Shawn Vestal: Phoenix-type appointment practices used at Spokane VA, retiree says

A former clerk at Spokane’s VA hospital says that he and his fellow clerks routinely logged in appointment times in a way that obscured the long waits veterans had for treatment – similar to allegations that have arisen at the Phoenix VA hospital.

The allegations made by John Bedwell, a Navy veteran of the Vietnam War, concerned some of the time that Sharon Helman was the director of what is now the Mann-Grandstaff VA Medical Center in Spokane. Helman has been placed on leave as head of the Phoenix hospital while officials investigate claims by a longtime doctor that her administration kept false records about veterans’ wait times, and that as many as 40 veterans may have died while awaiting treatment.

Helman’s brief time in Spokane, from June 2008 to January 2010, was marked by praise from many political and community leaders, and by controversies over the underreporting of veteran suicides and a revolt among the overworked psychiatric staff.

In 2008, Ben Gittings, the president of the Inland Empire Veterans coalition, sent Helman a letter complaining of severe staff shortages, chaotic care and incompetent management: “Morale in your hospital is at an all-time low. Too many hard-working VA employees are suffering under weak Chiefs and subservient mid-level Managers. Too many veterans are being seen only once or twice a year, having appointments canceled at the last minute, being dropped from hospital rolls, being assigned and re-assigned to different doctors.”

Bedwell’s complaints make the closest connection between what happened in Spokane and Phoenix. Bedwell, the former president of a union at the hospital, worked for 15 years at the hospital and the last eight years scheduling specialty services. He retired in 2009. He said when he saw the news about the latest scandal at the Phoenix VA – and the fact that it involved his former boss, Helman – he was taken aback.

“It really shocked me,” said Bedwell, who lives near St. Maries. “It was the same scenario we’ve got here – this electronic waiting list thing.”

For Bedwell, the intense focus on Helman is a little beside the point. He says the appointment recordkeeping he was involved in occurred both during her time and outside of it, and he believes the directive came from above her. He says the VA health care system is plagued with problems that track directly back to a lack of resources; he says those in Congress now calling for Helman’s head should also be looking at their own role in failing to provide enough funding to run a system that isn’t constantly, chronically falling behind the demand.

“The politicians are always talking about, ‘We’ve got to take care of these veterans,’ ” Bedwell said. “ ‘They deserve this. They deserve that.’ But when it comes down to paying for it and allocating, they don’t back up their words.”

Bedwell’s claims about recordkeeping involve the hospital’s electronic tracking of appointments. He worked on the sixth floor of the hospital, where most specialty services were located, he said. His job was to schedule appointments for specialists or specialty services once they were referred by the primary doctors. Among the items tracked by the system was whether veterans got the appointments they chose or had to wait for the next available times.

Bedwell says veterans were consistently waiting months for appointments, and consistently waiting longer than the referring doctor recommended. But when he made appointments, he was told to tell veterans when the next appointment was available and ask them if they wanted it. If they said yes, the appointment was recorded as one made at the veteran’s preferred time – not one that would reflect a long wait.

“It’s kind of a tricky thing,” he said. “It kind of lies to the system.”

Bedwell says he’s been in touch, both in the past and recently, with Sen. Patty Murray’s office about his concerns.

No one at the Spokane hospital would agree to an interview on this topic. In a written statement, the hospital said it did not have long wait times during Helman’s time on the job. It also said Helman was not the target of the criticism over the underreporting of veterans suicides and that she in fact was the one who stepped in to fix it.

“When a new patient requests care, every attempt is made to give them an appointment within 30 days of their desired date,” the statement read. “If a Veteran cannot be scheduled for an appointment in the next 90 days, they are listed on the (Electronic Wait List). Wait times vary. New patients for primary care are always seen within 90 days and usually much sooner.  Specialty clinic wait times for new patients are monitored and decisions for care are made based on need. The care may be outsourced to the community or referred to another VA Medical Center in the Network.”

The hospital did not respond to Bedwell’s central criticism: whether the electronic system was used to intentionally obscure wait times for patients.

The issues around funding and patient care for veterans and military service members are more or less perennial, and they put the lie to our talk about supporting the veterans. Periodically the issue surfaces shockingly – as in the yet-unproven allegations in Phoenix or the investigations into the appalling conditions at Walter Reed Army Medical Center in 2007.

Everyone makes a lot of noise and heads are identified to roll. And then it’s business as usual again.

Murray, in her role on the Veterans Affairs Committee, has pressed in recent months to stave off further “extreme” budget cuts that are looming for the Spokane hospital. She was among those blasting Veterans Affairs Director Eric Shinseki at a hearing Thursday, saying the Phoenix scandal was a “wake-up call” for widespread problems.

At an earlier hearing in March, she raised concerns with Shinseki and Dr. Robert Petzel, undersecretary of health for the agency, that were specific to the Spokane hospital.

“The Spokane Medical Center recently prepared a draft response to questions … about their budget,” she said. “They talk about the significant challenges of declining budgets, of numerous staffing vacancies, and leading the network in new veteran patients.

“And they said, and I’ll quote it, ‘Overall, senior management is very aware of the budget shortfall and is taking actions to limit the deficit. However, most actions will significantly limit staffing levels and access to care. These actions will have – and have had – a significant negative impact on morale and will drive some dissatisfaction amongst patients.’ ”

“Dr. Petzel, I asked you about similar budget problems at Indianapolis at the hearing on the 2012 budget, and you told me there was no evidence that any medical center would be unable to provide the care we expect. Unless your view has changed, Spokane’s assessment seems to disagree.”