard was used in prior investigations.
The IG also was asked to explain what its investigators did between October 2013, when it received the initial whistleblower complaint, and April 2014, when the allegations were revealed publicly at a House Veterans Affairs Committee meeting.
The IG refused to answer those inquiries, instead releasing only a generic response to the Examiner.
“In all instances, including the statement referenced in your email below, the OIG, and not VA, dictated the final findings and recommendations,” said Griffin spokesman Catherine Gromek.
