KGUN 9News


Whistleblowers say Tucson VA gamed the system

Posted at 10:15 PM, Feb 18, 2016
and last updated 2016-02-19 13:42:52-05
TUCSON (KGUN9-TV) - More claims that the VA covered up its severe staffing shortage that delayed care to patients. Two whistle-blowers describe exactly how staff was instructed to "game the system" to meet performance measures.
David Valdez is a Vietnam War veteran in a civilian hospital -- not the VA --  for surgery. He injured his knees while under gunfire and he said decades later his knees blew out.
For 11 years, he has been in severe pain and unable to walk. He's tried to schedule surgery at the VA.
"Couldn't get a surgery to save my life," said Valdez.
His brother, Raul Valdez, said "He'd complain about his knee. I'd say did you see your doctor. They cancel appointments. Why did they cancel?  I don't know. They just do that."
Valdez became a new patient just as Garry Ramirez started his new position as Medical Support Assistant -- scheduling appointments.
Ramirez was aware of the VA's policy. "We had to make an appointment within 30 days," he said.
But he said staffing issues made that difficult and he and co-workers had been instructed by his superiors to manipulate patient  appointments.
"So if we're talking today and the next appointment isn't until the first of June. We would have to schedule the patient in May so we can meet that 30 day timeline," he said.
In other words, if a patient called Ramirez Feb. 11 to make an appointment, it needed to be scheduled no later than mid-March. But if a doctor wasn't available until June, Ramirez would change the date range by entering a May date to meet the 30 day timeline.
And Ramirez says that wasn't the only tactic or "work-around" deemed "unethical" in an internal 2008 Department of Affairs memo obtained by KGUN9. He said co-workers ask patients if they were okay with an appointment scheduled months later - a yes response was noted on the form. 
Cavazos: So the patient is giving them permission to go beyond the 30 days. But do they know that? 
Ramirez: No.
Ramirez said he and other co-workers knew it was wrong, even spoke up to their supervisors, but he said nothing changed.
Ramirez: To me it looked bad. I'm not really helping the patient. 
Cavazos: And that bothered you? 
Ramirez: It bothered a lot of people. However, most of them who couldn't take the pressure left.
A reason, in part, Ramirez left in 2014.
Pat McCoy, Chief of Clinical Informatics, whose job it was review medical records for care issues, also started when Valdez became a new patient.
Valdez also needed what the VA calls consults -- consultations -- required before moving patients into specialty service, like orthopedics.
In mid-2009 and early-2010, McCoy discovered the VA had been in the practice of cancelling or discontinuing consults because of staffing shortages.
And in the summer of 2010, she also found "several hundred orthopedic cases that we not put on any wait lists at all. They were on pieces of paper placed on a past technicians desk."
And those two tactics stopped the consult clock. Two possible scenarios to explain why Valdez's consults may have been canceled.
"And so those folks were waiting for surgery. And there was no way to really formalize how they were going to come on to the surgery schedule because they weren't on a wait list so nobody really knew about them except for the orthopedic staff," she said.
McCoy reported the "inappropriate" tactics to top administrators at the Tucson VA, the Office of Inspector General, and Senator John McCain. McCoy left in 2013 frustrated that little or no action was ever taken on any of her complaints over her last 5 years at the VA.
And Valdez. He's not in the hospital for knee surgery. It was finally scheduled last month, but his doctor discovered Valdez has pancreatic cancer and that surgery took priority.
At this point, he's taking each day as it comes.
Cavazos: Did the VA do its job?
Valdez: No. Not at all.