New reports from the Department of Veterans Affairs Office of Inspector General have revealed evidence of wait time record manipulation at the VA hospitals in Manchester, New Hampshire and White River Junction, Vermont.
Multiple sources involved in scheduling veterans for appointments reported fudging numbers by offering veterans the first available appointment, rather than allowing the veteran to determine how soon they need to be seen. This allowed schedulers to show a wait time of "zero," when in fact veterans could have been waiting much longer to be seen.
Danielle Ocker is the director of the VA Medical Center in Manchester. She spoke with NHPR'sAll Things Considered host Peter Biello.
Thank you very much for joining me.
Well, thanks for having me. It’s important for us to be as transparent as we can. We recognize that this is an area that certainly could be concerning to our veterans and to our community members, and we really want to take the opportunity to be able to share all the work that’s been done in order to be able to address any of these concerns that occurred quite some time ago.
Seems like the most recent occurrence of this allegedly was in 2014, which is before the Veterans Choice Act went into effect, and we’ll get to that. But I wanted to start with the 14-day goal and have you help us understand that, because many of the allegations of wait time manipulation were based on this 14-day goal. What was this 14-day goal and who or what group of officials within the VA healthcare system made it a benchmark of success?
The 14-day goal was an effort for us to schedule patients and to see patients certainly as quickly as possible, and the idea behind the 14-day goal was that we would get patients scheduled timely and get them seen in the clinic.
As far as who specifically set that goal: I’m afraid I can’t really answer that question. It was a national goal. It was widely discussed throughout the VA community. And let me just explain that the idea of scheduling patients and seeing patients as quickly as possible really was the goal. It was never designed with the intent of doing anything other than really timely care and access to veterans.
And so people who were in charge of scheduling the veterans were aware of this goal and apparently before 2011, when they received instructions to the contrary, many schedulers were speaking to veterans and scheduling their appointments this way: They’d say, “I’m calling to schedule an appointment, this is what’s available. What would you like?” When in reality, they should have been saying, “I’m calling to schedule an appointment. When would you like to be seen?” And that was when the 14-day clock would start ticking.
That is correct. It would start ticking at the point at which the veteran identified that he or she wanted to be seen.
And there are several people in this report who report that they were instructed or perhaps pressured by their superiors to zero out these wait times by saying that the desired date was actually the one that was available when that may not have been the case. Why did that happen?
You know, I think it’s important to know that….so I came to Manchester in May of 2015.
Right. You came from White River Junction, Vermont, correct?
Correct, so—
And they were also experiencing almost identical problems with wait times with this 14-day goal.
I have not had the opportunity to look at any of the data from White River and I’m not in a position to really address the White River Junction data. What I can do is try to help understand sort of where it is we’re going in Manchester.
Back in 2011, when the goals were set, whether or not individuals felt pressured, I certainly have read that in the report, I think that there’s several actions that we have learned as a VA community over time, and those actions really are associated with how we set up systems so that our staff can, number one, schedule patients correctly, and I think number two, so that we have systems in place so that if there’s any need to report or to identify concerns to leadership, that we have a chance to provide them with that two-way dialogue with leadership.
So if a veteran calls the Manchester VA now and asks for a specific date, will the veteran be given that date?
If the veteran calls and asks for that specific date, we will go into the scheduling system and try to give them that date, if that date is available. If that date is not available, then we would negotiate a different date.
Veterans Choice went into effect shortly after the most recent of these allegations were made. To what extent has Veterans Choice eased long wait times at the Manchester VA?
What I can tell you is that it prevents us from creating a backlog today. I don’t want to predict on how it would have impacted in 2011, 2012, or 2013 because the Choice program wasn’t here in that time, but it certainly alleviates us from gaining a backlog today.
Under the system you described, it’s entirely possible that a veteran calling to make an appointment when these appointments were allegedly made incorrectly, that the veteran would never have known. The veteran doesn’t necessarily know the VA policy, and they may just think that being asked, “Here’s our available appointments—which do you want?” is perfectly acceptable, when in fact that wasn’t what was supposed to be happening. Do those veterans deserve an apology?
I think they do deserve an apology. I think on behalf of the Manchester VA Medical Center—we want to be absolutely sure that we are scheduling veterans in meaningful ways and getting them in to see their providers in the timeframes in which they want to be seen.
If you say veterans deserve an apology, from whom should that apology come?
Well, as the leader of this organization, I will offer an apology on behalf of the Manchester VA Medical Center. I have worked for the VA—not necessarily for Manchester—but I’ve worked for the VA for 31 years and I take this mission seriously. My father is a Vietnam Veteran and he seeks his care at a VA hospital. I will gladly offer an apology on behalf of the Manchester VA for any errors that we have made in the past and certainly, going forward, we’ll do everything in our power to continue to be above board and to always make the right decisions. But when we make a mistake, well, we will come back the next day and we will try twice as hard to make sure that mistake is not repeated.
