Employees at the VA Nebraska-Western Iowa Health Care System kept an unauthorized, off-the-books waiting list for some Omaha mental health appointments, according to documents obtained by The World-Herald.
The secret list dodged requirements the Department of Veterans Affairs issued in July 2016 setting strict rules for establishing and maintaining waiting lists, according to a memo from the system’s compliance officer to Director Don Burman dated Aug. 11. The compliance officer’s audit included two whistleblower complaints made about lists for appointments at the VA’s mental health psychotherapy clinic in Omaha.
The VA declined to answer questions about the audit but issued a statement acknowledging the investigation and stating that no veterans were harmed.
“Although no adverse patient outcomes occurred, some veterans waited longer for psychotherapy treatment,” the statement said.
Local VA officials would not say how many local veterans were impacted, or why or by whom the lists were kept. Nor would they say how many employees were involved or what disciplinary action was taken against them.
“Employees involved with this situation were held accountable; however, none was terminated from employment,” the statement said. It said the situations brought to its attention had been fixed.
The unauthorized waiting list echoed a nationwide scandal that erupted in 2014 at the VA Medical Center in Phoenix, which showed that veterans there were dying while waiting months for medical care on lists that were kept secret.
In that case, an “official” list was shared with officials in Washington showing that the VA was providing timely appointments. But the real list, where wait times could exceed a year, was kept secret.
As a result, Congress that year created a program called Veterans Choice, through which a veteran who doesn’t get an appointment within 30 days or who lives more than 40 miles from a VA facility is entitled to visit a therapist outside the VA, at the VA’s expense.
The VA hasn’t disclosed how many of its health care systems used unofficial waiting lists, but USA Today in 2016 tallied the VA’s own investigative reports and found that schedule manipulation had been discovered at 40 medical facilities in 19 states and Puerto Rico.
Until recently, that tally had not included Nebraska.
The report obtained by The World-Herald is an audit conducted this year of the cases of 301 unnamed veterans from Nebraska and western Iowa who were added to the VA’s official electronic waiting list between August 2016 and August 2017.
The audit showed that 160 of the cases were handled within 30 days, and 92 were handled within 10 days. It also showed that 68 veterans were added to the electronic waiting list twice for the same psychotherapy consultation, and five were entered three times. The memo didn’t explain the significance of those findings.
The audit memo also includes several “observations” by the compliance officer, including that staffers appear to have delayed officially recording their first contacts with veterans. The memo said that “may indicate another document source was being used for tracking.”
The report also includes, but does not directly address, two whistleblower complaints.
In the first, dated April 29, 2015, an unnamed person called in to say that a VA mental health provider — whose name is redacted — kept a separate, apparently unofficial, waiting list. The caller alleged that the provider placed veterans referred by other departments ahead of those who called the mental health department directly, and told employees “they were to disregard the patients already waiting for appointments and get the consults seen so they could meet metrics.”
The caller also said the provider earned $59,400 in bonuses between 2012 and 2015, and that the bonuses were given because the unauthorized waiting list helped the provider meet performance measures. It’s unknown whether any attempt was made to recover those bonuses.
In the second complaint, a VA employee produced a copy of paper waiting lists dating back to Jan. 1, 2014, containing the names of about 400 veterans who had requested psychotherapy appointments. The employee said the unofficial logs are used in place of the electronic waiting list.
The employee said the VA established therapy groups in order to meet the VA’s standard of scheduling mental health appointments within 14 days. The employee said the veteran is asked to attend the group session to satisfy the requirement for a consultation. Then, as appointment times open, the patient is contacted and an appointment established or a message left.
Rep. Don Bacon, R-Neb., whose district includes the health care system’s Omaha headquarters, said he had not been informed of the audit until being contacted by The World-Herald. He then contacted Burman, who has been the Nebraska-Western Iowa VA director since February 2015.
Bacon said afterward that Burman would not disclose details of the waiting list or the disciplinary action against those who kept it, but Bacon said he was satisfied with the VA’s response.
“A fake list that masks true waiting times at the VA is appalling, but I am glad that outrage is shared by Director Burman,” Bacon said in a statement. “I am supportive of the measures taken by Director Burman, who swiftly acted when concerns were brought to his attention.”