VA bosses in 7 states manipulated vets' wait times for care

[MADem]

Why is this 'still a thing' as they say?

WHAT is it going to take to resolve this?

People need to be FIRED. Enough of this protection of corrupt employees taking priority over veterans' care.


http://www.usatoday.com/story/news/politics/2016/04/07/va-wait-time-manipulation-veterans/82726634/

WASHINGTON — Supervisors instructed schedulers to falsify patient wait times at Veterans Affairs' medical facilities in at least seven states, according to newly released investigation reports from the department’s inspector general.

The manipulation gave the false impression that the facilities in Arkansas, California, Delaware, Illinois, New York, Texas and Vermont were meeting VA performance measures for shorter wait times.

The reports detail for the first time since the Phoenix VA wait-time scandal in 2014 how widespread scheduling manipulation was throughout the VA. Investigators previously have said manipulation was “systemic” but they did not identify which facilities had problems and how serious they were.

The investigations found that employees at 40 VA medical facilities in 19 states and Puerto Rico regularly “zeroed out” veteran wait times, which masked growing demand as new waves of veterans returned from wars in Iraq and Afghanistan and as Vietnam veterans aged and needed more health care....In some cases — in Gainesville, Fla., White River Junction, Vt., and Philadelphia, for example — they found VA employees improperly kept lists of veterans needing care outside the scheduling system, a violation that also hid actual wait times.

...But VA whistle-blowers say schedulers still are manipulating wait times. Shea Wilkes, co-director of a group of more than 40 whistle-blowers from VA medical facilities in more than a dozen states, said the group continues to hear about it from employees across the country who are scared to come forward.

[SidDithers]

1. DU rec...nt

Sid

[csziggy]

2. People need to be criminally charged

There HAS to be some law that prohibits lying about reporting their government service (or lack thereof).

A good prosecutor should search those records and find cases where veterans DIED because they couldn't get the care they needed. Then charge those responsible for murder, manslaughter or depraved indifference.

Send a few of these guys to jail, say a couple in every state, and it will stop.

[TipTok]

3. They've tried with the most egrigious cases...

They are too well insulated.

Some were demoted, appealed and returned with full rank and benefits. The system is disgusting.

[MADem]

4. It's not just "the system." The LAW is WEAK.

It places greater priority on protecting people based on their "union" affiliation, even if they are egregious violators of standards of care, than protecting the people who went into harms way in uniform and served their nation.

It's messed up.

It's a crying shame that the GOP will get credit for fixing it, too--it should not have been passed with all those unreasonable protections.

There comes a point in time where a fuckup is a fuckup, and worthy of a firing.

[roody]

37. The VA is unionized?

[MADem]

38. Yep. It's civilians in that outfit--not military personnel.

If the military ran it, it wouldn't be so fucked up.

[pnwmom]

5. Interesting. I'll have to pass it on to my cousin who uses a VA facility. Thanks! n/t

[MADem]

10. No excuse for this kind of backlog after all of the attention....

More than 480,000 veterans were waiting more than 30 days for an appointment as of March 15, public VA data show.

It INFURIATES me that the GOP, those same bastards who dragged their feet on up-armoring vehicles or providing body armor to troops, will get the credit for fixing this mess--and it is a mess, and it will be fixed.

[brer cat]

6. This is disgraceful.

I agree...people need to be fired.

[sheshe2]

7. Kick

[hobbit709]

8. Haven't had any problems with my care at the Austin Outpatient Clinic.

Did a walk-in yesterday on my foot from last Fri. Got there at 10:30, seen by the nurse at 11, had X-Rays at 11:20, talked to doctor at 11:30. Got out of there at noon.
Have broken metatarsal on left foot.

Never had a problem scheduling appointments. routine appointments were always within 2 weeks. Some specialty appointments might take 3 weeks.

[MADem]

9. Lucky you. You do realize that you ARE lucky, I assume? nt

[sorefeet]

26. 10 months for an eyeglass appointment

It's been 5 weeks now, still waiting for the actual glasses. Billings Montana. "Why don't you people just go away" (MMJ). I ask for penicillin she said nope. Ended in ER Thanksgiving day. Needed penicillin. "I don't know you so I don't trust you" "You better go before we get in a fight". The only thing they give a fuck is I pass their drug test. Usually a pretty humiliating process for me to go to the VA.

[hobbit709]

27. Certainly don't get that sort of treatment in Austin.

Last time I had my eyes checked they prescribed new glasses, got them about a week later.
They don't do a drug test here, at least they never gave me one.

[MADem]

30. Medical MJ is a "go" in these parts. It is VA authorized, you know.

I have a relative who avails himself of VA services, and they helped him get his MM card. He gets his stuff DELIVERED, lucky him~!

But in previous years, he's had extraordinary waits for service. I've been able to speed up the process on occasion with a few phone calls, but it should not have to be that way.

His facility seems to have evened out, and he gets pretty good care now--but it wasn't always that way.


http://www.disabledveterans.org/2015/11/16/veterans-affairs-can-now-discuss-medical-marijuana-treatment/

[DemonGoddess]

11. hubby's appointments are usually scheduled well in advance

because the wait is very, very long. It can take up to a week to get a call back on questions into the office as well. For example, he was prescribed a new med. It had an effect on him he was not expecting. So, until his phone call was returned, he stopped taking it. Turns out the dosage he was given was a bit strong, so he had to cut the pills in half. But it took a WEEK for them to get back to him about that.

[MADem]

12. There is just NO excuse for that. An over-the-phone consult should have been possible.

Even if the request was routed through, say, a hospital pharmacist who bounced it off the attending physician (to streamline and focus the problem/save time) and then the pharmacist called back with instructions, that would have been preferable.

Hell, they do distance medicine on submarines, why can't they manage it for a vet--cut down on foot traffic, maybe let them fill out a form online, have it reviewed, get a call-back followed by an email, for something like that.

They just aren't trying hard enough. And they're keeping incompetent staff on, because there are too many hoops to jump through even if an incompetent doctor kills a dozen patients.

[1939]

13. Solution

1. Eliminate everything in VA medical except eligibility determination. Fire them all.

2. Vets go to regular doctors who are reimbursed by VA just like Medicare only with no deductibles or co-pays.

VA problem solved.

[kristopher]

17. Nope. Just vote the GOP out and fund it as part of single payer.

The VA houses some valuable expertise.

Long term we can stop sending people all over the world in shitbox wars.

[MADem]

29. No. Private doctors don't "get" combat injuries. They don't understand PTSD that is battlefield

related. They aren't as good at replacement limb issues, and the physical therapy end of things, too.

Also, you need medical staff and facilities to determine eligibility--it's not just done online.

The patients prefer to be amongst their peers in a hospital setting--there is a sense of cameraderie that matters.

The VA is a valuable wartime asset, too. No, we don't "want" to use it for surge capability, but it's nice to have it should we need it.

You see civilian doctors pulling medicare scams all the time--veterans, especially those on the edges of society, would be easy pickins' for these types of grifters.

[TipTok]

32. That's what I would like....

Let me choose my doctor and refund the difference...

[scioto99]

14. I've seen something like this at a private hospital -

And based on that, I don't think the problem is what you think. It's not 'corrupt employees lying to protect their jobs."

It's more like: The VA staffing isn't enough (due to money issues) to get the increasing number of vets seen in a normal amount of time. Therefore, vets complain. Therefore, someone's boss's boss's boss gets heat over it and is told to "make it better." Shit rolls downhill. The top guy orders the underling to "make it better" - who stomps down on the next underling - who is actually on-site and begs the doctors to somehow see more patients in less time to make the big shots happy.

The doctors and nurses say, "how can we do that? There's only X number of us, and we can only see who we can see as fast as we can see them. If you want patients seen faster, great, just get some more staff hired, some more rooms opened; streamline the crappy insurance issues, and so forth. That's what's holding things up."

And the request gets sent up the ladder - "the med staff says they can't go any faster. you've got to hire more people for them."

And maybe some promise is made - "oh, yeah, we'll get right on that." And maybe it's done, sort of, but it's done half-assedly. (For example: more doctors are hired, but not more rooms prepared for the doctors to work in. Or maybe the lab can't keep up with the increased demand. Or the bottleneck moves to triage. Or the cardiol division is up to snuff but what's really needed is a psychiatrist and an addiction counselor. et cetera.)

So basically: political pressure is put on people to do a job they just can't do, by higher-ups who just "want it fixed now!" - and everyone on the ground knows it's impossible and it's bad medicine. But the new quota has been implemented and they have no say in it - they're told heads will roll if they don't keep some top guy in a suit happy and make his bad publicity go away. And they're doing their best but it's all a stupid bureaucracy.

The problem is actually lack of money.

The problem is *always* lack of money.

And the guys on the ground always say that, but no one listens.

Just my guess.

[MADem]

16. Nearly a half a million patients have seen major delays in service.

There's something else going on here.
The problem is that the people who are screw-ups are NOT fired. They can't get rid of them or replace them--there is a defect in the law that makes it extremely difficult to get rid of these bad actors.

The unfortunate thing is that the GOP will write the law to fix it, and BHO will sign it. And they will take the credit.


http://www.militarytimes.com/story/military/election/2016/02/18/sanders-va-firing-problems/80506664/

[scioto99]

18. But who are the screw-ups?

You mean the people who told the clerks to lie about the wait times?

Well, they're liars and that's wrong. But if it's what I think, they're just the whipping boys trying to stay afloat in an impossible situation.

I knew my local VA hospital as it was ten years ago. The walk in center was always crazy-busy - the staff worked their butts off. In the clinic, patients who called for an appt got scheduled for the next available opening - and if that was in five weeks, then it was in five weeks - what could the schedulers or staff do about that? The bureaucracy for getting pretty basic meds approved was nightmarish, which I'm sure was an attempt to cut costs by ensuring patients got only the cheap, almost-as-good medicine rather than the five-times-more-expensive medicine. But when the studies say the expensive stuff works better, well, doctors don't want to give their VA patients second-best care, so there's forms to fill out; oh the endless forms! It was horrible.

Then, in the hospital, the inpatient rooms were way lower quality than what you'd get in a private or academic setting (four patients to a room). The computer system was backward and ancient. They were so understaffed they had residents doing tech and phlebotomy jobs while on call, because they couldn't afford techs and phlebotomists after eight pm. (but this was made illegal under the new residency guidelines, so I guess they had to break their budget and hire actual night coverage for those jobs.) It was all incredibly cumbersome, like a lumbering monstrosity that had been stuck in time for thirty years. And yet the patients kept getting older and sicker and there were more and more of them. The system was buckling. And Washington DC, where decisions got made, was damn far away.

So then, of course, it became an environment people didn't want to work in. Good benefits, people said, but always an uphill struggle to get your people cared for. Why be nurse practitioner or a social worker or a dermatologist in a grim difficult bureaucracy, when you can work in a private clinic or an academic center, in a nice bright modern place that functions ten times better? So then, what you get is a hiring problem. The money is found, the jobs are posted... and no one takes the bait. Understaffed places have big wait times.

What would fix it? Tons more money diverted to VA medical care. But that money would have to come from somewhere. And the underlings have no control over that.

Maybe it's better now. I have my doubts.

[MADem]

19. Briefly, the screw ups are people who covered up, who ordered cover ups, who delivered

substandard care, and who are STILL AT WORK dragging their feet, waiting for the appeals process to play out, many KNOWING they are going to be fired at the end of the line, but maxing out their paydays until that day comes.

The retirement-eligible people have been pushed out. They can't get good people in until they get the bad people out, though.

It is incumbent upon the not-so-new head of the VA to articulate his needs to Congress. He'll never have an opportunity like this again--the political will is there to give him money hand over first. He also needs end strength, plainly, in some venues--the ones with the largest backlogs.

This isn't about underlings--it's about senior leadership, that don't need to be protected.

[scioto99]

21. Oh, okay.

If the problem is corruption at the top, I am with you in hoping they get what they deserve.

[kristopher]

24. It is so good of you to promote GOP talking points.

Blame it on the workers when the problem is a GOP/3rd Way establishment trying to privatize.

[MADem]

25. Excuse me--I will put the nearly half million vets getting shitty care in front of any partisan

considerations, and if you don't like it, tough noodles.

Can't believe you'd put covering the party's ass in front of the health and welfare of those who go in harms way.

You know, if we'd done this right THE FIRST TIME, we wouldn't still be in this mess.

If you bothered to read what I wrote, instead of getting all huffy and whiney with your "blame it on the workers" nonsense, you'd see that I was quite clear where the problems lie--with the IDENTIFIED shitbirds who cannot be fired--because the LAW was POORLY WRITTEN.

smh.

Feel good tossing the vets who use the VA under the bus, do you? I think they deserve better, and if the frigging Republicans have to be the ones to give it to them, so be it.

[kristopher]

28. You are not a champion of Vets nor of democratic values.

You are one of the worst on this site for spinning garbage to promote Hillary and damage Sanders.

I'm a vet and one of my daughters is a USMC vet that is currently under VA post op care.

[MADem]

31. I'm a vet too--Uncle Sam thanks me for my service on the 1st of every month.

If Sanders had done a better job when he had that chair, I wouldn't be so critical of him--but he held very few hearings, a fraction of what they held over on the House side--and he dragged his feet. He let down the side.

And ya know what? When you say stuff like this:

kristopher
28. You are not a champion of Vets nor of democratic values.
View profile
You are one of the worst on this site for spinning garbage to promote Hillary and damage Sanders.

I can only respond to your childish, bitter fit of pique with this:

[kristopher]

35. You admit you are grinding an axe against Sanders, not engaging in legitimate analysis ...

...of the problem.

This is old hat and you are just spraying scat hoping to stink up the political debate. So yes, You are promoting Republican privatization propaganda and You are not a champion of Vets nor of democratic values. You are one of the worst on this site for spinning garbage to promote Hillary and damage Sanders.

[MADem]

36. I am not "grinding an axe" against anyone. If he had done his job, there would be no issue.

The law he passed a) Is bad and b) Isn't working. That's just fact.

That's why a bipartisan group of legislators are getting together to craft a law to FIX the mess. It's NOT "old hat" --there will be new legislation by Memorial Day. You should do a better job of keeping up on veteran's issues, seeing as you're a vet, and all....why don't you start by reading the links I have provided in this thread.

smh!

And you can play the cranky, whiny insult game all day:

35. You admit you are grinding an axe against Sanders, not engaging in legitimate analysis ...
View profile
...of the problem.

This is old hat and you are just spraying scat hoping to stink up the political debate. So yes, You are promoting Republican privatization propaganda and You are not a champion of Vets nor of democratic values. You are one of the worst on this site for spinning garbage to promote Hillary and damage Sanders.

My response to your immature insults remains the same:

[kristopher]

15. Get the GOP out of the loop.

They want everything privatized and they are sabotaging anything they can to make that happen.

[MADem]

22. You can't until they lose the House (or Senate or both). Until then we're stuck with them running

the show.

[kristopher]

23. Then you can't fix the problem.

[MADem]

33. Pay attention. There will be new legislation.

http://www.stripes.com/news/senate-aims-to-fix-broken-va-choice-program-1.398625

The Senate Veterans’ Affairs Committee is working on an omnibus bill for federal government’s second largest department that aims to fix the Choice program along with a number of other issues that persist at the VA, such as accountability for managers accused of wrongdoing.

Tester’s bill would reform how contracted companies are used to connect veterans with private providers — an arrangement that has been blamed for the program breakdown by the VA.

Secretary Bob McDonald, who testified before the Senate on Thursday, said the VA made the mistake of outsourcing its customer service to so-called third-party providers.

“We would literally just give the veterans a phone number to call and that just isn’t right,” McDonald said.

The Choice program “has not worked” and has further damaged the department’s reputation, said David Shulkin, the under secretary for health at the VA’s Veterans Health Administration.

[NobodyHere]

20. I want single payer and everything

But looking at the VA gives me some pause

[MADem]

34. There's a lot of work to be done there. A LOT. nt

[4Q2u2]

39. Structural as well as Cultural

These are the reasons for the failures.

Structural: If a Vet has more than one Medical need (which is many) they are not addressed at the same time. They will have to make multiple appointments to get their total care just addressed let alone start the process of correction. This builds into the system
layers of delays and wait times.
Far too many Vacancies in jobs in all VA's. Hiring Freezes and long drawn out hiring process that takes multiple months to put an employee into the pipeline.
Lax verification standards that allow countless fakes and phonies to infect the VA system stealing valuable time and attention needed for real Veterans needs.

Cultural:
Many in the SES VA leadership have been convicted of wrong doings and have had zero punishment. From padding each others moving expenses. To the Director of Pittsburg VA being found directly responsible for the deaths of Vets due to Legionnaires Disease out break, getting a 16k bonus while COLA and Award Bonuses were frozen for all Federal Employees by Executive Order.
To fired directors still receiving bonuses and checks, many of whom were from the initial VA wait scandal.
Destabilizing the moral and system within the Organization.
GOP dream scenario; Put a CEO in charge and have them run it like a business. This is exactly what President Obama did. Can you even name the VA director? When was the last time you saw his name in the paper or any news of him since his appointment?
Sad thing is he is a Vet as well.

Is Union representation effecting Veterans Care? I would say no. There are steps and processes to have bad Federal employee fired, but those steps have to be initiated by a Supervisor and it seems that most are unwilling to do their due diligence. It also seems that Senior leadership is not properly engaged in the accountability department.

[MADem]

40. All the union people are GS-12 and below.

I agree that they aren't the biggest problem. There are people who do nothing but work on union stuff, and maybe there needs to be structural changes to spread that work around instead of concentrating it amongst a few people, but really, I think that many problems can be traced to abusive supervisors and the issues you mentioned.