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Wait Times Doctored At WRJ VA

Medical Center Employees Told of Systemic Concerns

  • White River Junction VA director Deborah Amdur speaks during the annual Veterans' Day ceremony at Colburn Park in Lebanon, N.H., on Nov. 11, 2015. (Valley News - Sarah Priestap)

    Copyright © Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.



Valley News Staff Writer
Friday, April 08, 2016

White River Junction — Employees at the White River Junction VA Medical Center raised concerns to federal investigators looking into the manipulation of scheduling data that some providers weren’t getting enough time with patients or that some veterans may have died while awaiting an appointment, according to a report released this week.

Veterans Affair officials on Thursday said the scheduling problems had been addressed and that the investigation had been requested by the director at the time, Deborah Amdur.

Investigators with the Department of Veterans Affairs Office of Inspector General found that medical service assistants before 2014 often entered patients’ “desired date” for an appointment as the date of their scheduled appointment to give the false impression of a “zero-day wait time,” according to the report released on Monday.

The assistants and schedulers said supervisors at the VA hospital instructed them to make the changes to scheduling data, but those supervisors told the Office of Inspector General that their employees misunderstood instructions.

The report also concluded that, “No specific patient harm had been identified as resulting from the wait time data manipulation allegations.”

However, one chief of a medical specialty service at the hospital reported that the pressure to have good access numbers forced the clinic to schedule patients for 15-20 minute appointments. She told investigators that such short appointment times didn’t permit full body exams, and some cancer cases were missed as a result.

A former medical service assistant also said she was aware of at least six patients who died awaiting care at the hospital between 2010 and 2012, but could not recall the names of those patients or the conditions surrounding the deaths.

Investigators visited the facility early in the summer of 2014 to look into allegations over scheduling practices, the Valley News reported at the time. Amdur, who was then the hospital's director, said she asked for the investigation after hearing from concerned employees, a point the VA reiterated on Thursday.

“We asked the inspector general to conduct and do this audit,” said VA spokesman Joe Anglin. “The discovery was actually made in-house.”

The 2014 visit followed a nationwide audit of VA hospitals that labeled 112 of 731 facilities as needing “further review.” Since the White River Junction hospital wasn’t identified as one of those facilities, there was no evidence of employees being instructed to fudge numbers, Amdur said at the time.

She did acknowledge scheduling problems, however, which were decentralized.

“We have identified that we need to have more consistency in scheduling practices (among our) clinics,” she told the Valley News in 2014.

Employees were telling investigators the same thing, the report said.

One unidentified medical assistant told investigators that she took required training about six years prior to their visit. But she was told afterward by supervisors that she was performing the job wrong.

If she entered a patient’s desired date correctly into the hospital’s electronic system, supervisors told her to go back and change it so the wait time was zero, she told investigators. And if she made the mistake three times, they told her it would go on her record and effect her performance review, she said.

“Although she didn’t know of any examples of patient harm, she thought it hurts the patients because the data manipulation did not give a clear picture of what VAMC WRJ needed: more doctors,” the investigators wrote of the medical assistant, who is not named in the report.

But once the scandal at the Phoenix, VA became national news in 2014, she said, the supervisors changed their tune.

“She stated that her current supervisor came up to talk with her and other schedulers on May 22, 2014, in an attempt to convince them that this was all a misunderstanding, as in the schedulers hasn’t heard what they had heard,” the report said.

An investigation of the Phoenix hospital found 28 cases of “clinically significant delays in care” and 17 other instances of care deficiencies. The hospital was also found to be using “unofficial wait lists” and “turmoil” in the urology department that resulted in poor care to some 3,500 patients.

Amdur was tapped to lead the beleaguered Arizona hospital in 2015, and was praised for exceeding VA goals of offering appointments in under 30 days about 95 percent of the time in Vermont when she left.

Other medical assistants were questioning VA medical practices as early as 2012, according to the report. One told investigators that she “never felt it was the right thing to do” to manipulate data, but was too afraid of retaliation to do anything about it. She told investigators that correctly entering desired dates was brought up as an error during a performance review in 2013 and was told that the chief of primary care “wanted these numbers to be at zero.”

Another assistant told investigators “I feel like we are trying to cover up patient wait times.” And one registered nurse said that when she correctly entered a correct date, an assistant was instructed to “undo and redo” the appointment scheduling.

Supervisors denied training assistants to set desired and scheduled appointment dates as the same, but they did cite times when assistants would set “today” as a patient’s desired date. That would be an error, they said, because when a veteran really needs to be seen on the same day the hospital offers them an urgent care slot or asks them to visit the emergency room.

“It’s not the goal to have zero days,” Anglin said, adding that such a goal would only be possible with unlimited resources at the hospital’s disposal.

“The training was inconsistent and some supervisors had different ideas of what that training was supposed to be,” he said.

Since the investigation kicked off, he said, the hospital made improvements to its scheduling practices. Training is now standardized and the VA has centralized its supervisors to better monitor scheduling, he said. The hospital also added additional staff to help handle the scheduling workload.

It’s not only wrong to manipulate scheduling data, Anglin said, but it also impedes the hospital administration in planning. Scheduling information helps administrators decide where to move resources and without correct information, departments could find themselves undermanned, he said.

The Inspector General also found similar scheduling discrepancies and instructions given to employees at the VA’s Manchester, N.H., medical center.

U.S. Sen. Bernie Sanders, D-Vt., then the chairman of the Senate Veterans Affairs Committee, helped write legislation to reform wait times after the Arizona scandal. Asked for comment on the Inspector General’s report citing problems at Vermont’s VA hospital, Sanders’ office issued a joint statement with Sen. Patrick Leahy and Rep. Peter Welch, also Democrats.

“Employees who are not properly trained, and especially those who intentionally manipulate scheduling data, do a disservice to our veterans,” the delegation statement said.

“We appreciate the responsiveness of former Director Amdur when these allegations first surfaced by requesting this investigation and making changes to processes and culture while it was ongoing.”

Some veterans on Thursday said the scheduling issues didn’t affect their access to health care. Tunbridge resident Randy Chapman said he’s been using the White River Junction facility for the past two decades and is usually seen a day after calling.

“They’ve really gone out of their way as far I’m concerned to treatment” said Chapman, an Army veteran who served in the Vietnam War. “I have nothing but good things to say about them.”

Tim Camerato can be reached at tcamerato@vnews.com or 603-727-3223.