Investigation: VA wait times posed health risk
As many as 450 veterans at the Orlando VA Medical Center faced long wait times for endoscopy procedures, including colonoscopies, and the center failed to refer them to community providers, potentially endangering the veterans’ health, according to a federal watchdog group.
The allegations were filed more than a year ago with the U.S. Office of Special Counsel by anonymous whistleblowers. The office is an independent federal agency in Washington, D.C., specializing in whistleblower disclosures and protecting federal whistleblowers against retaliation.
The Counsel referred the allegations to the Department of Veterans Affairs last February, which then conducted its own investigation in March, confirming the allegations and noting “that a substantial and specific danger to public health and safety exists at Orlando,” Secretary Robert Wilkie wrote in a letter to the Special Counsel in August.
Following the investigation, the VA asked the Orlando VA to find the root causes of delays and take corrective action to make sure high-risk veterans get timely colonoscopies. It also asked Orlando VA to look for an inadvertent increase in wait times and to conduct leadership reviews at the gastroenterology department to ensure compliance with VA policies.
“We appreciate the Office of Special Counsel’s (OSC) oversight. VA has reviewed extensively the issues OSC raised, and the Orlando VA Medical Center developed an action plan to address all recommendations,” said Heather Frebe, a spokeswoman with the Orlando VA Medical Center. “Orlando VAMC has been making progress on these efforts accord-
to the timeline established in its plan.”
Frebe did not share what specific actions the Orlando VA has taken.
Deciding that the Orlando VA has addressed the issues adequately, the Special Counsel closed the case on Wednesday and sent a summary report to President Trump and Congress. The Special Counsel will also send copies of the letter to the chairmen and ranking members of the Senate and House Committees on Veterans Affairs.
“Any additional followup actions would need to be taken by Congress,” said a Special Counsel spokesman in an email.
Wait times at VA facilities became a central issue for the agency more than four years ago, after a scandal at the Phoenix VA. A recent study showed that on average, wait times at the VA are similar to the private sector, but since 2014, there have been improvements in VA wait times, while there hasn’t been a noticeable change in the private sector.
The Orlando VA whistleblowers’ allegations filed with the Special Counsel and substantiated by the Department of Veterans Affairs said that:
The acting Chief of Medicine specifically instructed gastroenterology staff to not use community care, such as the Veterans Choice Program, which allows veterans in VA health care to go to community providers, especially when they have to wait more than 30 days or travel more than 40 miles for an appointment.
453 veterans at the Orlando VA Medical Center were waiting for an endoscopy procedure at the facility with wait times exceeding 30 days.
Orlando VA failed to offer veterans access to community care when wait times were more than 30 days, potentially violating the Choice Act of 2014.
In an effort to reduce VA wait times, the Trump administration is planning to increase veterans’ access to the private sector as part of the Mission Act, which was passed last year and scheduled to go into effect this year. Mission Act will replace the VA Choice Program.
The VA’s investigation of Orlando VA Medical Center also found that the rate of colonoscopy screenings for at-risk veterans within 180 days or less was going down, which increased the risk of delays in diagnosis and treatment of colorectal cancer, according to the Special Counsel.
“The report further acknowledged that the wait times between preliminary evaluations and colonoscopies appeared to be increasing, and thus, raising the risk for other medical conditions to worsen and complicate the ability to complete the colonoscopy,” the Special Counsel wrote in its letter to the president and the Congress.
The VA also concluded that the Orlando VA failed to follow the Choice Act rules, offering community care to only 222 of the 507 veterans on a waiting list for different types of endoscopy, including colonoscopy.
Since the investigation, the Orlando VA has contacted 245 additional veterans on the waiting list for endoscopy and has offered them community care, according to the Special Counsel.
During the investigation, the VA team also spoke with several employees at the Orlando VA, including the gasing troenterologists.
“The gastroenterologists we interviewed indicated that they were not aware of wait times from the screening appointment until the procedure date because they had no reason to know this information,” according to Wilkie’s letter to the Special Counsel.
According to the letter, one gastroenterologist told the VA team that the facility could conduct only about 12 specialty procedures a month — in comparison with 20 to 30 specialty procedure consults per week — and was concerned that the facility could not meet the potential demand. They also indicated that they were short two provides and had a limited number of anesthesiology staff, resulting in only using only three of the eight procedure rooms.
Following the site visit in March, the Orlando VA leadership reported to Wilkie that they had filled the two open positions by June.
“I have great admiration for the whistleblowers who brought this serious matter to our attention,” said Special Counsel Henry Kerner, in a statement. “Because of their intrepid allegiance to the VA’s mission, these disclosures ensure that veterans receive the care they deserve.”