November 29, 2021

VA Scandal: Testing and Care Rationed “Because of Dollars and Cents”

It’s pouring rain in the Veterans Affairs (VA) healthcare scandal, with a fifth location now accused of gaming the system to conceal unacceptable wait times. Allegations and whistleblowers have emerged in Arizona, Colorado, and at two Texas facilities. Now add Wyoming to the list. CBS News reports:

A Veterans Affairs employee at the VA Medical Center in Cheyenne, Wyoming, has been placed on administrative leave after CBS News obtained an email showing an employee directing his staff on how to game the appointments system to make it appear as though veterans were being seen within the VA’s 14-day directive. The email, written by Telehealth Coordinator David Newman, a registered nurse, describes how patients at the Cheyenne VA Medical Center are always listed getting appointments within a 14-day window, no matter when the appointment was first requested, and no matter how long the patient actually waited. The memo admitted, “Yes, this is gaming the system a bit…” because “when we exceed the 14 day measure, the front office gets very upset, which doesn’t help us.” The employee further instructs staff on how to “get off the bad boys list” by “cancelling the visit (by clinic) and then rescheduling it with a desired date within that 14 day window.”

VA Secretary Eric Shinseki has resisted calls for his resignation as this scandal has gained steam, ordering a nationwide audit to review these practices. But will its findings do any good? CBS reports that the Cheyenne incident was reported by an informant last year, yet it took media scrutiny six months later for anything to happen:

CBS News has learned that the VA’s Office of the Medical Inspector had already investigated and substantiated claims of improper scheduling practices at the Cheyenne VAMC, sending a report to the Office of Special Counsel on December 23, 2013. It is unclear why it took five months, and an inquiry by CBS News, for the VA to take action against an employee there and order an Inspector General’s investigation.

As I’ve written previously, accountability is in short supply these days. Meanwhile, in Texas, another tentacle of the VA’s appalling health system has come to light. When conservatives warn about poor quality of care and treatment rationing under government-run and -operated systems, this is the sort of thing we’re talking about (content warning — via the Examiner):

Patients in a Southeast Texas Department of Veterans Affairs medical system faced denials or long delays in getting routine colonoscopies and other medical tests because of bureaucratic cost-cutting, a former top administrator told the Washington Examiner in an exclusive interview. Dr. Richard Krugman, former associate chief of staff at the Veterans Affairs health care system based in Harlingen, Texas, said his boss implemented a policy in 2010 that colonoscopies would only be approved if the patient tested positive in three successive screenings for bloody stools. “By the time that you do the colonoscopies on these patients, you went from a stage 1 to a stage 4 [colorectal cancer], which is basically inoperable,” said Krugman. “That was done because of dollars and cents. For the VA, they have to be bleeding out of their rectum before they would authorize a colonoscopy. That was the standard of care,” he said. Since the Harlingen VA health center couldn’t do colonoscopies at that time, all referrals had to go to local private providers…As many as 15,000 patients who should have gotten the colonoscopies either did not get them or were examined only after long and needless delays, Krugman said. That estimate is based on the demographics and total number of veterans treated in the Texas Valley network, about 40,000. Many likely died, Krugman said. But, since there is no VA hospital in the area, their final days would have been spent in a private hospital or at home, where they would not appear in VA statistics, he said.

No further comment is necessary. This is an abomination. Where else are these ghoulish guidelines in place? It took one former doctor to step forward and expose the wait list scheme in Phoenix, which has led to a steady stream of similar revelations across the country. Are other facilities denying veterans basic screenings and care for budgetary reasons? I’ll leave you with this observation from Iraq veteran and wounded warrior JR Salzman, who remembers when the media and Democrats used the Walter Reed scandal to bludgeon President Bush:

I’m still blown away by the media’s double standard on the VA scandal vs. Walter Reed. Bush was blamed for everything bad at Walter Reed.

— J.R. Salzman (@jrsalzman) May 12, 2014

You may think that I’m flogging this story. Hell yes, I’m flogging this story. While the political lessons about single-payer are no doubt important to underscore, more than anything, it’s a national disgrace the way our sick veterans are being treated by the bureaucracy charged with their care. The lack of action in Cheyenne discovered by CBS suggests that only the searing, sustained light of scrutiny is likely to affect change.

UPDATERound six, in North Carolina.