Health Care
11:45 am
Tue May 20, 2014

Waiting At VA Hospitals: A Matter Of Life And Death

Originally published on Tue May 20, 2014 12:26 pm

Transcript

MICHEL MARTIN, HOST:

I'm Michel Martin, and this is TELL ME MORE from NPR News. At some point, many of us have encountered a wait to see a health professional. It can be annoying and frustrating and an inconvenience. But what if it turns out that the health problem is not minor and that wait is the difference between life and death? Now, some families of veterans who waited for care from the Department of Veterans Affairs claim it was the difference between life and death.

SALLY ELIANO: I had a phone call from the hospital VA that we're here to set up a doctor's appointment for Mr. Thomas Breen. And my reply, I quote, was, "you're a little too late. He's dead, thank you very much."

MARTIN: That's Sally Eliano, the daughter-in-law of one of 40 veterans who allegedly - well, who did die while pursuing care at the VA in Phoenix, Ariz. Now about a dozen other VA health care facilities have come under scrutiny for alleged secret waiting lists. The undersecretary for health at the VA has resigned. And lawmakers and family members are demanding answers.

We wanted to learn more about a story that has gained more and more national attention, so we've called Quil Lawrence, NPR's veterans correspondent. Quil, thanks so much for joining us.

QUIL LAWRENCE, BYLINE: Oh, thanks for having me.

MARTIN: So let me start with that one important detail, and we'll work our way to the whole story. Is there evidence right now that the 40 deaths in Phoenix could have been prevented if veterans were seen sooner?

LAWRENCE: No, this is sort of one of the most misrepresented facts about this story. There is a whistleblower who says that 40 people may have died while on this waiting list - this separate waiting list that was kept off the books, and they received much delayed visits. There's no evidence that they died because they were waiting. In the case of Mr. Breen, he had advanced stage bladder cancer. There's no evidence yet that anyone on that list died because of those denied care visits.

MARTIN: Is that - so thank you for clarifying that 'cause I think it is an important detail. But is that how this whole issue came to light? I mean, that there was a whistleblower who had specific facts about a specific place and then it kind of went from there?

LAWRENCE: Exactly. That was in Phoenix. And now there's an investigation going on there by the inspector general of the VA. Since then, there have been whistleblowers at cities all over the country, really, coming forward and saying the same thing happens here. We have unofficial waitlists that sort of hide the fact of how long it takes us to see patients.

And I think, particularly in mental health care issues, there's concern that, for example, someone who's waiting and can't get to see a therapist might commit suicide while waiting. And with a high rate of suicide among veterans that's a particular concern.

MARTIN: Talk to me a bit more, if you would, about how this whole issue is supposed to have worked. Like what's the - there's not the allegation that people are deliberately not seeing patients or something like that. So this is not an issue of, like, fiscal malfeasance. What's the issue here? What happened here?

LAWRENCE: It's about cooking the stats. This has been a problem for years in the VA. For going back a dozen years, there are congressional inquiries about this and reports within the VA. And the issue of this 14-day period was a standard that was sent down saying, OK, everyone you've got - you've got to see your patients within 14 days. They have to have an appointment 14 days from their request.

Now, this couldn't be met across the country. Especially in the last three years, you've seen 50 percent - a 50 percent jump in the number of primary care visits and only a 9 percent jump in the number of primary care doctors. That's because of Iraq and Afghanistan veterans. It's also because, say, Vietnam veterans are hitting the age where they need a lot more medical care. And so, essentially, what was happening - it seems pretty much across the country - is people who wanted to look good in their stats were cooking the books. And they were sending in - or gaming the system in ways - and there's internal communication within the VA saying, stop gaming the system. Two years ago there was a memo sent out saying, you have to stop changing these around to make you look like you're making these stats when you're not.

MARTIN: Yeah. The agency was heavily criticized previously for an enormous backlog. Is that the same issue or is one a response to the other?

LAWRENCE: No, it's really easy to confuse those two. So this is the wait times problem - the long wait times for people to get access to the medical care. The backlog, commonly referred to, is the wait for people to get a disability rating. They come home from Iraq or Afghanistan. They've got ringing in their ears from explosions. They've got a bad back and bad knees, like every veteran I've ever spoken with, from carrying around heavy gear and running around combat zones. And so they apply to the VA and say, I'm disabled. I need a 50 percent disability rating. And then they send it in.

And very often they wait and wait. What happened at the same time all of these vets were coming back into the system, VA Secretary Eric Shinseki made a few rulings that added an enormous number of people to his list. Agent Orange people from Vietnam, who had been claiming that they had illnesses related to the herbicide Agent Orange - for years they'd been fighting over the VA saying I have cancer because I was sprayed with Agent Orange. Finally, Secretary Shinseki just said, if you were in Vietnam while Agent Orange was being used and you have one of these dozen conditions, we're just going to say you've got it because of Agent Orange. And he added a huge number of backlog claims to his own list then.

He also invited a lot of people in who have PTSD and just said, if you were in combat and you've got PTSD now, we're just going to go out on a limb and say it's because of the combat. We're going to say that serve is connected. So he really ruined his own bottom line in terms of clearing numbers of people in the backlog several years ago.

So in the last year, that has been reduced from its high point of 600,000 vets, who were waiting more than a few months to get their rating - it's now down to under 300,000 who are waiting. They say they're going to finish this up within a year, that they'll clear the backlog completely.

MARTIN: If you're just joining us, we're talking about investigations into the so-called gaming strategies to cover up delays in veterans' health care. Our guest is Quil Lawrence, NPR's veterans correspondent. He's walking us through this story.

Let's talk about Eric Shinseki for a minute. He's a retired four-star general, the secretary of this agency. Has he been well respected to this point, or has it been a rocky issue all along for his dealing with the backlog and then with the additional demands for care and so forth?

LAWRENCE: So Eric Shinseki's a disabled vet himself. Even the people who've called for him to resign have never questioned his integrity. And there was - there were a lot of calls for him to resign last year about the backlog issue. Now, they've made a lot of progress on it. In this case, it was kind of a surprise.

When this wait time scandal started to break, there were criticisms from some people on the Hill who had already called for his resignation in the past. But then the largest - the largest American veteran service organization, the American Legion, came out in what was a surprise announcement and called on Eric Shinseki and his two deputies to resign. And then since then, there has been a string of other health care facilities saying that we also had this problem cooking the books. And different people are on the fence waiting to see the results of this investigation before they'll pass judgment on Shinseki.

Other veterans groups have come out strongly in favor. And they'll say he's reduced veterans' homelessness. He has brought down the backlog now, and they respect his leadership. Others will say, well, we're not thrilled with Shinseki, particularly with his public communication. But we think it would take a new secretary so long to get up to speed that we think he should stay.

MARTIN: Let me just play an exchange from the - there was a hearing last Thursday before the Senate Veterans Affairs Committee. And this is an exchange between Sen. Patty Murray of Washington and the secretary. Of course, she's a Democrat. We'll play it.

(SOUNDBITE OF ARCHIVED RECORDING)

SENATOR PATTY MURRAY: The standard practice at the VA seems to be to hide the truth in order to look good. And I want to know how you're going to get your medical directors and your network leaders to tell you when they have a problem rather than pursuing these secret lists and playing games with these wait times.

ERIC SHINSEKI: Well, Senator, if there's anything that gets me angrier than just hearing allegations, is to hear you tell me that we have folks that can't be truthful because they think the system doesn't allow it.

MARTIN: Well, what about that? I mean, is there the implication here that this is - this whole issue is a reflection of his management style or a broader cultural problem at the agency where you can't tell the truth or that the problems, real problems, somehow don't surface until it's too late? What's the thought here?

LAWRENCE: This issue was there long before Shinseki. But he's now been in office almost six years. So it's really on him now to do something about it. He's tried.

There are many, many stories about trying to fix the bureaucracy within the VA. And in fact, there's a bill coming out of the House this week to give the secretary the power to more easily fire people. He would defend his record, and did in that Senate hearing, saying that they have relieved about 3,000 people from their jobs last year for performance issues. But then they couldn't really answer the question about whether those people were fired or maybe they were moved to a different post or they were demoted. It's notoriously difficult to fire people within this vast health care system that is the VA.

MARTIN: So finally, we have about a minute left, Quil. And thanks for bringing us up to date on this. I know that many people will have been hearing pieces of the story, so thanks for bringing it all together for us.

But naturally, people are horrified when they hear of something like this, I mean, particularly people who have served the country and have been injured as - possibly as a result of that. And they find out that they're not getting the care they should have. But as an independent health care system, how does the VA rank? I mean, we keep hearing that there are surveys that show that veterans overall are generally happy with the care that they receive. So what's the big picture here?

LAWRENCE: Well, in that same hearing, it was pointed out that medical errors within the health care system outside the VA is one of the leading causes of death in the United States. So it sort of made the point that the VA health care system can be riddled with errors and problems, especially getting access. Once people get the care, they're generally very satisfied with it. And even the Shinseki's critics last week said that, that they like the care. They want vets to trust the VA to go in and get the care.

But it may just be that it can be riddled with errors and still be one of the best health care systems in America. And it may - the counter to that is some people say, well, our vets should have better than that. They shouldn't have to stand for these errors even if this is relatively good compared to health care in America in general.

MARTIN: Quil Lawrence is NPR's veterans correspondent. He was kind enough to join us from our bureau in New York City. Quil, thanks so much for joining us.

LAWRENCE: Thanks, Michel. Transcript provided by NPR, Copyright NPR.