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Latest insult to U.S. veterans: Wait times for medical care

Emergency room visits can take twice as long

By Kellan Howell
The Washington Times
Wednesday, May 7, 2014

By the government's own estimate just last month, the average American waits about 26 minutes in a hospital emergency room before being treated. But on average, war veterans must wait twice that long for the same care at Veterans Affairs hospital centers, and a string of internal investigations suggests the ER wait times for retired troops frequently can last hours.

The disparity, documented in a Washington Times review of VA and Medicare records, is raising questions about why Americans who have given all to serve the country can't get the same speedy care from the VA that they would if they went to local hospitals. Sometimes, the consequences of delayed treatment can be fatal.

"By the department's own count, the deaths of at least 23 veterans throughout the country have been linked to delays in VA medical care," said Jeff Miller, Florida Republican and chairman of the House Committee on Veterans' Affairs. "This is proof that the department's system for ensuring veterans receive timely appointments is in dire need of an overhaul."

Veterans advocate groups are echoing Mr. Miller's concerns.

"No veteran should ever have to wait for emergency care at any VA medical facility," said Joe Davis, a spokesman for Veterans of Foreign Wars.

The VA says its standard wait time for veterans to see emergency room doctors is one hour, but it refused to release hospital-by-hospital data showing the actual wait times for veterans when requested by The Washington Times. Even the Center for Medicare and Medicaid Services, which oversees the federal government's health care programs, couldn't get the data for its national database.

The reason may be that the wait times could be much longer, according to The Times' review of eight recent VA inspector general reports, which documented that average waits at VA emergency rooms can be as long as 10 hours.

According to research from the Department of Veterans Affairs, a nurse or doctor gives veterans a quick emergency room evaluation in an average of 12 minutes. But the average time a veteran must wait to be treated formally by a doctor is approximately 50 minutes.

However, several inspector general reports have indicated that the wait is much longer than average at certain facilities.

The department has set a target of averaging less than 10 percent of patients with a six-hour length of stay at emergency rooms.

A recent inspector general investigation of a VA facility in Las Vegas found that up to 25 percent of patients experienced a length of stay of more than six hours on all but one of the days in a week monitored.

Although the less than 10 percent target rate has been met in Denver, some veterans are spending over eight hours in the emergency department before they are discharged, transferred or admitted to the hospital for treatment.

During a 2011 investigation, the watchdog found that a majority of ER patients had an average length of stay exceeding nine hours at a facility in Memphis, Tennessee, and roughly 27 percent of veterans spent over six hours in the emergency room.

The Times uncovered eight inspector general reports citing patients' complaints of excessive ER wait times at VA hospitals in Las Vegas; Memphis; Denver; Chicago; Baltimore; Columbia, South Carolina; Northport, New York; and Dallas.

Breaking an extended media silence on the controversy, Veterans Affairs Secretary Eric K. Shinseki told NBC News Wednesday evening that he was "angry" at the reports of VA hospital deaths, but insisted his department was working hard to fix any problems.

"I offer my condolences — to these families — for anyone who's lost a veteran, any unexpected death in one of our facilities," said Mr. Shinseki, a former Army general and Vietnam veteran. "What I want veterans to know ... is that this is a good quality health care system."

The White House has stood by the VA secretary, and Mr. Shinseki said Wednesday night that he had no plans to step down.

"We're going to do something about it, to get to the bottom of it and to the best of our abilities to assure it never happens again," he said.

Claims of falsified data

Several reports that have surfaced suggest that some facilities have been falsifying data to cover up excessive average wait times for scheduled appointments.

The Austin American-Statesman in Texas reported that a scheduling clerk accused VA officials in Austin and San Antonio of manipulating medical appointment data in an attempt to conceal long wait times to see doctors and psychiatrists.

The employee, who is seeking whistleblower protection, said he and others were "verbally directed by lead clerks, supervisors and during training" to ensure that wait times at the Austin VA Outpatient Clinic and the North Central Federal Clinic in San Antonio were "as close to zero days as possible," according to the report.

In reality, the clerk said, wait times for appointments could be as long as three months. The department's goal wait time is less than 14 days. The latest accusation echoes reports about VA facilities in Colorado and Arizona, where officials also are accused of manipulating data to show shorter wait times.

A retired doctor at the Phoenix VA facility told CNN that more than 40 veterans died while waiting for appointments.

Three top officials at the Phoenix hospital were put on leave and the inspector general is investigating a reported secret waiting list on which the 40 veterans supposedly were placed.

Officials at the facility denied having a secret waiting list.

"We have never instructed our staff to create a secret list, to maintain a secret list, to shred a secret list — that has never come from our office as far as instruction to our staff," Dr. Darren G. Deering, chief of staff, told CNN, but the whistleblower stands by the charges.

Mr. Miller said the VA should solve these issues by referring some patients to other physicians.

"Sadly, VA is not using as often as it should a very simple tool at its disposal to help eliminate these delays and provide veterans care if the department doesn't have the capacity to do so in house, which is to pay for veterans to see private health care providers — something called fee-based care. So whether we're talking about allegations of secret lists, data manipulation or actual lists of interminable waits, the question VA leaders must answer is, 'Why isn't the department using the tools it has been given — fee-based care being one of them — to ensure veterans receive timely medical care?'"

More protection urged

Although improvements have been made at most facilities after the inspector general investigations, some critics say the watchdog office has not done enough to protect veterans from a system that they say mistreats and ignores them.

"Although the VA has an inspector general, we feel that given the controversial allegations that have recently come to light this position is arguably akin to asking the fox to guard the henhouse," William A. Thien, VWF commander in chief, said in a statement Friday.

Mr. Thien said the incident in Phoenix was the result of a failure in leadership and said the VFW would be scrutinizing procedures at VA facilities.

"This tragic breach of trust doesn't lie with doctors or nurses, but with the bureaucrats who are safely entrenched within the system. It's time to eliminate the bonuses, fat paychecks and positions of those who would violate this most sacred trust. It is paramount that Eric Shinseki move immediately to ensure measures are put in place to reestablish the credibility of the entire VA health care system and importantly, that of the office of the secretary of VA," Mr. Thien said.

Congressional lawmakers and major veterans groups including the American Legion and Concerned Veterans for America have called for Mr. Shinseki to step down after the revelations of the department's health care failings.

"The president needs to find a new leader to lead this organization out of the wilderness, and back to providing the service our veterans deserve," Sen. John Cornyn, Texas Republican, said in a statement Tuesday.

Howell, K. (2014, May 7). Latest insult to U.S. veterans: Wait times for medical care. The Washington Times. Retrieved from http://p.washingtontimes.com/news/2014/may/7/veterans-wait-longer-for-ca... May 8, 2014.