WASHINGTON -- New complaints about long wait lists and falsified patient appointment reports have surfaced at Veterans Affairs hospitals and clinics across the country, the department's internal watchdog said Thursday, but he said there's no proof so far that delays in treatment have caused any patient's death.
VA Secretary Eric Shinseki said he was "mad as hell" about allegations of severe problems and said he was looking for quick results from a nationwide audit. He rejected calls for him to resign and a senator's suggestion that he call in the FBI to investigate.
At a sometimes-combative congressional hearing, Richard Griffin, the department's acting inspector general, said that after an initial review of 17 people who died while awaiting appointments at the Phoenix VA hospital, none of the deaths appeared to have been caused by delays in treatment.
"It's one thing to be on a waiting list, and it's another thing to conclude that as a result of being on the waiting list that's the cause of death, depending on what your illness might have been at the beginning," Griffin told the Senate Veterans Affairs Committee.
Griffin said his office is working off several lists of patients at the giant Phoenix facility, which treats more than 80,000 veterans a year. He said a widely reported list of 40 patients who died while awaiting appointments "does not represent the total number of veterans that we're looking at." He said his office has 185 employees working on the Phoenix case, including criminal investigators, and said he expects to have a report completed in August. The U.S. Attorney's office in Arizona and the Justice Department's public integrity section also are assisting in the investigation.
Since reports of the Phoenix problems came to light last month, allegations about problems at VA facilities have spread nationwide. At least 10 new allegations about manipulated waiting times and other problems have surfaced in the past three weeks, Griffin said.
VA Secretary Shinseki told the committee he hopes to have preliminary results within three weeks on audits he ordered at the VA's 150 medical centers and 820 community outpatient clinics nationwide in an effort to determine how widespread the treatment delays and falsified reports are.
"I'm not aware, other than a number of isolated cases, where there is evidence of that," he replied when the committee's chairman, Sen. Bernie Sanders, I-Vt., asked bluntly if VA officials at the facilities were "cooking the books."
Shinseki resisted calls from Sen. Richard Blumenthal, D-Conn., to call in the FBI.
"Isn't there evidence here of criminal wrongdoing, that is falsifying records, false statements to the federal government? That's a crime," said Blumenthal, a former state attorney general and federal prosecutor.
VA operates the largest single health care system in the country, serving some 9 million veterans a year. Surveys show that patients are mostly satisfied with their care but that access to it is becoming more of a problem. Vietnam veterans are aging, and increasing numbers of vets from the Iraq and Afghanistan wars are seeking treatment for physical and mental health problems, including post-traumatic stress disorders.
The agency has a 14-day target for seeing patients after they ask for appointments. Some lawmakers called that target unrealistic and said basing employee bonuses and pay raises on it is outrageous.
"Giving bonuses to hospital directors for running a system that places priority on gaming the system and keeping their (wait list) numbers down -- rather than provide care to veterans -- must come to an end," said Sen. Patty Murray, D-Wash.
Shinseki said he was "mad as hell" over the allegations, vowed to hold employees accountable for any misconduct and welcomed President Barack Obama's appointment Wednesday of deputy White House chief of staff Rob Nabors to review VA health care procedures and policies.
"Any adverse event for a veteran within our care is one too many," Shinseki said. "We can and we must do better."
As a sign of his seriousness, Shinseki said that in 2012 and again in 2013 the agency "involuntarily removed" 3,000 of its 300,000 employees for poor performance or misconduct. Some employees were given new assignments, others retired and some were fired, Shinseki said.
While some Republicans and veterans groups have called for Shinseki to resign, there was little talk of it at Thursday's hearing. Only Sen. Dean Heller, R-Nev., asked Shinseki why he shouldn't resign.
"This is not a job," Shinseki replied. "I'm here to accomplish a mission that I think they critically deserve and need," he said of the nation's veterans. Shinseki is a retired four-star general and Vietnam veteran. He was the Army's chief of staff during part of Bill Clinton's and George W. Bush's presidencies
Pushing back against sometimes hostile questions, Shinseki said he welcomes the White House review.
"If allegations about manipulation of appointment scheduling are true, they are completely unacceptable -- to veterans, to me and to our dedicated VA employees," he said.
But Murray said reports of problems at the VA were not new.
"It's extremely disappointing that the department has repeatedly failed to address wait times for health care," she said, citing congressional, inspector general and other investigations dating back to 2000.
Sen. John McCain, R-Ariz., said the Obama administration "has failed to respond in an effective manner" to allegations made public more than a month ago. "This has created in our veterans' community a crisis of confidence toward the VA," McCain said.
Separately, Republican National Committee Chairman Reince Priebus called for an independent investigation. He said, "Our veterans are our heroes and they deserve better than a White House insider-led investigation."