Wait gain at the Denver VA refocuses on Aurora opening date

Aurora Sentinel

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Aurora, CO, June 13, 2014 | Aaron Cole and Anna Gauldin | comments

| Virtual horror stories across the country about veterans waiting weeks or months for medical care have placed a renewed emphasis on veteran care and what role the beleaguered VA hospital in Aurora will play going forward.

Simmering scandals finally boiled over in May when major problems within VA medical care were confirmed by the release of a departmental audit June 9. The report, which detailed thousands of veterans on waiting lists for months, was the latest news for a battered system under fire for mismanaged facilities and care.

Locally, the VA has been the target of relentless criticism on how it’s handling a replacement VA hospital being built in Aurora. The project is hundreds of millions of dollars over budget and the target of federal scrutiny.

The new audit, which analyzed veteran access to medical care, coincided with an ongoing investigation launched in 2012 by the subcommittee for oversight on the House Veterans Affairs Committee, headed by Aurora Congressman Mike Coffman.  The audit revealed that more than 1,600 veterans have waited more than 90 days to get medical care at the Denver VA hospital system.

Coffman, whose district includes the future site for the central hospital for providing care for veterans in the metro area, said the renewed emphasis on care for veterans may be leverage to speed the replacement hospital
construction along. 

“All the stuff that has become public with the VA provides momentum for reform, and construction management is one element of that reform,” Coffman said. 

Suspicion surrounding VA practices intensified in March 2013, when it was revealed in a hearing before the oversight subcommittee that serious injuries and preventable deaths had occurred as a result of delayed care.

Following the hearing, Coffman requested information from the Department of Veteran Affairs on patient wait times at VA medical centers across the country. He said he encountered difficulties securing information from VA officials, but a number of whistle-blowers within the system brought important issues to light.

“Without them, there’s no way we would have the information we have today,” he said. “Management has never self-identified a problem.”

Since last spring, numerous issues within the VA medical system have come to light, including pressure to alter veterans’ desired appointment dates to improve performance reviews, which impact bonuses. The controversy led to the May 30 resignation of Eric Shinseki, head of the Department of Veteran Affairs.

“The whole system needs to be overhauled,” Coffman said. “But how big the problem is, it’s really hard to quantify right now. I think this is just the tip of the iceberg; there are systemic problems.”

In Colorado specifically, more than 1,600 new patients had to wait 90 days or longer for appointments at eastern Colorado VA medical centers, the audit revealed, in addition to 115 patients facing prolonged waits at western Colorado facilities.

These waits occurred despite the department’s stated goal of scheduling appointments within 14 days of a veteran’s desired date, which has now been scrapped.

“Meeting a 14-day wait-time performance target for new appointments was simply not attainable given the ongoing challenge of finding sufficient provider slots to accommodate a growing demand for services,” the audit report reads. “Imposing this expectation on the field before ascertaining the resources required and its ensuing broad promulgation represent an organizational leadership failure.”

The audit results were based on an analysis of 731 VA hospitals and large outpatient clinics nationwide on a single day in May, when it was revealed that more than 57,000 patients faced delays of 90 days or longer. The review also indicated that 13 percent of schedulers reported being told by supervisors to falsify appointment schedules to make patient waits appear shorter.

Colorado officials blamed delays on rapid growth in the number of new veterans enrolling in the system and periodic shortages of doctors and other providers.

“We’re one of the fastest-growing VAs in the United States,” said eastern Colorado VA system spokesman Dan Warvi. “Of the 1,632 on the wait list, that only represents 2.5 percent of all of our appointments. We had 66,000 appointments on the books that day. Ninety-three percent of our veterans get an appointment within 30 days. The other 7 percent don’t, and we are working really hard to try and resolve that.”

As for western Colorado, spokesman Paul Sweeney said the system was short-staffed on the day of the audit but has been aggressively recruiting more providers.

The eastern Colorado system includes a medical center in Denver and 10 satellite clinics. The western Colorado system includes a Grand Junction medical center and five clinics.

The Grand Junction hospital and an outpatient clinic in Colorado Springs will get follow-up reviews based on the findings of inspections in May, the report said.

The Colorado Springs review was prompted by three anonymous reports that staffers were pressured to alter records of wait times, Warvi said.

Grand Junction VA officials haven’t been told the reason for the follow-up, Sweeney said.

A VA clinic in Fort Collins was not listed for a follow-up review, even though investigators have said employees there were instructed to falsify appointment records.

However, the Fort Collins facility reports to the VA hospital in Cheyenne, Wyoming, and that hospital is in line for a follow-up review.

Cheyenne VA spokeswoman Patricia Hill said she couldn’t comment without reviewing the findings.

According to the audit report, more than 700 patients never got appointments at the eastern Colorado facilities after enrolling and requesting them.

Warvi said VA officials are looking into the reasons. Some might have been soldiers from Fort Carson who asked for appointments as they were leaving the Army but then moved to another state, he said.

Looking toward the future of the eastern Colorado VA system, Warvi said the staff is focused on resolving delayed care issues.

“There are problems, but at least we are trying to identify them,” he said, mentioning ongoing efforts to contact all veterans on the electronic wait list. “We’re transparent, we’re trying to study this and we’re trying to make things better.”

However, the release of the audit results continue to cast doubt on the efficacy of VA decision-makers both in Colorado and nationwide. Since breaking ground in 2009, the new VA hospital in Aurora has fallen at least four years behind schedule and is projected to exceed its initial budget by $400 million. 

To help curtail costs and increase efficiency, Coffman has proposed involving the Army Corps of Engineers in managing the hospital construction, and he is optimistic the legislation will be pushed through by the end of the year.

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