WASHINGTON -- Congressional critics are blasting Secretary of Veterans Affairs Eric Shinseki for new allegations of abuse in the VA system, but many of these same abuses are detailed in an 6-year-old internal VA memo that might as well be called, "How We're Cheating Veterans."
The memo, written in 2008 by a team of VA managers, lists 25 ways that VA scheduling clerks were cooking the books to make it appear that veterans waiting for medical care actually were being seen on time -- when in fact they were being made to wait weeks or months.
At the VA medical center in Phoenix, former employees have alleged that as many as 40 ailing veterans may have died while waiting for medical care. At a Senate hearing Thursday, Shinseki, a twice-wounded Vietnam veteran who has led the VA since early 2009 after retiring as U.S. Army chief of staff, said such an allegation "makes me mad as hell."
But he parried demands from Republicans and Democrats alike that he take immediate action, insisting that everyone wait for the findings of internal investigations he has set in motion. And he politely insisted he would not resign.
"I came here to make things better for veterans," he said. "Over the past five years we've done a lot to make things better. We are not done yet. I intend to continue the mission until I have satisfied that goal or I'm told by my commander in chief that my time has been served."
That wasn't good enough for Republican and Democratic members of the Senate Veterans Committee, who seemed equally mad as hell that no one seemed to have done anything to correct long-standing abuses in the VA's scheduling procedures.
"If the VA had asked hard questions," Sen. Richard Burr (R-N.C.) thundered, "we would not be here today." He charged Shinseki with failing to act, causing "patient harm and patient death."
Sen. Patty Murray (D-Wash.) lectured Shinseki that scheduling abuses have gone on far too long. "There are problems we know exist and there is no reason for the department to wait before acting on the larger problem," she said. "The "intimidation and cover-ups … are inexcusable."
"We've come to the point where we need more than good intentions."
Since the allegations arose last month that veterans were forced to wait months for appointments at the Phoenix VA medical center and that VA officials were covering up the problem, Shinseki said he has asked the VA's inspector general to investigate. He said he has also launched an intense investigation of scheduling practices at the VA's other 151 medical centers. That initiative, he said Thursday, has already turned up evidence that compliance with VA regulations "is under question."
The committee chairman, Sen. Bernie Sanders (I-Vt.), pounced. "Are people cooking the books?" he demanded.
"I'm not aware that, other than a number of isolated cases where there is evidence of that," Shinseki replied. "It behooves us to take a thorough look."
"If these allegations are true, they are completely unacceptable -- to veterans, to me and to our dedicated VHA [Veterans Health Administration] employees," Shinseki continued. If the claims are substantiated by the investigations, he promised, "responsible and timely action will be taken."
Shinseki said the VA removes roughly 3,000 employees each year for poor performance or misconduct -- not necessarily related to scheduling abuses. The total VA workforce is over 300,000.
But scheduling abuses have been detailed time and again over the past years. Murray, who chaired the Senate Veterans Committee until two years ago, said she asked at a hearing in November 2011 whether VA schedulers were "gaming the system." She was told, she said, that the VA was unaware of any such allegations. By 2012, she continued, VA officials were conceding that scheduling abuses were so pervasive throughout the VA that as soon as new regulations were being issued, VA employees were tearing them apart to see how they could be gamed.
"The standard practice at VA seems to be to hide the truth in order to look good," Murray said.
Much of the trouble appears to stem from Shinseki's efforts to make sure veterans are seen by medical and mental health specialists on time. To that end he has instituted iron-clad reporting requirements that veterans be seen within 30 days and in some cases, within two weeks. At some VA medical centers, according to internal and outside reports, understaffing led some scheduling clerks to hide the actual wait times.
The tricks outlined in the 2008 internal VA memo are a case in point. When outpatient clinics were full, the report said, clerks would simply tell callers seeking an appointment to call back another time. Or, clerks would jot the request in a secret log book and but not enter the appointment on the electronic waitlist, which is monitored by senior VA officials, until the appointment was within the required 30 days.
Numerous patients, the report said, were crammed into a single time slot to see a doctor; some patients were assigned an appointment at a "ghost" clinic that did not exist. In each of those cases, the appointments were logged in as being within the time frame ordered by Shinseki.
The internal 2008 memo not only describes the ways VA clerks were cheating the system -- but also suggested ways that VA managers could catch them.
The memo was forwarded again to senior VA officials in April 2010.
The abuses detailed in that report were one of dozens of examples raised by VA critics about abuses and problems in VA scheduling. Two years ago, for example, the Government Accountability Office reported that VA schedulers were fudging wait times for veterans seeking outpatient care and avoiding using the electronic waitlist as required.
The GAO report includes a response from Shinseki's chief of staff at the time, John Gingrich, whose office was joined with Shinseki's through a single doorway. Gingrich wrote that the VA agreed with the findings and that the VA has "proactively taken steps in response to GAO's findings."
Shinseki said Thursday he could not recall having seen many of the reports.
The VA secretary, known for his quiet, low-key demeanor, couldn't effectively explain how it is that the scheduling abuses could go on and on, and be committed by relatively junior clerks, without being abruptly halted by him.
But a clue may come from the management style he has used during his career as a senior Army officer and at the VA. In a November 2012 interview with The Huffington Post, Shinseki explained that he has "spent a lifetime watching kids [young soldiers] make mistakes, because they were not trained or motivated or led to do well."
"I never faulted the kids," he said. Instead, he used those occasions "to motivate, improve, to work on leadership -- not to punish the individual. We are trying to get the same system within the VA."
Shinseki also said in that interview that he felt he could not turn down President Obama when he asked Shinseki, then in retirement, to take over the VA.
As Shinseki said, "I had no idea what I was getting into."