Arizona Eagletarian

Arizona Eagletarian

Tuesday, April 29, 2014

Phoenix VA Medical Center -- time to weigh in on the controversy UPDATED 10:00 pm MST 4-30-14

Today, three members of Arizona's Republican Congressional delegation sent letters to Veterans Affairs Secretary Erik Shinseki and Phoenix VA medical center director Sharon Helman calling for Helman's resignation.
"Under your leadership, a ‘secret list’ or second set of books was kept, holding the official number of days that veterans waited for service artificially low.  Because of you and your leadership team’s choices, over forty veterans have died due to lack of care," the letter reads.
"The mistakes made by the PVAHCS cannot be undone, and drastic changes need to be made to ensure that this never happens again.  In order to begin to restore faith in the veteran’s health care system, department executives who were aware of and presided over this unethical and alarming mismanagement must be held accountable," the letter continues. "It is for this reason we demand that you and the leadership team at PVAHCS resign from all leadership positions."
Of course, Helman has been interviewed by Arizona Republic reporters, on camera, denying the allegations. I cannot say to what degree the specifics in Schweikert's letter are complete and factual but I know that the Congressman has specific information from veterans [disclosure: including me, because I live in the district he represents and have required the assistance of his constituent services staff to resolve several problems at the Phoenix VAMC over the last 6 to 8 months and less frequently prior to that] that he is not at liberty to disclose publicly at this time.

Among the allegations detailed in the Arizona Republic's investigation, having appointments cancelled and not rescheduled -- with no notice given to the veteran -- has happened to me.
 Whistle-blowers allege a common practice of "scrubbing," or canceling patient appointments and not rescheduling, with wait times erased from databases.
Deering said "scrubbing" is an effective and approved administrative tool. He said providers contact patients several days before a planned appointment and ask about their needs. For example, if a prescription refill can be handled without a doctor visit, it saves the patient time and opens a spot for another vet.
"If there are things that can be handled by telephone care, we try to encourage that. ... I think multiple staff may be sharing what they perceive as us doing something inappropriate" even though it's a helpful practice, Deering said.
Dr. Deering's "response" to this allegation is subterfuge. The description of the practice he gave is unrelated to the allegation made by the whistleblowers. Giving him the benefit of the doubt, the best that could be is incompetence on his part -- not knowing what his staff is doing. At worst, it's a deliberate act of deception to mislead reporters, veterans, Congress and the public about the scope of the problem.

Again, this happened to me. An annual cardiology appointment I had set in January 2013 for early January 2014 was cancelled at the beginning of April 2013. Because the VA has an electronic system for veterans to track their appointments (as well as request Rx refills and look at test results), I started asking, in September 2013 what had happened to my January 2014 appointment. After I asked several people at the Phoenix VAMC, including the Patient Advocate, to figure out what happened and to fix it, with NO response from any of them, I finally had to contact Schweikert's office. Only then did the VA reschedule the appointment.

It's not fair to Congressional staff nor for any veteran for the VA to require this intervention to resolve every issue.

A brother-in-arms and fellow Democratic activist has expressed deep concern about what looks to some like a partisan witchhunt. He commented (online, to one of the Republic's stories on the subject) a short time ago:

The Arizona Veterans Community deserves better than a group of never served, budget cutting ideologues who have done nothing but vote against Veterans every step of the way.
Arizona Veterans should be demanding a comprehensive examination of all the facts, a nonpartisan review, and transparent resolutions which improve the outcomes for all the VA stakeholders.
On these points, he is absolutely correct. However, that does not change the facts of the situation and that an immediate change in leadership at the Phoenix VAMC is required. In order to implement the necessary procedural changes, that comprehensive examination of all facts is of the utmost importance.

But allowing executive leadership -- which has personally profited (by way of pay bonuses) from the institutionalized deception -- is unconscionable and completely unacceptable.

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The Phoenix VAMC main campus sits in Arizona's Ninth Congressional District. Thus, it is most reasonable to expect the person who holds that seat to exercise leadership in getting to the bottom of this situation and fixing it.

That Congresswoman, Kyrsten Sinema, an attorney and social worker by profession prior to her election to represent the Ninth District, last week wrote the following (in pertinent part) to VA secretary Shinseki,
Did in fact, 40 veterans die as a result of delays in care?  Did the PVAHCS intentionally misrepresent wait times? Were there two lists as asserted by Dr. Foote and is this practice still in use? What is the actual wait time for care at the PVAHCS?  Arizona veterans and their families deserve answers to these questions, and the individuals responsible for misconduct must be held accountable.
Again, we request a response to these allegations and swift action to ensure that Arizona veterans have timely access to the best possible care.  Thank you for your attention to this matter and we look forward to your prompt response.

First, let me say that I certainly appreciate Sinema's request for swift action and response to her letter.

However, for an attorney and social worker who should have some clue as to how to ask probing questions that would elicit more than just a yes or no answer, the questions she asked are ANEMIC and seemingly impotent. That's not what I would characterize as leadership from an attorney who represents everyday Arizonans.

Here's the answers that Sinema can expect to her questions, without even so much as Helman having to tap dance around them. 1) No;  2) No; 3) No. In fact, I have no idea what Dr. Foote is talking about; 4) Two weeks, of course.

The question about wait time is negligently vague. Wait times for what kind of care? There is a wide range of situations, with a range of degrees of urgency, which will all have different wait times, if they actually keep track.

Can you think of any open ended question that might get Helman to spill the beans with more than a simple, one-word response of "no" regarding Dr. Foote's claims of fraudulent wait time lists?

I asked Sinema's staff about this. Mary answered the phone when I called right before the end of posted office hours. Mary said the first and last word on the subject could only come from Janey Pearl. Janey was not in the office today but MIGHT respond to email.

Here's what I got from Ms. Pearl:
Hi Steve, I'm driving and away from my computer right now. Our letter is also on our website, under the release section. Sinema.house.gov. Thank you!
Janey Pearl
Communications Director
Congresswoman Kyrsten Sinema
Not only did Sinema get upstaged by three Republican Congressmen in Arizona, but also last week, Democratic Maricopa County Supervisor Mary Rose Wilcox, who is competing in the CD7 primary with state Sen. Steve Gallardo and (Marine veteran and former state Rep.) Ruben Gallego succeeded in getting a little bit of earned media calling for hearings as did 2012 CD9 Republican primary candidate Martin Sepulveda.

I can say with a good bit of confidence that when Harry Mitchell represented me in Congress, he took a back seat to NO ONE in advocating for Arizona veterans and keeping an eye on the Phoenix VA Medical Center.

I seriously hope that Sinema steps up and gets with the program here and does so VERY soon.

Until then, Phoenix area veterans need an immediate change in executive leadership in the local medical center. Then, to fully identify all of the steps that must be taken to remedy the deep dysfunction locally, the comprehensive, nonpartisan investigation must take place on an expedited basis.

I don't know that either Schweikert, Franks or Salmon will have any serious opposition in this year's election, but I thank them for speaking up on this issue. I'd love to be able to press them further for adequate funding to implement all of the solutions necessary. In the meantime, they need to also denounce the horrendously disastrous budget cutting that their buddy Paul Ryan has been and is still all about.

UPDATE 4-30-14

Today Congresswoman Sinema joined with Republican Congressman Matt Salmon to offer an amendment to HR 4486 to transfer $1 million from VA administration funding to specify it will be for the VA Office of the Inspector General.

From Sinema's press release dated today:
"The recent allegations of secret lists and long wait times at the Phoenix VA, which may have caused some 40 veteran deaths, require answers and action. This is immoral, unconscionable, irresponsible and un-American. We need answers in Phoenix but this is not an isolated incident. Stories of health complications and deaths because of wait times have surfaced in other places around the country including South Carolina and Texas," said Congresswoman Sinema.
In introducing her amendment, Sinema gave the following remarks for the Congressional Record:

2 comments:

  1. Sinema passed legislation on this. I'd say that's "getting with the program".

    http://sinema.house.gov/index.cfm/press-releases?ID=E4DC4CDE-4DBA-435E-8976-5B2BBDA036B2

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  2. It's a start. There are and will be delays in getting this money to the VA Inspector General even after the bill is passed and signed into law.

    In the meantime, I received a bill in the mail today from a private specialist that said the VA declined his claim, even though my primary care doctor recommended the specialist in January and the VA fee basis office (the bureaucracy that is supposed to handle the situation so that those doctors get paid) authorized it in February. And that is only PART of the story.

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