Personal Health

Leaked Internal Memo Shows How VA Systematically Screws Over Wounded Vets to Maintain Performance Grades

A newly surfaced internal memo shows that VA health facilities get good grades by delaying and denying care.

The Veterans Health Administration systematically delays and denies sick veterans medical care and masks it with bogus documentation. That's what the VA Inspector General and a number of veterans' advocates have been claiming since the early days of the Iraq War, when soldiers returning from Operation Enduring Freedom began flooding VA facilities. Now an internal department memo, posted Wednesday on a watchdog Web site, confirms these charges.

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The April 26 memo from William Schoenhard, Deputy Undersecretary for Health Operations and Management, alerts supervisors overseeing scheduling in the nation's largest health care system that he has learned of unacceptable practices. VA facilities have adopted what he calls “gaming strategies" in order to “improve scores on various access measures" by diminishing patient access to treatment.

An eight-page attachment identifies 24 "tricks" detected so far, but Schoenhard says there may be more. Using fine-print rules to cancel patients' appointments is one of the more sinister strategies that Schoenhard describes. Here, a patient arrives on time for an appointment only to be told he has no appointment. When the patient shows the employee his/her appointment form, the employee shows the patient the fine print on the form, which says that patients who do not come 10 (sometimes 15) minutes early to check in risk cancellation.

In another example of the VA gaming the system, employees enter into the computer a later date (often by months) than the doctor has specified for a return visit . Another practice is recording a patient's initial request to be treated in a paper log, not the computer system, then calling them in months or a full year later (law requires they be seen within 30 days) and recording that date as their first request to be seen.

In the block-scheduling strategy, employees book several patients in the same time slot for the same doctor or provider, leaving patients to wait for hours to to be seen, sometimes for something as simple as a monthly prescription renewal, which, due to frustration or obligation, they sometimes leave without.

Paul Sullivan, director of the veterans advocacy group, Veterans for Common Sense (VCS), told AlterNet he believes Schoenhard's memo "forces a key leadership test upon VA Secretary Eric Shinseki" to end the shenanigans and solve the underlying problems. "The constant stream of hurricane-force flooding of new combat veteran patients from the wars and into VA hospitals has totally overwhelmed VA and caused the improper gaming," Sullivan said, adding that the memo "reveals how VA takes the easy way out."

VA Watchdog editor Larry Scott, who discovered the memo and has written of his suspicion of system-wide tricks since 2004, remains suspicious of the memo's effect and perhaps its intent. The detailed explanations and illustrations of gaming strategies, Scott wrote on his site, amount to a message to employees “to find a better way to hide their sins." Sullivan told AlterNet he "hopes VA’s intent is to end the harmful practice."

Whatever the intention, VCS is urging Congress to hold an oversight hearing on the uncovered memo. Paul Sullivan wants Congress to press VA for a "real plan" to address both the gaming of the system and the scarcity of resources the gaming hides. Congress, he said, needs to learn how many veterans over the years have been harmed by the improper practices; what other practices have been used to hide VA's severe staffing problems; when and how VA will retrain all staff on the proper use of the appointment system; how VA will hold accountable VA leaders and employees who use illegal practices to delay and deny medical care; and how many more doctors and medical staff VA will hire and when.

The problems VA faces from the current wars are staggering. From the Pentagon and VA's own reported data, we know that in addition to some 4,400 U.S. troop fatalities, the wars in Iraq and Afghanistan have been responsible for some 86,000 casualties, 37,280 wounded in action and 48,272 medically evacuated due to injury or illness. As much of 20 percent of Iraq and Afghanistan veterans (360,000) may have suffered traumatic brain injury from IED blasts, according to a DoD estimate issued last year. Every day 18 U.S. veterans attempt suicide, more than four times the national average. There are 537,099 Iraq and Afghanistan veteran patients in the VA system, and thousands more wait as much as a year for VA treatment.

Schoenhard, who recently retired from an administrative career in private health care, is new to the VA system, which he joined in February. He alone knows his purpose in providing administrators with the elaborate documentation of tricks. One thing we can be sure of is that VA has a scandal on its hands. How it faces it and underlying problems could mean life or death for hundreds of thousands of veterans from current and past wars. According to Sullivan, "another tidal wave" of Vietnam War veterans with PTSD and Agent Orange-related problems is flooding into VA facilities. And recent studies on toxic exposure and Gulf War illness are causing even more veterans to seek VA health care.

The revelation of gaming is only one of many scandals plaguing VA health care. Botched prostate surgery, substandard suicide prevention, reuse of un-sanitized medical devices--the list goes on. Tainted colonoscopy equipment discovered in 2008 in multiple VA facilities---which has sickened scores of veterans with HIV and hepatitis--continues to be a "systemic issue," VA Secretary Eric Shinseki admitted just last week.

Using dirty equipment is not an "issue" and ignoring sick veterans and faking documents to hide the fact is not a "game" -- these are crimes. VA needs to abandon its alternative virtual universe and dedicate its time and ingenuity to actual veterans suffering real injuries and illness.

This week, as we wave our flags, watch the sky explode, and sing of rockets' glare and America the beautiful, let's not forget the ugly rockets, bombs and toxins killing, maiming and sickening invaded populations and our own young soldiers, who return home to a brutal health care bureaucracy fixed above all else on its own survival.

Nora Eisenberg is the director of the City University of New York's fellowship program for emerging scholars. Her short stories, essays and reviews have appeared in such places as Partisan Review, Village Voice, the Los Angeles Times and Tikkun. She is the author of three novels. Her most recent novel, When You Come Home (Curbstone, 2009), explores the the 1991 Gulf War and Gulf War illness.