Audit: Area VA staff ordered to change wait times
By Mary Troyan
Montgomery Advertiser
Monday, July 28, 2014

"This audit shows what we've suspected for some time: that the rampant scheduling manipulation in Central Alabama wasn't some misunderstanding, but rather a facility-led, standard operating procedure. And compared to other peer systems, Central Alabama's numbers are off the charts," said Rep. Martha Roby, R-Montgomery.

More than half the staff surveyed at Central Alabama Veterans Health Care System say they were instructed to change the dates of when a veteran asked for an appointment, according to an internal Veterans Affairs' audit.

By altering the date of the appointment request, a VA hospital or clinic can mask how long veterans have to wait to see a health care provider.

The unethical practice has been found at dozens of veterans' health facilities around the country, including CAVHCS, and investigations are underway.

The data released Monday by the VA to members of Congress is the first look at how common the practice is in each facility.

The VA surveyed thousands of employees at more than 900 VA health care sites over five days in May, just as the wait time scandal was developing.

In that survey, 57 percent at the Montgomery-based VA reported receiving "instruction" from their facility to enter a date other than the date the veteran first asked for the appointment. Nationally, it was 13 percent.

"This audit shows what we've suspected for some time: that the rampant scheduling manipulation in Central Alabama wasn't some misunderstanding, but rather a facility-led, standard operating procedure. And compared to other peer systems, Central Alabama's numbers are off the charts," said Rep. Martha Roby, R-Montgomery.

Roby, who has been critical of CAVHCS director James Talton, said the survey backs up what she's been hearing from whistleblowers contacting her office about wrongdoing. The audit says staff on the Montgomery campus were told verbally — in training and by supervisors — to record the next available appointment date as the date that the veteran requested.

"Evidence suggests that schedule manipulation isn't an accident at CAVHCS; it's an outcome expected by the administration," she said through a spokesman.

But even with manipulated dates, CAVHCS has been cited for unusually long wait times. In June, the VA reported that in central Alabama, veterans wait an average of at least two months to see a primary care doctor, specialist or mental health professional for the first time.

CAVHCS, which includes medical centers in Montgomery and Tuskegee, is one of 112 facilities that the VA has referred to its Office of Inspector General for further investigation.

VA officials are briefing congressional delegations this week about the issue of access in their local VA facilities. The data on Montgomery shows the facility has a worse problem than many other VA health centers in the region. For example, 9 percent of the staff at the Birmingham VA reported being told to change request dates for appointments, and it was about 17 percent in Tuscaloosa.

It also showed that one of the obstacles to getting veterans appointments more quickly is staffing. Asked to rank on a scale of 1 to 5 (1 equals never and 5 equals always) how often a lack of appointment slots for a health care provider affects a veteran's access to timely care, CAVHCS staff ranked it 4.3. The national average was 3.0, and Tuscaloosa was 2.3.

CAVHCS also gave itself the lowest customer service rating in the Southeastern region. Facilities in Atlanta, Augusta, Birmingham, Charleston, Columbia, Dublin and Tuscaloosa gave themselves an average of 3.8, with 5 meaning excellent and 1 meaning poor. CAVHCS staff rated itself at 2.7.

The VA audit also cites a specific concern on the Montgomery campus of CAVHCS of schedulers using unofficial paper wait lists instead of computerized appointment tracking, which is against VA policy.

Talton last month told Roby that three employees involved in manipulating the wait time data had been reassigned.

Efforts to reach a spokeswoman for CAVHCS Monday were unsuccessful.