Veterans Affairs employees in Norfolk, Nebraska, were trying to “do the right thing” when they jotted down the names and phone numbers of veterans interested in a new type of eye exam.
But the employees’ use of an unauthorized waiting list violated Department of Veterans Affairs rules and led to disciplinary action against several employees at a Norfolk VA medical clinic.
Don Burman, director of the VA Nebraska-Western Iowa Health Care System, said he received an anonymous tip in early November about a “secret” waiting list for a new program, called technology-based eye care services. Within days, VA investigators from outside the clinic found a folder with names and addresses of 56 veterans seeking the care in a locked drawer at the Norfolk Community-Based Outreach Clinic.
Burman would not say how many employees were disciplined or what punishments they received. He said 19 clinic employees were retrained in the use of the VA’s official electronic waiting list.
“They were trying to do the right thing, but they were doing it in the wrong way,” Burman said. “We identified it, we took swift action, and we corrected it.”
The discovery in Norfolk followed revelations by The World-Herald in October that hundreds of veterans referred for psychotherapy treatments at the Omaha VA hospital had received delayed care, or none at all, after their names were placed on an off-the-books spreadsheet. The unauthorized lists dated back to at least 2006, according to an internal investigation, and were stopped in 2015 but were restarted in early 2017. At least three former managers in the hospital’s mental health department left the VA after the list was discovered.
Such lists became toxic across the Department of Veterans Affairs after a series of reports, centered on the Phoenix VA health care system, surfaced in 2014. Those reports showed that hundreds of veterans had languished on secret lists for months while waiting to be seen by VA doctors. Some of those veterans died.
The fallout from the psychotherapy list in Omaha prompted Burman to write a memo to staff at the Omaha VA hospital, and to all the system’s clinics across Nebraska and Western Iowa. His message: He wanted nothing even faintly resembling an unauthorized list.
The issue at the Norfolk clinic arose in early September, when brochures for the new eye program were placed in the lobby. The program allows veterans to come into the clinic for examination with a new machine that takes photographs and measures pressure inside the eyes. The scan can then be reviewed by an ophthalmologist at another clinic for serious vision problems including cataracts, glaucoma, macular degeneration and diabetes-related blindness.
The addition of such eye services is welcome in Norfolk, said Gregg Hanson, Madison County veterans service officer. Until now, northeast Nebraska veterans typically had to drive to Omaha or other distant clinics for care.
“That’s a good thing, if it’s supposed to happen,” Hanson said. “It’s not a good thing if there’s a (unauthorized) list.”
The brochures quickly began to generate calls. But the eye care equipment didn’t arrive on time, Burman said, and no technician had been trained in how to use it.
So the Norfolk staff began taking the names and phone numbers of veterans who wanted to use the service and put them in a folder, according to the summary of an investigative report released to The World-Herald. That violated VA rules, which state that only a single, approved computerized list may be used for prospective VA patients.
“What they should have done was refer them where the program actually is being done now (in Lincoln and Grand Island),” Burman said. They could also have offered them a chance to get the service at a private eye clinic through the Veterans Choice program, he said. Created in 2014, Veterans Choice gives vets a private-sector option if care isn’t available near their home or if the wait time will be longer than 30 days.
Staff weren’t permitted to take the veterans’ names and offer to call them back when the care became available, even though that was the option requested by veterans whose names were on the unauthorized list.
Burman launched the investigation Nov. 8. A Norfolk manager — whose name was redacted from the report — told investigators she had instructed the staff to stop using the ophthalmology folder after receiving Burman’s memo but did not order the folder destroyed. The names were not transferred to an “authorized” list, either.
“My tolerance level for a secret list was not very high,” Burman said. “The person who was involved should have known.”
After investigators sent by Burman to Norfolk found the list, a supervisor returned the following week with orders that all veterans whose names were in the folder be contacted by Nov. 17 and offered eye care at another VA clinic, or an opportunity to schedule an appointment at a non-VA clinic.
The report said 33 of the veterans chose non-VA care. Others used another VA clinic or declined care.
Teresa Forbes, a VA spokeswoman, said technology-based eye care services aren’t yet available at the Norfolk clinic. The equipment to perform the tests is now there, and the VA is recruiting a technician who will be trained to operate it.