The inspector general for the U.S. Department of Veterans Affairs reported Wednesday that at least 1,700 veterans at the agency's medical center in Phoenix were not registered on the proper waiting list to see doctors, meaning veterans "continue to be at risk of being forgotten or lost" in the convoluted scheduling process.
All the while, the hospital falsely reported waiting times that suggested delays were minimal, the report said.
The report prompted several Republicans including Sen. John McCain of Arizona and Rep. Rick Crawford of Arkansas to call for the secretary of Veterans Affairs, Eric Shinseki, to step down.
"While our work is not complete, we have substantiated that significant delays in access to care negatively impacted the quality of care at this medical facility," Richard Griffin, the acting inspector general for the department, said in an interim report on his investigation into the Phoenix medical center.
Irregularities in how the 1,700 veterans' cases were handled, the report said, mean "these veterans may never obtain a requested or required clinical appointment."
Shinseki, who earlier this month put top administrators in Phoenix on leave, called the findings of the interim report "reprehensible" and promised to take immediate action.
Griffin, whose office is investigating dozens of Veterans Affairs medical facilities across the country, said he believes that "inappropriate scheduling practices are systemic throughout" the veterans health-care system.
At the same time, the most explosive allegation that has been made about the Phoenix facility -- that the deaths of as many as 40 veterans were linked to manipulated waiting lists -- was not addressed in the report Wednesday.
The report validates allegations raised by whistle-blowers and others that employees in Phoenix kept an off-the-books waiting list or used other artifices to cloak long waiting times that many veterans faced for medical care.
For example, the investigators from the inspector general's office reviewed a sample of 226 patients and found that they waited an average of 115 days for their first primary-care appointment at the medical center, but that their average waiting time was reported to the national Veterans Affairs office as being only 24 days.
The interim report did not dwell on the motivations for falsely reporting waiting times, nor did it single out any employees or hospital administrators by name.
But it stated that a "direct consequence" of the inappropriate waiting lists was that the medical center's leadership "significantly understated the time new patients waited for their primary care appointment" when it noted its performance-appraisal accomplishments for fiscal 2013, which was a factor considered for bonuses and salary increases.
Griffin said in the report that investigators were examining "whether any delay in scheduling a primary care appointment resulted in a delay in diagnosis or treatment, particularly for those veterans who died while on a waiting list." He said determinations could be made only after examining autopsy reports, death certificates and nonagency documents that are still being obtained and reviewed.
In Senate testimony this month, Griffin said investigators had examined the deaths of 17 veterans in Phoenix but so far had found no link between their deaths and the waiting lists.
In the report Wednesday, Griffin added that "when sufficient credible evidence is identified supporting a potential violation of criminal and/or civil law, we have contacted and are coordinating our efforts with the Department of Justice."
The release of the inspector general's report Wednesday increased the pressure on Shinseki to step down.
Rep. Jeff Miller, R-Fla., who is the chairman of the House Veterans Affairs Committee, said the report "confirmed beyond a shadow of a doubt what was becoming more obvious by the day: Wait-time schemes and data manipulation are systemic throughout VA and are putting veterans at risk in Phoenix and across the country."
Miller called on Shinseki to resign immediately, saying he "appears completely oblivious to the severity of the health-care challenges facing the department."
He also called on Attorney General Eric Holder to start a criminal investigation into what he called the "VA's widespread scheduling corruption."
Crawford, who last week said that he was reluctant to ask for the general's resignation, called on Shinseki to resign from his position Wednesday in a statement.
"It is with deep regret that I join my colleagues in both the House and Senate in calling for the resignation of General Eric Shinseki from his position as Secretary of Veterans Affairs. General Shinseki's service to his country is to be applauded. He has contributed selflessly to our nation's security for some four decades," the lawmaker from Jonesboro said.
"However, in light of the latest inspector general's report detailing the systemic and ongoing problems rampant in the VA Healthcare system, I do not believe General Shinseki can effectively implement the wholesale reforms necessary to make the VA the effective and efficient agency our veterans deserve," Crawford said.
McCain, who also had declined to call for Shinseki's resignation, added his voice to those demanding new leadership at the agency.
"I haven't said this before," McCain said Wednesday on CNN moments after the investigative report was released. "I think it's time for Gen. Shinseki to move on."
McCain's position is likely to carry a lot of weight in Washington, where he is viewed as a respected leader on veterans issues.
McCain, a former naval aviator, was captured and tortured for five years by the Vietnamese during the Vietnam War.
McCain said on CNN that he had intended to wait to comment on Shinseki's future until further hearings were held on the VA issue. But after hearing about the report Wednesday, he decided to speak out.
"I think it's reached that point," he said. "This keeps piling up."
The Pentagon announced late Tuesday that Defense Secretary Chuck Hagel has ordered a 90-day review of the entire military health-care system in response to the allegations of treatment delays at VA facilities. The review will assess the quality of the health care at military treatment facilities and care the department buys from civilian providers, spokesman Rear Adm. John Kirby said.
Meanwhile, the chief of Womack Army Medical Center at Fort Bragg, N.C., was relieved of his command because of problems with patient care there, and three deputies were suspended, the Army said in a statement.
The shake-up comes after two deaths this month of patients in their 20s and problems with infection control at the facility that were pointed out in March by a hospital accreditation group, two defense officials said. They spoke on condition of anonymity because they were not authorized to discuss the matter publicly.
A meeting was held at Womack to introduce staff members to their new commander after the Army relieved Col. Steven Brewster of his position, the defense officials said.
"Senior Army medical leaders have lost trust and confidence in the commander ... to address the changes needed to maintain a high level of patient care," the Army statement said. Suspended were the deputy commanders for clinical services, nursing and administration, the Army said.
Problems at Womack have been developing for some time. It had a higher-than-expected rate of surgical complications in recent years and in March suspended elective surgery for two days after inspectors found problems with infection-control procedures, one of the defense officials said.
The military health-care system is separate from the one for veterans. The Pentagon system serves some 9.6 million active-duty troops and their family members, as well as retirees.
The VA health system serves 9 million veterans who were not long-term career troops.
Information for this article was contributed by Richard A. Oppel Jr. and Michael D. Shear of The New York Times; by Pauline Jelinek of The Associated Press; and by Sarah D. Wire of the Arkansas Democrat-Gazette.
A Section on 05/29/2014