Overload at the VA: Flood of cases, long waits for medical care

Backlog has some South Sound veterans despairing for timely care

Staff writerMay 25, 2014 

Iraq veteran Brian Ansley hit a wall last September when he started calling VA Puget Sound to make a medical appointment.

Doctors could not see him until December, he was told. Then, a few weeks before the scheduled visit, he got a call from the Department of Veterans Affairs canceling the appointment because the doctor was unavailable.

The next date a primary care provider could see Ansley? Sometime in May.

That’s a wait of eight months for a veteran with chronic pain and a history of suicidal thoughts.

“I explicitly said ‘I’m in pain and it’s affecting my day-to-day life,’ ” said Ansley, 29, of Olympia.

He was attempting to get treatment for persistent problems he’s had since his two Iraq tours. What he found was a government health system straining to absorb extraordinary growth since the beginning of the wars in Afghanistan and Iraq.

The scale of that growth is staggering. The number of patients visiting VA Puget Sound hospitals in Seattle and Lakewood has nearly doubled, rising from 54,000 in 2000 to a projected 100,000 this year.

VA hospitals all over the country are seeing the same trends as young veterans leave the military and older veterans seek care for the complications of aging. Some VA sites are now under intense scrutiny amid reports that administrators in several states skewed records to hide patient requests for appointments while veterans died waiting for care.

A nationwide audit of VA record-keeping is underway, and President Barack Obama has pledged to hold VA staffers accountable for misleading reports.

“I will not stand for it,” he said at a press conference Wednesday.

The audit already reached VA Puget Sound. The team of four federal auditors did not find evidence of “hidden lists” or falsified wait-time reports crafted to give the appearance of meeting the VA standards, VA Puget Sound spokesman Chad Hutson said. The VA is expected to release the national report later this summer.

However, the local VA is falling short of the national wait-time goal, according to data the medical center provided to The News Tribune. In March, that meant about 1,100 VA Puget Sound patients had to wait longer than two weeks for a primary care visit.

Resources are starting to catch up to the demand. Hundreds of millions of dollars’ worth of construction projects are in the works, ranging from a new parking facility in Seattle to a large expansion at American Lake.

And the VA is hiring constantly as it builds up new programs in the region. Its payroll here tops 3,350, up from 2,450 a dozen years ago.

Joel Mitchell, director of behavioral health for Puget Sound VA, said the cases when VA care doesn’t go well are “absolutely the exception.”

“These buildings are filled with people who dedicate their professional lives to this population,” he said.

Yet in busy hospital corridors and outside the walls, the VA faces tough criticism from individual veterans who are getting lost.

Nearly four years after being blinded by an IED blast while serving in Afghanistan in 2010, Cory Kemp still struggles daily with the physical and emotional pain of his injury. (Dean J. Koepfler, staff photographer.)

“I don’t even know who to talk to. I get run around in circles,” said Cory Kemp, 32, a former Air Force explosive ordnance technician blinded by a bomb in Afghanistan four years ago.

Kemp, a Lacey resident and former technical sergeant, relies on the VA for blindness therapy, psychiatric therapy, dental care, a chiropractor and acupuncture. He braces himself when he calls the VA to schedule an appointment because he expects it to go poorly.

He loses his temper when he feels he’s being passed around.

“I have a hard time putting things together. I get overwhelmed very easily. It’s impossible for me to deal with these things,” Kemp said.

Complaints like his are driving scrutiny from U.S. leaders pushing to hold the VA accountable for its performance after they doubled the agency’s budget since 2006. Obama requested $163.9 billion for the agency next year, up from $73.1 billion eight years ago.

Democratic U.S. Rep. Denny Heck of Olympia last week voted for a bill that would make it easier for the VA to fire underperforming employees.

“Enough’s enough,” said Heck, whose district includes American Lake. “I think it’s time that there was something different done.”

Officials with the VA say complaints of long lines and waiting times for appointments at the Seattle (pictured) and American Lake VA hospitals is emblematic of the challenges they face. (Dean J. Koepfler, staff photographer.)Officials with the VA say complaints of long lines and waiting times for appointments at the Seattle (pictured) and American Lake VA hospitals is emblematic of the challenges they face. (Dean J. Koepfler, staff photographer.)

HITTING THE GOALS

The VA’s main way to measure whether it’s providing timely service is its published goal to schedule appointments for 99 percent of primary care patients within two weeks of a request. It also aims to fill 98 percent of specialty care requests within 14 days.

Those are both accelerated goals from the VA’s standards in the 1990s and early 2000s, when it aimed to schedule appointments within 30 days of a request.

VA Puget Sound records show that the local hospitals are not quite hitting the performance target for scheduling primary-care appointments.

A backlog developed in 2013 — when Ansley first sought care — because VA Puget Sound lost 10 primary care doctors to retirements and turnover, hospital administrators said. That was a loss of about a third of the hospital’s primary care team.

This year, wait times are declining, according to data the hospital provided to a reporter.

VA Puget Sound has filled the vacancies for primary doctors who left the system in 2013. In March, about 98 percent of VA Puget Sound patients were able to get primary care appointments within two weeks of asking.

That means 1,131 patients had to wait more than two weeks for a primary care appointment past the requested date — an improvement from November, when about 2,200 VA Puget Sound patients had to wait that long.

“Our numbers continue to come down very nicely,” said William Campbell, VA Puget Sound’s medical director.

Nationally, the VA system has come under fire recently for appointment-scheduling gimmicks.

For instance, VA staff members in Phoenix allegedly would take note of a patient request for an appointment, set it aside on a “hidden list” if they could not fulfill it within two weeks and call the patient back when the VA could schedule a visit with a doctor.

That pattern would hide any long wait times by obscuring the patient’s first request for an appointment.

Click to enlarge:

Whistle-blowers have brought forth a similar complaint regarding hospitals in Texas and Missouri. A VA inspector general report obtained by USA Today reflects concerns about misleading information on patient wait times in Fort Collins, Colorado.

The Government Accountability Office identified inconsistent VA protocols for scheduling appointments in late 2012, when it called the VA’s measurements “unreliable.” It noted that the wait time depended on when the VA staffer chose to date the request, and it said that different hospitals had different scheduling policies. An updated GAO report released last month revealed the same concerns.

“We have known this for a long time,” said U.S. Sen. Patty Murray, D-Wash., a past chairwoman of the Senate Veterans Affairs Committee. “The VA says it’s meeting the goal, but too often we hear from people who are waiting too long for care.”

She said the manipulated data makes it impossible for Congress to fund the VA appropriately because lawmakers don’t have trustworthy information for budgeting.

At a hearing this month, Murray prodded VA Secretary Eric Shinseki to test the data he obtains from the nationwide record-keeping audit.

“This review will not work if those people who are telling you the information do not tell you the truth,” she said.

Shinseki in turn said he was “mad as hell” about the allegations in Phoenix. His chief medical officer resigned and Shinseki suspended the VA medical center director in Phoenix.

“Anybody found to have manipulated or falsified records at VA facilities has to be held accountable,” Obama said at an Oval Office press conference Wednesday.

“I will not stand for it, not as commander in chief but also not as an American. None of us should,” the president said. “So if these allegations prove to be true, it is dishonorable, it is disgraceful and I will not tolerate it, period.”

FINALLY, SOME HELP

Iraq war veteran Sgt. Brian Ansley was forced to wait for seven months to see a VA doctor for chronic pain and post-traumatic stress disorder. (Dean J. Koepfler, staff photographer.)

It’s not clear what held up Brian Ansley’s request for an appointment. He grew so upset by the agency putting him off for months that he wrote a complaint to the White House in January.

He got a call from the VA and a somewhat expedited appointment with help from a case manager. Instead of waiting until May, Ansley was rescheduled for an April visit. He has since met with a primary care doctor and a physical therapist.

Between his first call to Puget Sound VA and his first visit, Ansley nearly lost control of himself in a crosswalk at The Evergreen State College in Olympia last month.

A driver jokingly made a move as if he’d hit the former soldier. Ansley raced after the driver on foot, fuming at the reckless joke.

He felt grateful he couldn’t catch the car, fearing what he might have done. He connected his response to the post-traumatic stress disorder he has experienced since leaving the Army in 2010.

“It sticks with me longer than it would with somebody else,” he said, recalling his outrage. “It makes me physically sick when I have moments like that.”

His first trip to the VA took place in 2010, about a year after he left the Army’s 82nd Airborne Division at Fort Bragg, North Carolina, with the rank of sergeant.

He sought care at a VA emergency room in Houston because he was thinking of killing himself. For a time, he tried medication to help cope. He later turned to endurance marathons as a form of therapy and pushed himself through college.

When PTSD comes over him, “it just feels like I drink poison. My brain is foggy, and I can’t concentrate,” he said.

Ansley moved to Olympia late last summer to work on a master’s degree in environmental sciences at Evergreen. He reconnected with Kemp, an old friend from the military. Kemp had returned to the South Sound because he fell for the region when he served at McChord Air Field and wanted to return after he received his medical retirement last year.

They found a common complaint in their reactions to the VA: They appreciated their caregivers but had trouble scheduling appointments and getting past the “front lines” to doctors.

“It shouldn’t be us fighting for everything,” said Kemp’s wife, Tara, who receives a VA stipend as her husband’s full-time caregiver.

Veterans Affairs Puget Sound Deputy Director Mike Tadych is overseeing hundreds of millions of dollars worth of construction projects in Seattle and American Lake, including a new behavioral health center (depicted in a artist rendering) which is just beginning construction. (Dean J. Koepfler, staff photographer.)Veterans Affairs Puget Sound Deputy Director Mike Tadych is overseeing hundreds of millions of dollars worth of construction projects in Seattle and American Lake, including a new behavioral health center (depicted in a artist rendering) which is just beginning construction. (Dean J. Koepfler, staff photographer.)

HIGH MARKS FOR VA

Their concerns contrast with many VA patients who have come into the system and found timely, life-saving care at new programs developed for the system’s surging enrollees.

“It’s been excellent, top-notch care,” said Ryan Burgess, an Afghanistan veteran recently admitted to a VA Puget Sound inpatient PTSD program.

The 38-year-old veteran from Oregon came to the VA at a moment of crisis when he was about to lose his family and his job. He was enrolled quickly in the American Lake PTSD program. He feels he’s learning coping techniques that will give him a new start when he goes home.

Across the country, researchers who survey veterans have found that most former service members have favorable impressions of the care they receive at the VA and their access to it. In May, a nationwide survey showed that VA patients gave the system high customer-satisfaction ratings, indicating they like the VA at least as much as private hospitals.

Air Force veteran Anthony Hassan has noted the disparity in views about the VA in his surveys of veterans for the University of Southern California’s School of Social Work.

“Half like it, half don’t,” he said.

The trouble is that veterans who avoid the system could wind up losing control of their lives if they don’t get care.

“The half that aren’t getting it, if they don’t get it, they will end up chronically ill, chronically homeless,” Hassan said.

Going forward, the VA plans to make care more accessible in the Puget Sound region by improving its two main hospitals while opening more services to veterans at facilities outside King and Pierce counties.

Last month, the VA reopened a renovated clinic in Port Angeles. It also unveiled a partnership with Navy Hospital Bremerton that allows Kitsap County veterans to get care there.

VA Puget Sound Director Michael Murphy said the Port Angeles expansion tripled the agency’s offerings on the peninsula, while the Bremerton agreement opens up diagnostic and urgent-care options.

Meanwhile, new VA liaisons are coming to military installations such as Joint Base Lewis-McChord to speak to active-duty service members about the VA.

In the next few years, VA Puget Sound has hundreds of millions of dollars’ worth of construction projects planned to improve facilities in Seattle and at American Lake, said deputy director Mike Tadych.

First up is a $44 million parking garage, now under construction at the Seattle hospital.

Next is a $178 million behavioral health center, also in Seattle. It’ll be a home for research and care for veterans suffering from PTSD and other ailments. It’s scheduled to open by 2017.

After that, the VA has set aside $200 million to improve the American Lake campus. It is scheduled to receive a 76,000-square-foot outpatient specialty care center as well as a renovation of its primary care facilities to expand services for veterans who’d prefer not to travel to Seattle.

More growth in the number of VA Puget Sound patients is expected for the next 15 years or so, Tadych said.

“I actually feel privileged that we are in growth mode,” said Campbell, the VA Puget Sound’s medical director. “We come to work each and every day to repay a debt we quite frankly can never repay.”

Cory Kemp, still recovering from a 2010 IED blast in Afghanistan, relaxes with music as an acupuncturist at American Lake Veterans Hospital inserts therapeutic needles into his forehead during a visit in March. (Dean J. Koepfler, staff photographer.)Cory Kemp, still recovering from a 2010 IED blast in Afghanistan, relaxes with music as an acupuncturist at American Lake Veterans Hospital inserts therapeutic needles into his forehead during a visit in March. (Dean J. Koepfler, staff photographer.)

GETTING TREATMENT

This spring, Ansley and Kemp both moved forward with health care plans at the VA.

Ansley has a behavioral health appointment scheduled for June. He’s also looking forward to easing pain in his neck and shoulders through physical therapy.

Kemp and his wife traveled to the VA’s main hospital in the San Francisco Bay Area, where Kemp received advanced blindness therapy.

He’s hoping to return to Lacey with a new attitude in his dealings with the local VA. In the past year, he quit seeking behavioral health therapy because he didn’t trust the psychiatrist the VA gave him. He wanted to try again when he last spoke to The News Tribune.

He’s eager to move into a new house under construction for him and Tara in Rainier. It’ll be good to get out in the country, he said.

“It’s more therapeutic for me not to go to the hospital,” he said.

Adam Ashton: 253-597-8646
adam.ashton@thenewstribune.com

The Olympian is pleased to provide this opportunity to share information, experiences and observations about what's in the news. Some of the comments may be reprinted elsewhere in the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from profanity, hate speech, personal comments and remarks that are off point. Thank you for taking the time to offer your thoughts.

Commenting FAQs | Terms of Service