A report released last week by the Office of Inspector General found that many of the problems that have plagued Veterans Affairs Administration hospitals throughout the nation were not present at the Dallas health system, clearing it of any allegations of inappropriate document destruction or secret waiting lists.
The OIG launched an investigation into the VA North Texas Health Care System nearly two years ago amid concerns raised by Congresswoman Eddie Bernice Johnson, D-Dallas, that its leaders were ordering employees to destroy scheduling records and stifling whistleblowers. In 2014, Director Jeff Milligan told D Healthcare Daily that two independent auditors had investigated the claims and found no evidence to substantiate them. The OIG’s report is the first time similar findings have become public.
Quoting the report: “The investigation did not substantiate that VA patient records were being destroyed, or that specific employees were intentionally manipulating patient wait times in order to meet the VA’s since-rescinded goal of having patients seen within 14 days of their desired date. Additionally, VAMC Dallas police had no record of an altercation concerning destruction of binders.”
The OIG did suggest implementing further training—a Fort Worth training specialist used an outdated presentation to train the new schedulers, which “may have led some schedulers to schedule patient appointments incorrectly, by using next available date or by using the appointment date as the patient’s desired date.” That was the only citation mentioned in the findings.
The report was released alongside more than a dozen others of other hospitals, some of which did substantiate problems. At the time of the investigations, the VA had a policy mandating that patients be seen within 14 days of their requested date. That pressure helped spur a culture of wait time manipulation, most notably in Phoenix where patients died while awaiting care. The investigation results show a wide variety of results. In Austin, schedulers told the OIG that they were ordered to “zero-out” wait times. El Paso was cleared of wrongdoing and ruled that any inconsistencies in the scheduling were not intentional.
Many of the reports confirmed long wait times, but, like El Paso, found no wrongdoing.
The Phoenix controversy spurred new policy mandates, including the striking of the 14-day rule. It was replaced with an aim of 30 days. In an interview, VA North Texas Assistant Director Eric Jacobsen said that about 98 percent of the veterans in Dallas were seen within a 30 day window from their desired date. The remaining 2 percent were scheduled at facilities outside the VA system. The hospital spent about $75 million providing care in the community in 2015.
“We still purchase a lot of care in the community, we’ve increased care in the community referrals by over 75 percent,” he said. “We do that for a lot of reasons, but primarily we want to get veterans timely access to care.”
The VA is also opening an outpatient center in Plano and has doubled capacity at its Tyler clinic. The system has spent another $100 million in new equipment and has added an additional 65 physicians and 225 nurses, Jacobsen said. The expansion efforts were planned prior to the nationwide controversy. VA North Texas is also now about 95 percent staffed.
Jacobsen said he was pleased with the findings.
“It’s concerning to hear allegations like that but we’re fortunate that we have partners with the VA OIG that come in and look at allegations like that to clear our name, so to speak,” he said.