Digging deeper
In response to questions from this newspaper, the Dayton VA in July 2015 confirmed it had discovered an “informal list” of patients needing follow-up care in the pulmonary clinic. Today’s story, using records obtained through a Freedom of Information Act request, follows up on that earlier reporting.
High-ranking medical officials at the Dayton VA Medical Center knew of a backlog of patient appointments in the pulmonary clinic, but didn’t initially take “definitive action” to address the issue, according to a VA internal investigation obtained by this newspaper.
A VA Administrative Investigation Board concluded in September that no one had formal leadership over the pulmonary section and cited “a lack of clear communication,” in the report, a redacted version of which was released to the newspaper through a Freedom of Information Act request.
Dayton VA officials have cited a “scheduling irregularity” in the pulmonary clinic that caused a backlog of more than 1,000 patient appointments at the clinic. The Dayton VA has said an “informal list” was used to track patient appointments, including follow-up care, from at least October 2013 until May 2015.
The informal list had roughly 150 patients who died, though those deaths were not linked to delayed care, VA Director Glenn Costie said last year. The patients continued to receive medical care at the VA, but not at the clinic during the delays, official have said.
In a separate report released by the VA Office of Inspector General, the VA reported “there does not appear to be any criminal violations at this time, but rather is part of a larger, well-established systematic problem with scheduling practices with VHA,” an abbreviation for the Veterans Health Administration.
U.S. Sen. Sherrod Brown, D-Ohio, has said he contacted VA Secretary Bob McDonald about concerns the Dayton VA had not scheduled the callbacks. Brown is a member of the Senate Veterans Affairs Committee.
The VA has refused to say if any employees were disciplined because of the scheduling delays. A review of the patient deaths did not find evidence that any individual died or was harmed as a result of the delay in care, Dayton VA spokesman Ted Froats said in an email Friday.
The Administrative Investigative Board report found medical service leadership had “multiple notices of the backlog” that dated to 2011.
The VA subsequently hired additional staff and changed workload distribution, the board report said.
A newly hired scheduler at the Dayton VA last year found more than 1,000 appointments had not been properly entered into the VA’s main electronic scheduling system. Prior to then, a respiratory therapist had been scheduling the appointments, the investigative report said.
The Dayton VA in May 2014 responded to concerns about off-the-books waiting lists at other VA hospitals by saying it “conducted our own internal audit of how our appointment system and wait lists work, looking for anything that could possibly be interpreted…correctly or otherwise…as a ‘secret wait list.’” Froats wrote at the time: “I am pleased to share that the results of that audit were entirely positive.”
In July 2015, in response to questions from this newspaper, the Dayton VA confirmed it had discovered an "informal list" of patients needing follow-up care in the pulmonary clinic. The investigative report says the scheduler began raising concerns in May 2015 that a list existed outside the normal scheduling system.
The report said the board could not find “willful disregard” for scheduling practices. The informal list, or spreadsheet, had been created to address concerns that veterans were being scheduled into closed clinics or when physicians weren’t present. An employee created the spreadsheet in 2011 “so patients would ‘not fall through the cracks,’” the report said.
The employee who handled the scheduling from that list told the board “she never received any supervision or monitoring of her scheduling practices,” the report says.
“Her prepared statement clearly indicates she felt that she was doing the right thing by making the list of patients needing follow-up appointments,” the report says.
Leadership within the medical service at the VA “did not thoroughly understand or properly communicate requirements for scheduling and following-up patients for clinics,” the report says.
A medical support assistant later took over appointment scheduling and notified managers of the informal list when it was discovered, the report said. The VA has said it contacted each patient and caught up on the scheduling backlog.
The board concluded that a “thorough clinical review of expired patients on the pulmonary list” had been conducted and no further reviews were warranted. But it was unable to determine if an adequate clinical review of surviving pulmonary patients had been completed.
The board took testimony from 19 employees, according to the investigative report, which omitted the names of most of those interviewed, except Dayton VA Medical Center Director Glenn A. Costie, Mark Murdock, associate medical center director, and Dr. James T. Hardy, chief of staff.
Of the 26,806 appointments completed in January by the Dayton VA system — including clinics in Middletown, Lima, Springfield and Richmond, Ind. — about 2.7 percent took longer than 30 days to complete, according to VA statistics. The national VA average was 4.2 percent.
The numbers are worse for currently pending appointments as of Feb. 25, however. Those numbers show 1,482 Dayton VA patients — or 5.4 percent — are waiting more than 30 days for an appointment, including 1,334 who are waiting between one and two months.
In the nationwide VA system, 7.8 percent of appointments are more than 30 days out.
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