Metastasizing

05.18.14

Exclusive: VA Scandal Hits New Hospital

Veterans with serious heart conditions, gangrene, and even brain tumors waited months for care at the Albuquerque VA hospital, a whistleblowing doctor tells The Daily Beast.

Add Albuquerque, New Mexico’s to the growing list of VA hospitals accused of keeping secret waiting lists to hide delays for veterans seeking medical care. And it may already be too late to get to the truth and find out what harm, if any, was done to veterans there—VA officials are already destroying records to cover their tracks, a whistleblower inside the hospital tells The Daily Beast.

Last month, word broke that the Department of Veterans Affairs hospital in Phoenix kept a secret waiting list that allegedly led to dozens of preventable deaths. The VA’s inspector general was brought in to investigate the charges and hasn’t yet found any deaths in Phoenix linked to wait times, but his investigation is ongoing. Since then five other facilities have come under fire, leading to calls for VA Secretary Eric Shinseki to step down. And now there’s Albuquerque’s. The evidence for this new secret list may be hard to track down, however.

“The ‘secret wait list’ for patient appointments is being either moved or was destroyed after what happened in Phoenix,” according to a doctor who works at the Albuquerque VA hospital and spoke exclusively with The Daily Beast. “Right now,” the doctor said, “there is an eight-month waiting list for patients to get ultrasounds of their hearts. Some patients have died before they got their studies. It is unknown why they died, some for cardiac reasons, some for other reasons.”

There’s no proof yet that veterans died while waiting for treatment, like what allegedly happened in Phoenix. But the doctor says it’s quite possible that some veterans would still be alive if they hadn’t been pushed through a record-keeping trap door that buried their requests for medical care.

On March 19, 2014, for example, a patient with a deteriorating heart condition requested to see a doctor. The patient was finally seen only days ago, on May 16, when they were admitted to the hospital for decompensated heart failure. “A near miss” as the VA doctor familiar with the case described it. “He could have died before being seen.”

The Albuquerque VA did not respond to requests for comment but Ozzie Garza, director of the VA Regional Office of Public Affairs, provided this statement to The Daily Beast: “We are not familiar with the allegations but will call immediately for an external review as we take all allegations seriously.” 

“When everyone found out the IG was doing the audit, the word I heard was ‘Make sure nothing is left out in the open,’” the VA doctor said. “And that ranged from make sure there’s no food out to make sure there’s no information out in the open.” The doctor is not involved in the scheduling process and was unsure of how exactly VA officials would purge the secret wait lists but has heard it discussed among colleagues.

As VA officials reacted nervously to news of an impending audit, the doctor described hearing officials involved in scheduling patient appointments say, “The database had been removed or renamed.” To cover their tracks the doctor said they decided, “Instead of calling it a wait it would be called something like a precedence list.”

On March 19, a patient with a deteriorating heart condition requested to see a doctor. The patient was finally seen on May 16, when they were admitted to the hospital for decompensated heart failure.

When another of the doctor’s colleagues, a physician in a managerial position at the Albuquerque VA, saw the initial story about secret wait lists break he heard him say, “I always knew that Phoenix was better than us at playing the numbers game.”

Secret waiting lists may not be the only problems at the Albuquerque VA, in fact they may only be an accounting trick to mask the deeper issues.

Veterans with heart problems are waiting an average of four months to see a cardiologist at the Albuquerque VA, according to the doctor there who has access to patient records.

There are eight physicians in the cardiology department. But at any given time, only three are working in the clinic, where they see fewer than two patients per day, so on average there are only 36 veterans seen per week. That means the entire eight-person department sees as many patients in a week as a single private practice cardiologist sees in two days, according to the doctor.

For perspective, 60% of cardiologists reported seeing between 50 and 124 patients per week, according to a 2013 survey of medical professionals’ compensation conducted by Medscape. On the low end, the average single private practice cardiologist who participated in the study saw more patients in a week than the Albuquerque VA’s entire eight-person cardiology department.

In some cases, a long wait to see a doctor is just another routine inconvenience of the sort people expect in a large bureaucracy, but other times it can be a matter of life and death.

One veteran’s heart troubles were serious enough that a physician requested they be seen in the next available slot on January 8, 2014. Over three months later, the patient was seen in late April.

A patient whose initial blood test on December 8, 2013 suggested he might have a brain tumor waited until April 28 2014 before he was seen again. Another veteran, diagnosed with gangrene, was referred for surgery so doctors could try to salvage his limb or amputate it if necessary—it’s 36 days after he was initially supposed to see the surgeons and he’s still waiting now.

A second source inside the Albuquerque VA, a medical technician, said the facility provided high quality care. But the technician acknowledged it could take a long time before veterans get in the door to receive it.

The list of patients waiting for tests grew so long in one department that the technician became disheartened and stopped checking it around Christmas of last year. “I honestly stopped doing that because it just overwhelmed me personally,” the technician said.

The VA’s Office of Inspector General began investigating the Albuquerque medical center last year, according The Albuquerque Journal, after employees there reported that appointments were being manipulated to conceal patients’ actual wait times. That would mean that the inspector general, and the VA itself, knew about allegations of corruption there long before the Phoenix story broke in April.

Rep. Jeff Miller, chairman of the House Committee on Veterans’ Affairs, has been beating the drum about wait times and advocating reform since before the latest crisis  put the VA back in the spotlight. “VA’s delays in care problem is real and has already been linked to the recent deaths of at least 23 veterans,” Miller told The Daily Beast.

Yet it wasn’t until the latest VA scandal broke nationally—months after the inspector general first investigated claims that are strikingly similar to what was later reported in Phoenix—that Albuquerque’s came back into focus. The status of the initial investigation still hasn’t been made public.

Last week, New Mexico Senator Tom Udall requested a new investigation into his state’s VA hospitals. Udall called for the audit after his office received dozens of complaints from veterans about long wait times at the VA, and reports that Albuquerque’s schedulers were forging appointment records.

New Mexico is now the seventh state where allegations have emerged about VA medical facilities cooking the books. As new incidents continue to display the same features uncovered in past cases, the details are revealing a common language of bureaucratic corruption communicated across state lines between different VA facilities.

Yet, even as evidence builds of a systemic problem within the VA, the department itself has been slow to acknowledge it and even slower to act. In his testimony before the Senate last week, VA Secretary Shinseki referred to the six cases that had been revealed up to that point as “isolated incidents.”

Veterans, for their part, are divided over the proper response; many believe that the actual care provided by the VA is good and the problem is primarily about access. But as each new week brings another case that seems to show the same pattern of duplicity inside the VA, some are growing impatient.

“Our members are outraged and are demanding true accountability and systemic reform for what appears to be increasingly widespread problems,” said Derek Bennett, chief of staff for Iraq and Afghanistan Veterans of America (IAVA). “We cannot fix the problems until all the facts are on the table,” Bennett said but added that, “scapegoating and politicization of this issue will not reform the Department of Veterans Affairs nor best serve our veterans.”

To encourage getting the facts on the table, the IAVA has started its own initiative to gather stories from veterans and VA employees. “We have partnered with the Project on Government Oversight on vaoversight.org to provide a safe place for whistleblowers to come forward for this very reason,” Bennett said.

Despite the volume of incidents that have already been publicly revealed and the inspector general’s admission last week that he had more evidence pointing to new mismanagement, the VA has not announced any broad reforms or disciplinary actions. In the only major leadership shakeup since the VA became embroiled in the secret wait list charges, Secretary Shinseki announced the resignation last week of Dr. Robert Petzel, his undersecretary for health. But as many were quick to point out, and in what the IAVA called a “cynicial twist,” Petzel was already scheduled to retire this year after a 40-year career.

For Rep. Miller, the time is overdue for change within the VA. “We simply can’t afford to wait for the results of another IG investigation or VA’s internal review when veterans may be at risk,” Miller said. Immediate actions can be taken now, Miller added, even before formal investigations draw their conclusions. “Sec. Shinseki needs to take emergency steps,” he said, “to ensure veterans who may have fallen victim to these schemes get the medical treatment they need.”

On Sunday, the White House, which has remained relatively quiet on the VA’s latest troubles, weighed in with an interview by President Obama’s chief of staff, Denis McDonough.

“The president is madder than hell, and I’ve got the scars to prove it, given the briefings that I’ve given the president,” McDonough told CBS’ Face the Nation. “Madder than hell” was the first echo of Secretary Shinseki, amplifying a phrase he used in his testimony last week to describe his own feelings. The second echo of Shinseki came when McDonough said the president had sent staff to look into the VA investigation and “find out if this is a series of isolated cases or whether this is a systemic issue.”

The VA’s own investigation is ongoing and will continue to attract attention as more revelations, like the claims about the Albuquerque VA, keep coming out. It remains to be seen how leaders who are “madder than hell” will react to the evidence they find and what, if anything, they will order done about the situation. 

If you are a VA employee and have firsthand information about waiting lists, or other problems with patient care at the VA, we want to hear about it and can keep the details of your account confidential. Email your story to submissions@thedailybeast.com.