WASHINGTON -- Government investigators found no proof that delays in care caused veterans to die at a Phoenix VA hospital, but they found widespread problems that the Veterans Affairs Department is promising to fix.
Investigators uncovered large-scale improprieties in the way VA hospitals and clinics across the nation have been scheduling veterans for appointments, according to a report released Tuesday by the VA's Office of Inspector General.
The report said workers falsified waitlists while their supervisors looked the other way or even directed it, resulting in chronic delays for veterans seeking care.
"Inappropriate scheduling practices are a nationwide systemic problem," said the report by Richard Griffin, the VA's acting inspector general. "These practices became systemic because (the Veterans Health Administration) did not hold senior headquarters and facility leadership responsible and accountable."
The report could deflate an explosive allegation that helped launch the scandal in the spring: that as many as 40 veterans died while awaiting care at the Phoenix VA hospital. Investigators identified 40 patients who died while awaiting appointments in Phoenix.
But, the report said: "While the case reviews in this report document poor quality of care, we are unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans."
Top VA officials said the report's findings were troubling.
"I'm glad that veterans didn't die because of delays in care, or at least they weren't able to conclude that they did," Deputy VA Secretary Sloan Gibson said in an interview. "But the fundamental issue is, veterans are waiting too long, and that's the problem we've got to face."
Addressing the American Legion's national convention in Charlotte, N.C., President Barack Obama said lengthy wait times and attempts to hide scheduling flaws were "outrageous and inexcusable."
"We are very clear-eyed about the problems that are still there," Obama said. "And those problems require us to regain the trust of our veterans and live up to our vision of a VA that is more effective and more efficient and that truly puts veterans first. And I will not be satisfied until that happens."
Investigators examined health records and other information for 3,409 Phoenix patients, including the 40 who died. They identified 28 patients who experienced "significant delays in care." Of those patients, six died, the report said.
In addition, they identified 17 patients "whose care deviated from the expected standard." Of those patients, 14 died, the report said.
Since problems at the VA emerged earlier this year, the inspector general's office says it has received 225 allegations of misconduct at the Phoenix VA, and 445 allegations of manipulated wait times at other VA medical facilities.
The inspector general's office is now investigating wait list issues at 93 medical facilities. The report said investigators have already found problems at "many medical facilities."
Among the problems at "many medical facilities," investigators said workers were canceling appointments and rescheduling them to make wait times appear shorter than they actually were. "We substantiated that management at one facility directed schedulers to do this," the report said.
Investigators also found workers using paper wait lists instead of official electronic ones that can be tracked.
Sen. Bernie Sanders, chairman of the Senate Veterans Affairs Committee, said the Phoenix VA "failed to meet our nation's obligation to provide timely, quality health care to veterans."
"What happened in Phoenix is inexcusable and must never happen again in any VA facility," said the Vermont independent. "The people who lied or manipulated data at Phoenix and elsewhere must be held accountable."
Earlier this year, Dr. Samuel Foote, who had worked for the Phoenix VA for more than 20 years before retiring in December, told Congress that up to 40 patients died while awaiting care at the hospital. Foote accused Arizona VA leaders of collecting bonuses for reducing patient wait times. But, he said, the purported successes resulted from data manipulation rather than improved service for veterans.
The allegations rocked the agency. Eric Shinseki resigned as VA secretary. In July, Congress approved spending an additional $16 billion to help shore up the system.
On Tuesday, Foote issued a statement questioning the inspector general's inability to "conclusively assert" that veterans died because of delays in care.
"What charts did they look at? How many did they look at? And what kind of standard is" conclusively assert? Foote said. "Without question, their statement was worded such that the reader will assume that no harm came to the patient due to the delay in care. That is unlikely to be true."
The inspector general runs an independent office within the VA. The investigation was done by a team of physicians, special agents, auditors and health inspectors, who reviewed VA medical records and outside medical records for patients who died while waiting for care, the report said. They also reviewed more 1 million emails and 190,000 computer files.
"This report cannot capture the personal disappointment, frustration and loss of faith of individual veterans and their family members with a health care system that often could not respond to their mental and physical health needs in a timely manner," the report said. "Immediate and substantive changes are needed."
The VA has said it was firing three executives of the Phoenix VA hospital. The agency has also said it planned to fire two supervisors and discipline four other employees in Colorado and Wyoming accused of falsifying health care data.
In a memo responding to the report, VA Secretary Robert McDonald apologized to veterans and pledged to implement the 24 recommendations in the inspector general's report.
"We sincerely apologize to all veterans and we will continue to listen to veterans, their families, veterans service organizations and our VA employees to improve access to the care and benefits veterans earned an deserve," said McDonald's memo, which was also signed by Carolyn Clancy, VA undersecretary for health.
To help reduce backlogs, the VA is sending more veterans to private doctors for care.
Congress approved $10 billion in emergency spending over three years to pay private doctors and other health professionals to care for veterans who can't get timely appointments at VA medical facilities, or who live more than 40 miles from one.
The new law includes $5 billion for hiring more VA doctors, nurses and other medical staff and $1.3 billion to open 27 new VA clinics across the country.
The legislation also makes it easier to fire hospital administrators and senior VA executives for negligence or poor performance.