Reports mixed at Spokane VA facility

As the VA scandal grows outward from Phoenix, ripples keep appearing in Spokane.

The agency’s inspector general released an initial report that said it was reviewing 42 VA facilities nationwide. Though it did not specify that Spokane was among them, an IG team did visit the hospital here recently.

It wasn’t the first time. In 2012, the IG investigated complaints at the Mann-Grandstaff VA Medical Center in Spokane and concluded that there were long wait times that resulted in “adverse patient outcomes,” and systemic record-keeping problems between primary care doctors and specialists within the system. Local VA officials say the problems have been addressed.

A former employee of the hospital, meanwhile, says that when he was working there under director Sharon Helman – now under fire as the head of the Phoenix facility – “consults” from primary care doctors ordering specialist care were canceled and rescheduled by a clerk, to make it appear as though patients were being seen within a 30-day window, when in fact they were waiting much longer.

“It was so obviously wrong,” said Delvin Wagner, a 66-year-old who retired after a 26-year career at the VA hospital in Spokane. “They were trying to make themselves look good at the expense of the veterans.”

The scandal under Helman at the Phoenix VA includes unproven allegations of secret waiting lists and 40 patients dying while waiting for care. An initial IG’s report on the problems at that facility concluded that as many as 1,400 veterans on the electronic waiting list did not yet have an appointment, and that 1,700 veterans who were waiting for care were not even recorded on the facility’s electronic waiting list.

Though its investigation is ongoing, the IG concluded the problems with wait times and record-keeping are systemic throughout the VA. It blamed, in part, the confluence of a deep shortage of doctors in the system and an intense pressure to excel where raises and bonuses were based on metrics such as wait times. It has coordinated its investigation with the Department of Justice, which would handle any criminal matter.

“To date, we have ongoing or scheduled work at 42 VA medical facilities and have identified instances of manipulation of VA data that distort the legitimacy of reported waiting times,” the report says.

It does not say whether Spokane is one of those facilities, but an IG team recently visited the Spokane hospital to “review wait times and the documenting of wait times,” Spokane VA officials said in a written answer to questions on Thursday. “Although the final results of the review are pending, during a verbal exit briefing, no issues were noted.”

In 2012, investigators looked into a complaint about the consultation process between primary care doctors and specialists at the Spokane hospital. The IG concluded that there were delays in care for patients in Spokane, and that requests for consultation were sometimes canceled without the patient being treated. It also concluded that there was a rancorous relationship between primary care doctors and specialists.

In some cases, the report said, when doctors requested a consultation, a specialist would determine that a “non-visit consultation” was appropriate instead.

Primary care doctors “often expressed dissatisfaction with this process by writing inappropriate comments in consult notes,” the report said. “Consultants, in turn, sometimes responded with unprofessional comments.” Meanwhile, veterans were waiting too long for care. Investigators reviewed 14 cases related to the 2012 complaint. If a patient was seen or scheduled to be seen within 30 days of a request for consultation, it was considered an “appropriate response.”

“We substantiated that delays in care occurred for 8 of the 15 patients reviewed and we determined that in 7 of the 8 cases, patients suffered a delay in the amelioration of symptoms,” the report concluded.

VA officials noted this week that the concerns raised in that report were addressed by the hospital, and the IG closed the report in May 2013 based on the corrective actions.

Wagner, the former VA employee, said that when he was working as a “tech” in the urology department at the hospital in 2007, a directive came down that patients would be seen within 30 days – a window that he considered unrealistic. That point of conflict is where he and others say a lot of the problems at the VA arise: a political or administrative insistence on setting standards that the resources of the system cannot meet, which leads to abuses in record-keeping to make it seem as if goals are being met.

He said that while he was working in urology after the 2007 directive, he noticed that a lot of the “consults” he was getting, which were usually signed by a doctor or other medical professional, had been signed by the nighttime clerk of the ER. Wagner said that as the 30-day window on consults expired, they were canceled and rewritten to prevent the appearance of delays.

“They would cancel that consult and resubmit a new one,” he said.

Wagner says he complained to a supervisor, who took it up with Helman and later told him that the process was legal and appropriate. Spokane VA officials said this week that they were not aware of the situation Wagner described, “However, it would not be acceptable and is not occurring at the Mann-Grandstaff VA at this time.”