In the News
Canceled VA appts pushed vet to suicide attempt
March 30, 2016
By Jeanette Steele
An investigation released Thursday by the U.S. Department of Veterans Affairs says the San Diego VA hospital triggered one veteran’s suicide attempt in 2014 by repeatedly canceling his mental health appointments.
The investigation also found that at least two San Diego VA employees instructed appointment clerks to “zero out” wait times in the scheduling database, presenting an unrealistically positive picture of how long patients were waiting for mental health care.
The tactics may have affected hundreds of San Diego veterans seeking mental health treatment.
The VA’s inspector general found that employees in the San Diego mental health clinic scheduled more than 700 appointments with a 98 to 100 percent rate of zero-day wait times -- described as virtually impossible without data manipulation.
The findings are among more than 70 investigations the VA has released nationally over the past few weeks.
The investigations of VA facilities in several states followed a sweeping scandal in 2014 that started over allegations of falsified wait times at the Phoenix VA hospital.
The suicidal San Diego veteran, not named in the report, had three or four appointments canceled in a row by the VA leading up to his attempt to kill himself in 2014. The attempt happened at a VA clinic in San Diego.
The investigation found that 13 to 14 percent of his appointments were canceled with less than a day’s notice in 2013 and, in the following fiscal year, that number rose to between 24 and 27 percent for various clinics.
A spokeswoman for the San Diego VA health care system said seven employees have been held accountable for the scheduling issues, but she declined to say exactly who.
In total, three staff members resigned and two retired, while two others faced “accountability actions,” spokeswoman Cindy Butler said Thursday. One of the people who faced “accountability action” was moved to a job with no scheduling responsibility and the other stayed in the position.
In a statement released Thursday, San Diego VA officials said the inspector general only examined data from early 2014 -- before leaders here made an effort to address the issue.
“VASDHS has aggressively trained and retrained all of our front-line personnel and supervisors to ensure compliance with scheduling procedures,” the statement said.
“Regular scheduling audits are conducted and staff are able to clearly articulate scheduling procedures. Where there were allegations and findings were validated, VASDHS took appropriate administrative actions.”
In a follow-on statement addressing canceled appointments, spokeswoman Butler said, “It is never acceptable to prolong care because of cancellation of appointments and we have implemented changes to prevent that.”
Under the 2014 Veterans Choice Act, VA patients facing long wait times can seek care in the private sector, at taxpayer expense. More than 6,000 San Diego veterans have received care through the Choice program since October.
This is the first official sign of trouble at the San Diego VA, which has been touted as a model by local veteran advocates and even VA Secretary Bob McDonald.
The “One VA” committee concept, an idea started in San Diego, brings leaders from the veterans community together with local VA officials on a regular basis to air issues. McDonald has called for the idea to be duplicated nationally.
U.S. Rep. Scott Peters, D-San Diego, issued a statement late Thursday saying that he will follow up with McDonald to discuss why anyone involved in the data manipulation still gets a VA salary.
“I’m particularly saddened to hear that another horrible wait time cover up contributed to a suicide attempt – which shows how desperately this veteran needed the help that was delayed by someone’s desire to put a sunny face on a dark problem,” Peters said.
“Congress was rightly shocked into action after learning of ‘schedule fixing,’ most notably in Phoenix but also in other regions. How anyone could think it was better to cover up that veterans in need weren’t getting the care they’d earned, rather than speak up, is appalling and an egregious abuse of trust.”
One member of San Diego’s One VA committee said he is surprised and troubled by the findings, but it doesn’t shake his faith in the local institution.
“Some people didn’t do what should they should have. It doesn’t seem like a lot of people,” said Jack Harkins, chairman of the United Veterans Council of San Diego County.
“This shows me there are means for corrective action. It isn’t utterly broken. Instead, it’s responsive. And employees were willing to come forward to speak out,” said Harkins, a retired Marine Corps officer from the Vietnam era.
Ron Stark, co-chair of the San Diego One VA committee, said the group got a briefing last month that the inspector general’s report was coming and a few of the findings.
“It’s always bad news when a veteran takes suicide as an action to get attention they need or in response to troubles,” Stark said. “When appointments gets canceled over and over -- those are the things we have to work on with the VA.”
The inspector general’s investigation was prompted by complaints from two San Diego VA employees in May 2014.
They alleged that a national team sent earlier that month to audit the San Diego VA -- in light of the national scandal -- was presented with employees hand-picked and coached to give a glowing picture.
Separately, in June 2014, a VA employee alerted the inspector general’s office about the veteran’s suicide attempt following canceled appointments.
However, investigators noted that San Diego VA employees first raised concern about manipulated wait times back in 2013, and discrepancies were found in a follow-on inquiry.
But, apparently, that early alarm bell went unheard.
The director of the San Diego VA health care system at the time expressed surprise when faced with the inspector general’s conclusions, according to the report released Thursday.
“He said he was very surprised at our findings as he had spoken to (several employees) regarding the initial allegations and was told there was no altering of desired dates happening in the mental health department,” the report said.
Jeff Gering was the San Diego director from May 2012 until late December, when he left for a job at Family Health Centers of San Diego.
The investigation found that an unnamed San Diego VA medical administrative officer put pressure on “medical support assistants” -- the people who schedule appointments -- to “zero out” the number of days that a veteran was waiting for an appointment.
Also, a mental health program analyst played a role.
In emails sent in April 2014, the analyst advised schedulers to call patients with wait times more than 14 days past their desired appointment dates and offer them earlier visits.
If the veteran declined the earlier appointment, the scheduler was told to change the veteran’s desired date to the original appointment date -- making it appear there was no wait time.
“The employee stated that, at the time, she thought that she was correct, but had now come to understand it is not the proper way to capture desired dates,” the report said.
The report notes that the VA directive on wait time policy is from 2010.
In an odd twist, the VA on Thursday also released results of an investigation that did not substantiate an allegation of pressure to “fudge” wait times at the San Diego VA.
That inquiry, also prompted by a VA scheduler’s complaint, provides a look at the nuances of VA scheduling and calculation of wait times. Schedulers are supposed to ask, “When do you want an appointment?” However, some simply state when the next open appointment is, and ask if the veteran wants it. Also, some doctors schedule their own follow-up appointments.
All of those factors affect wait time data.
VA officials point out that in San Diego -- and nationally -- the federal agency has struggled to handle the influx of new patients as troops returned from the Iraq and Afghanistan conflicts.
San Diego has seen an overall average patient growth rate of 5 percent over the past 10 years and a 10 percent growth rate in mental health cases, officials here said.
Back in May 2014, at the beginning for the wait-time scandal, auditors faulted VA national leadership for setting the 14-day goal in 2011, calling it “not attainable.”