Wilmington VA Center under investigation
The Wilmington Veterans Affairs Medical Center is one of at least 42 VA facilities being investigated by the agency's inspector general over schedule manipulations meant to hide how long patients have to wait for appointments, the News Journal has learned. A staff physician and a staff nurse, who requested anonymity due to a fear of retribution, said investigators had been at the medical center near Elsmere recently, a visit the Wilmington VA acknowledges took place May 20-21.
Wilmington VA also confirmed a Wednesday visit by the inspector general to the Kent County Community Based Outpatient Clinic. Delaware is only the third state in which IG investigations are now confirmed. Its Wilmington findings have not been released.
The same "significant delays" discovered at Phoenix also vex patients who rely on the facilities in Wilmington and Kent County, according to the two Wilmington system sources. In Phoenix, investigators identified "multiple types of scheduling practices" that were not officially approved.
The inspector general has not found evidence at the Phoenix Veterans Affairs Medical Center, where the scandal erupted, of delays causing patient deaths, as has been alleged.
In one method employed at Wilmington, the two clinicians said, entire patient loads, or "panels," were shifted from one primary caregiver's team to another's, causing vets to essentially lose their place in line.
"Patients are scrubbed from primary care panels," the nurse said. "They remove patients from primary care panels, they become unassigned. They then are like orphans – although that provider still believes the patient is their responsibility."
Another has been to periodically rename primary care teams – "which they seem to do with regularity," the doctor said. This, the clinicians said, "resets" the waiting list. VA has a 14-day target for seeing primary care patients.
"They become brand new again," the nurse said. "And if they've been in VA for years, it doesn't matter.
"There's no rhyme or reason to any of it," the nurse said. "We can't appropriately staff, that's why providers leave, or, providers are gone, and it can take a year before management can decide we need to replace them. 'Well, we can reassign those patients to other people. We can scrub these panels and get rid of patients.' And that's what they do. And the patients don't go away. They just become unassigned."
The Wilmington issues have attracted the attention of the state's congressional delegation.
"Rep. [John] Carney is outraged, disturbed, and saddened by the ongoing revelations about the VA's actions," Sheila Grant, Carney's legislative and communications director, said Thursday. She said Carney will be meeting Friday with Wilmington leadership as part of a previously scheduled visit "to get the facts and understand the situation." Sens. Tom Carper and Chris Coons will join them, spokepersons said.
The investigation, which began at Phoenix, spread to 26 facilities and, within days, to the current 42. A statement from the Wilmington center, however, says the inspector general was responding to its invitation.
"Robin Aube-Warren, the facility's new medical center director, requested the IG to do an in-depth review of scheduling practices at the Wilmington VA Medical Center and Community Based Outpatient Clinics to get an accurate assessment and to ensure all Wilmington VA staff have a full understanding of VA's policy and continued integrity in managing patient access to care," spokesman James Coty said in an emailed statement. "All staff have been highly encouraged to fully participate in the review."
The clinicians took issue with that stance, saying the inspection was prompted by the results of a recent visit by investigators from the VA central office and the regional office in Pittsburgh.
The Phoenix VA director issued a written statement inviting the IG to investigate following stories on the reported delays in Gannett's Arizona Republic and an explosive Apr. 9 hearing in the House Committee on Veterans Affairs. In its interim report, the IG said it went to Phoenix in response to hotline complaints, expanding it at the request of the committee chairman and embattled VA Secretary Eric Shinseki following the hearing.
Shinseki placed the entire Phoenix medical system leadership on administrative leave late Wednesday.
At Phoenix, investigators found that about 1,400 patients were on the approved electronic waiting list for primary care appointments, but did not have one. It also found an additional 1,700 patients who were waiting for an appointment, but were not on the list. Similar issues are affecting patients in the Wilmington system, the clinicians said.
For instance, they said, patients are typically booked for appointments up to three months in advance, while others are placed on a separate electronic wait list called the Recall Reminder System, in which a patient is sent a letter, six months to a year out, reminding them to make an annual appointment.
"It's rampant, it's huge," the nurse said. "It's a Ponzi scheme. A complete Ponzi scheme."
Neither could say who at Wilmington is making those decisions.