Deaths at Phoenix VA hospital may be tied to delayed care

• Rep. Jeff Miller's hearing Wednesday probed allegations of preventable deaths at VA medical centers.
• Miller said he's investigating as many as 40 deaths in the Phoenix VA system.
• Current and former VA employees say long delays in patient treatment are being covered up.

Editor's Note: This story was originally published April 10, 2014.

The chairman of the House Committee on Veterans ­Affairs said Wednesday that dozens of VA hospital patients in Phoenix may have died while awaiting medical care.

Rep. Jeff Miller, R-Fla., said staff investigators also have evidence that the Phoenix VA Health Care System keeps two sets of records to conceal prolonged waits that patients must endure for ­doctor appointments and treatment.

"It appears as though there could be as many as 40 veterans whose deaths could be ­related to delays in care," ­Miller announced to a stunned audience during a committee hearing Wednesday.

Thomas Lynch, assistant deputy undersecretary for health and clinical operations for the Department of Veterans Affairs, testified that he was not aware of the Arizona record-keeping practice, and asked for more detailed information from congressional staffers.

Miller's response: "So, your people (in Arizona) had two lists, and they even kept it from your knowledge?"

The congressman issued a protective order to preserve relevant records in the Phoenix VA system.

A recent report by the VA shows no Phoenix patient deaths in recent years resulted in "adverse disclosures" to family members, a requirement whenever medical negligence or mistakes are to blame.

Arizona administrators declined to be interviewed, but Sharon Helman, director of Phoenix VA Health Care System, issued a written statement: "We take seriously any issue that occurs in our medical center and outpatient clinics. Therefore, we have asked for an external review by the VA Office of the Inspector General ... If the OIG finds areas that need to be improved, we will swiftly address them as our goal is to provide the best care possible to our veterans."

Congressional discourse about Phoenix care for vets occurred during a hearing titled "A Continued Assessment of Delays in VA Medical Care and Preventable Veteran Deaths." The committee has spent months investigating patient-care scandals and allegations at VA facilities in Pittsburgh, Atlanta, Miami and other cities.

Wednesday's testimony came amid an Arizona Republic investigation into allegations by VA whistle-blowers who have complained about falsified records, preventable or premature deaths, mismanagement and other systemic problems.

Dr. Sam Foote, who retired from the Phoenix VA in December, provided the newspaper documents he filed with the VA inspector general seeking investigations of alleged medical-care failures and administrative misconduct.

In a Feb. 2 letter to the inspector general — also sent to Miller; Sen. John McCain, R-Ariz.; Rep. Ann Kirkpatrick, D-Ariz.; and the U.S. Attorney's Office — Foote said the Phoenix system is afflicted by "gross mismanagement of VA resources and criminal misconduct" that produced "systemic patient safety issues and possible wrongful deaths."

He wrote that IG investigators came to Phoenix late last year and verified allegations he'd made in an October complaint, yet no Arizona administrators were removed and "patients are still dying. How can that be three months after I first notified you of the problem?" he asked.

Foote and other whistle-blowers said that Arizona VA executives collect bonuses for reducing patient wait times, yet purported successes stem from manipulation of data instead of improved service to ailing veterans.

Foote, a doctor of internal medicine, spent 25 years at the VA. His letter to the Inspector General says investigators already have information concerning22 vets who died while on an electronic waiting list for appointments, and 18 more who died while on waiting lists for consultations with specialists.

In an interview, he said patients "were deliberately being held off the lists" to misrepresent the speed of health services for vets, but it remains unknown how many of the deaths may have been preventable.

System's problems

The Republic recently submitted multiple requests for documents and data from the VA. No materials have been provided. It is unclear how long Arizona veterans typically wait for medical care, or how many died before diagnosis or treatment.

Foote and other employees alleged a variety of other institutional breakdowns in Arizona's VA, including:

• Medical record-keeping so backed up the system is 250,000 pages behind, and millions of records reportedly are missing.

• A compromised mental-health system where patient suicides doubled in the past few years, while staff ­suicides also emerged as a serious concern.

• A swamped emergency room that becomes the last resort for veterans who cannot get appointments with primary-care doctors or specialists. In some cases, VA health system employees have told the newspaper, vets with life-threatening conditions have waited hours without diagnosis or treatment because nurses are overworked and undertrained.

• Discrimination, cronyism and security breakdowns in the VA police department that endanger the safety of patients and employees.

• Hostile working conditions that caused an exodus of quality doctors and nurses, producing backlogs in specialty areas such as urology, where bladder cancer and other serious diseases are detected. Patients reportedly are referred to out-of-state VA centers or private physicians for treatment.

The Phoenix VA Health Care System, which includes the Carl T. Hayden VA Medical Center and a half-dozen satellite clinics statewide, serves about 81,000 patients and has a budget of $438 million.

VA health system workers who asked not to be named because they fear retribution, said patient access data incorrectly show vets are able to see physicians within days when actual waits may be months.

They described elaborate techniques that they said were used to mischaracterize system responsiveness. Foote estimated up to 30,000 patient charts have been "tampered with." He said thousands of new patients must wait up to a year for assignment to primary-care physicians who are overbooked.

"The backlog has gone up," Foote added, "but it's all about appearances. If you're delaying care for these people, you're going to kill some of them."

Claims of neglect

Sally Eliano of the San Tan Valley area said her father-in-law, Thomas Breen, died Nov. 30 of bladder cancer after a series of treatment delays and errors. Eliano, who has some medical training, said she delivered a container of Breen's blood-tinted urine for testing at one point. She said he received no diagnosis, the urine was not tested and she was scolded for bringing an unsanitary item to the hospital.

Eliano said Breen received no treatment, just instructions to see his VA primary-care doctor "with urgency," but she was unable to get an appointment for months. "I started calling every day saying he needs a doctor," she recalled, weeping. "They were nasty. They just said, 'You know, there's a waiting list.' I told my ­father-in-law, 'Dad, you're dying and I don't know what to do.' "

Breen's condition ­deteriorated until he was rushed to a non-VA hospital and diagnosed with terminal tumors.

"I was screaming," Eliano said.

"They told me to get a priest."

Breen, who served about two decades in the U.S. Navy, died at age 71.

Eliano said the death certificate showed bladder cancer, which was never detected or treated.

"They neglected him," Eliano said. "That, along with cancer, caused him to die."

About a week later, someone called Eliano from the VA hospital to say an appointment time was available.

"I said, 'Uh ... he's dead. Now you call? Now it's too late,' " Eliano ­noted. "Then all these other calls came in: 'We're ­sorry ... We should have been quicker.' " Eliano said she ­received no written apology or notification of adverse care required by VA ­policy.

Foote and other current and former staffers allege that employees who point out flaws — or try to improve the system from within — are bullied by bosses who won't acknowledge the system is broken because to do so would damage their careers. Retaliation against whistle-blowers, discrimination and mismanagement have caused an exodus of nurses and doctors, insiders said, so that remaining employees are chronically overworked and stressed out.

"They (administrators) just don't respect any rules at all," Foote said. "They just don't care. ... They beat me to the ground. I retired just exactly so I could do this."