Working the system at expense of veteran care

June 15, 2014

Rather than figure out how to meet the demand for care and comply with the policy, news reports and congressional committees indicate that staff members developed strategies to “game” the computer scheduling system to make it appear as though timely appointments were being given when such was not the case. How many veterans might have suffered some irreversible vision loss as a result of delays in eye care?

Dr. McDonnell

 

By Peter J. McDonnell, MD

My friend, Allan, a loyal reader of Ophthalmology Times, recently sent me an email message with the subject line entitled: “Moral Compass.” In it, he describes his experience as an ophthalmologist working, many years ago, in a medical clinic run by the government.

Finding himself with a lot of free time-because he was scheduled to see only two patients per hour, and not happy that so many patients were waiting up to 6 months to get an appointment-Allan adjusted his template to increase his patient volume by 50%. Two days later, Allan was reprimanded by the government official who oversaw the clinic for caring for more than the approved two patients per hour, and had his schedule cut back.

The sharing of this anecdote was occasioned by the ongoing scandal in which, it is alleged, employees of one or more Veterans Affairs (VA) hospitals came up with a plan to violate the policy of seeing patients within 2 weeks. Rather than figure out how to meet the demand for care and comply with the policy, news reports and congressional committees indicate that staff members developed strategies to “game” the computer scheduling system to make it appear as though timely appointments were being given when such was not the case. Tragically, if true, some 40 patients at a single hospital in the Southwest are alleged to have died as the result of their being denied timely appointments. Employees at other hospitals are coming forward with similar tales, including patients dying while waiting 6 months to see a cardiologist.

How many veterans might have suffered some irreversible vision loss as a result of delays in eye care?

 

What were they thinking?

The most brilliant actor in this play that I have read about so far is a Mr. Newman. This person was, until his recent firing, a VA employee who took it upon himself to write an email detailing how best to cheat, using the scheduling software, to make it appear that the patients were being scheduled within 2 weeks when they were not.

One has to wonder what goes through the minds of people who, in email messages, document the clever ways they are doing the wrong thing. Are they bad people? Are they simply people who don't agree with the rules and want to help others violate them also? Are they nincompoops who believe, despite all evidence to the contrary, that email messages today are “private”?

According to testimony at a recent senatorial subcommittee hearing, there are email messages from as long as 4 years ago describing this type of cheating. Rather than doing their best for their patients and providing great service in a timely manner, it seems that many will devote considerable time and effort to devise clever ways to shortchange patients without getting caught.

What is not so clever is documenting, for the world to see, one’s perfidy in an email message.

 

In Allan’s email, he concludes: “I do think many should go to jail.” Even worse, they should be ashamed for denying to their patients the timely medical care that military veterans of the wealthiest country on earth should expect.

Related references

http://www.thewire.com/politics/2014/05/congress-holds-a-hearing-on-a-real-scandal-the-va-hospital-delays/370940/

http://www.foxnews.com/politics/2014/05/10/gaming-system-email-reveals-how-wyo-va-workers-were-taught-to-fake-records/