Letter from the US: Veterans screwed in health care scandal

Monday, May 26, 2014
Veterans Affairs secretary General Eric Shinseki listens as veterans testify before a Senate committee on May 15.

The way the United States government treats soldiers returning from its wars of imperial conquest indicates its priorities.

There have been many reports of failures to adequately treat all the cases of mental illness resulting from the wars of occupation in Afghanistan and Iraq. High levels of alcoholism, drug use, depression and suicide have been reported by veterans and their families.

The latest scandal first erupted in the Veterans Affairs Health Care System, in Phoenix, Arizona. In April, CNN reported: “At least 40 U.S. veterans died waiting for appointments … many of whom were placed on a secret waiting list.

“The secret list was part of an elaborate scheme designed by … managers in Phoenix who were trying to hide that 1,400 to 1,500 sick veterans were forced to wait months to see a doctor.”

Dr Sam Foote, recently retired after working for 24 years in the VA system, said there was a fake “official list” for public consumption that showed the VA providing timely appointments. However, there was a separate, real list that was kept secret. It showed waiting times can be more than a year.

The scheme included shredding of evidence to hide the real list. Foote said officials instructed staff not to make appointments on the VA computer system.

Instead, when a veteran came seeking an appointment, “they enter information into the computer and do a screen capture hard copy printout. They then do not save what was put into the computer so there’s no record that you were ever even there.

“That hard copy that has the patient demographic information is then taken and placed onto a secret electronic waiting list.” The hard copy is shredded.

“So the only record that you have ever been there requesting care was on that secret list,” Foote said.

Whenever an appointment was finally made months later, the patient was taken off the secret list. A record on the public list showed the appointment was made at that date for less than 14 days after.

One case publicised in the media was that of a 71-year-old Navy veteran Thomas Breen. His son and daughter-in-law noticed he had blood in his urine and took him to the emergency room at the VA facility in September last year.

The doctors noted his history of cancer and wrote on his chart that he should see a primary care doctor “urgently” in one week. He was sent home.

Placed on the secret list, he was not given an appointment. He or his daughter-in-law called “numerous times”, she said. She was told: “Well, you know, we have other patients that are critical as well. It’s a seven month waiting list. And you’re gonna have to have patience.”

Finally, she got a call on December 6. “We finally have an appointment. We have a primary [care doctor] for him.”

But he had already died on November 30.

Foote says Breen is a perfect example of a veteran who needed an urgent appointment and was instead put on the secret waiting list.

Foote says that when veterans on the secret list die, they are simply removed. “They could just remove you from that list, and there’s no record that you ever came to the VA and presented for care … It’s pretty sad.”

Foote put the number of such cases resulting in death in Phoenix as at least 40.

Top VA officials initially downplayed the scandal. They insist there were no such deaths associated with the system and denied there were secret waiting lists.

But whistleblowers reported the same system was used to conceal long wait times at VA facilities in Colorado, Texas and Wyoming. More will undoubtedly come to light.

CBS News obtained an email, written by a registered nurse, exposing how patients at the VA medical centre in Cheyenne, Wyoming, were always listed as getting appointments within a 14-day window regardless of when the appointment was first requested and regardless of how long the patient actually waited.

An official memo to the staff admitted: “Yes, this is gaming the system a bit…” It instructed staff to cancel the record of when a veteran first comes in and then “rescheduling it within a desired date within that 14 day window”, sometime later.

The Cheyenne incident was reported by an informant last year. CBS News said: “The VA’s Office of the Medical Inspector had already investigated and substantiated claims of improper scheduling practices.”

It was not until an inquiry by CBS that any action was taken, six months later. It is clear the problem is system-wide and known at the top.

Under pressure, VA Secretary General Eric Shinseki has promised an investigation. In other words, the VA will investigate itself.

On May 16, Shinseki accepted the resignation of undersecretary for health in the Department of Veterans Affairs Dr Robert Petzel. However, Petzel was already scheduled to retire this year, making it an obvious move to deflect public attention from the scandal.

It was met with derision by the Iraq and Afghanistan Veterans of America.

“We don’t need the VA to find a scapegoat,” the group said, “we need an actual plan to restore a culture of accountability throughout the VA. To be clear, Dr. Petzel’s resignation is not the step towards accountability that our members need to see from VA leaders.”

The VA hospitals are understaffed and underfunded. One main reason for the long waiting lists and cover-up came to light in one of the Texas cases.

A former top administrator of the system in south-east Texas said: “Patients faced denials or long delays in getting routine colonoscopies and other medical tests because of bureaucratic cost-cutting.

“Dr. Richard Krugman … said his boss implemented a policy in 2010 that colonoscopies would only be approved if the patient tested positive in three successive screenings for bloody stools.

“By the time you do the colonoscopies on these patients, you went from a stage one to a stage four [cancer], which is basically inoperable.

“This was done because of dollars and cents.”

In World War I, the term “cannon fodder” was used to explain the fundamental attitude of the warmakers towards the grunts who fight their wars for them: disposable tools.

The same attitude prevails today. It is an attitude that cuts costs not by slashing the war machine, but by cutting care for the veterans who like the occupied populations are victims of Washington's imperialist wars.

[Barry Sheppard was a long-time leader of the US Socialist Workers Party and the Fourth International. He recounts his experience in the SWP in a two-volume book, The Party — the Socialist Workers Party 1960-1988, available from Resistance Books. Read more of Sheppard's articles.]

From GLW issue 1010