A fatal wait: Veterans languish and die on a VA hospital’s secret list
By Scott Bronstein and Drew Griffin, CNN Investigations
April 24, 2014 — Updated 1315 GMT (2115 HKT)
At least 40 U.S. veterans died waiting for appointments at the Phoenix Veterans Affairs Health Care system, many of whom were placed on a secret waiting list.
The secret list was part of an elaborate scheme designed by Veterans Affairs managers in Phoenix who were trying to hide that 1,400 to 1,600 sick veterans were forced to wait months to see a doctor, according to a recently retired top VA doctor and several high-level sources.
For six months, CNN has been reporting on extended delays in health care appointments suffered by veterans across the country and who died while waiting for appointments and care. But the new revelations about the Phoenix VA are perhaps the most disturbing and striking to come to light thus far.
Internal e-mails obtained by CNN show that top management at the VA hospital in Arizona knew about the practice and even defended it.
Dr. Sam Foote just retired after spending 24 years with the VA system in Phoenix. The veteran doctor told CNN in an exclusive interview that the Phoenix VA works off two lists for patient appointments:
There’s an “official” list that’s shared with officials in Washington and shows the VA has been providing timely appointments, which Foote calls a sham list. And then there’s the real list that’s hidden from outsiders, where wait times can last more than a year.
Deliberate scheme, shredded evidence
“The scheme was deliberately put in place to avoid the VA’s own internal rules,” said Foote in Phoenix. “They developed the secret waiting list,” said Foote, a respected local physician.
The VA requires its hospitals to provide care to patients in a timely manner, typically within 14 to 30 days, Foote said.
According to Foote, the elaborate scheme in Phoenix involved shredding evidence to hide the long list of veterans waiting for appointments and care. Officials at the VA, Foote says, instructed their staff to not actually make doctor’s appointments for veterans within the computer system.
Instead, Foote says, when a veteran comes in seeking an appointment, “they enter information into the computer and do a screen capture hard copy printout. They then do not save what was put into the computer so there’s no record that you were ever here,” he said.
According to Foote, the information was gathered on the secret electronic list and then the information that would show when veterans first began waiting for an appointment was actually destroyed.
“That hard copy, if you will, that has the patient demographic information is then taken and placed onto a secret electronic waiting list, and then the data that is on that paper is shredded,” Foote said.
“So the only record that you have ever been there requesting care was on that secret list,” he said. “And they wouldn’t take you off that secret list until you had an appointment time that was less than 14 days so it would give the appearance that they were improving greatly the waiting times, when in fact they were not.”
Foote estimates right now the number of veterans waiting on the “secret list” to see a primary care physician is somewhere between 1,400 and 1,600.
Doctor: It’s a ‘frustrated’ staff
“I feel very sorry for the people who work at the Phoenix VA,” said Foote. “They’re all frustrated. They’re all upset. They all wish they could leave ’cause they know what they’re doing is wrong.
“But they have families, they have mortgages and if they speak out or say anything to anybody about it, they will be fired and they know that.”
Several other high-level VA staff confirmed Foote’s description to CNN and confirmed this is exactly how the secret list works in Phoenix.
Foote says the Phoenix wait times reported back to Washington were entirely fictitious. “So then when they did that, they would report to Washington, ‘Oh yeah. We’re makin’ our appointments within — within 10 days, within the 14-day frame,’ when in reality it had been six, nine, in some cases 21 months,” he said.
November: A dire situation in South Carolina
In the case of 71-year-old Navy veteran Thomas Breen, the wait on the secret list ended much sooner.
“We had noticed that he started to have bleeding in his urine,” said Teddy Barnes-Breen, his son. “So I was like, ‘Listen, we gotta get you to the doctor.’ “
Teddy says his Brooklyn-raised father was so proud of his military service that he would go nowhere but the VA for treatment. On September 28, 2013, with blood in his urine and a history of cancer, Teddy and his wife, Sally, rushed his father to the Phoenix VA emergency room, where he was examined and sent home to wait.
“They wrote on his chart that it was urgent,” said Sally, her father-in-law’s main caretaker. The family has obtained the chart from the VA that clearly states the “urgency” as “one week” for Breen to see a primary care doctor or at least a urologist, for the concerns about the blood in the urine.
“And they sent him home,” says Teddy, incredulously.
Sally and Teddy say Thomas Breen was given an appointment with a rheumatologist to look at his prosthetic leg but was given no appointment for the main reason he went in.
The Breens wait … and wait … and wait …
No one called from the VA with a primary care appointment. Sally says she and her father-in-law called “numerous times” in an effort to try to get an urgent appointment for him. She says the response they got was less than helpful.
“Well, you know, we have other patients that are critical as well,” Sally says she was told. “It’s a seven-month waiting list. And you’re gonna have to have patience.”
Sally says she kept calling, day after day, from late September to October. She kept up the calls through November. But then she no longer had reason to call.
Thomas Breen died on November 30. The death certificate shows that he died from Stage 4 bladder cancer. Months after the initial visit, Sally says she finally did get a call.
“They called me December 6. He’s dead already.”
Sally says the VA official told her, “We finally have that appointment. We have a primary for him.’ I said, ‘Really, you’re a little too late, sweetheart.’ “
Sally says her father-in-law realized toward the end he was not getting the care he needed.
“At the end is when he suffered. He screamed. He cried. And that’s somethin’ I’d never seen him do before, was cry. Never. Never. He cried in the kitchen right here. ‘Don’t let me die.’ “
Teddy added his father said: “Why is this happening to me? Why won’t anybody help me?”
Teddy added: “They didn’t do the right thing.” Sally said: “No. They neglected Pop.”
First hidden — and then removed
Foote says Breen is a perfect example of a veteran who needed an urgent appointment with a primary doctor and who was instead put on the secret waiting list — where he remained hidden.
Foote adds that when veterans waiting on the secret list die, they are simply removed.
“They could just remove you from that list, and there’s no record that you ever came to the VA and presented for care. … It’s pretty sad.”
Foote said that the number of dead veterans who died waiting for care is at least 40.
“That’s correct. The number’s actually higher. … I would say that 40, there’s more than that that I know of, but 40’s probably a good number.”
CNN has obtained e-mails from July 2013 showing that top management, including Phoenix VA Director Sharon Helman, was well-aware about the actual wait times, knew about the electronic off-the-books list and even defended its use to her staff.
“Clerks scheduling medical appointments for veterans were ‘cooking the books’ at their bosses’ behest to hide the fact some had to wait weeks, if not months, for appointments, a VA scheduler in San Antonio said Thursday…The allegations surrounding this Texas VA hospital comes as the federal department fends off claims of potentially deadly delays at other facilities, including claims of a secret wait list in Phoenix…” In response, the VA has now ordered a “face-to-face audit” of all clinics across the country. Watch the American Legion’s response to the allegations. [CNN]