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A fatal wait: Veterans languish and die on a VA hospital's secret list

(CNN) -- At least 40 U.S. veterans died waiting for appointments at the Phoenix Veterans Affairs Health Care system, many of whom were placed on a secret waiting list.

The secret list was part of an elaborate scheme designed by Veterans Affairs managers in Phoenix who were trying to hide that 1,400 to 1,600 sick veterans were forced to wait months to see a doctor, according to a recently retired top VA doctor and several high-level sources.

For six months, CNN has been reporting on extended delays in health care appointments suffered by veterans across the country and who died while waiting for appointments and care. But the new revelations about the Phoenix VA are perhaps the most disturbing and striking to come to light thus far.

Internal e-mails obtained by CNN show that top management at the VA hospital in Arizona knew about the practice and even defended it.

Dr. Sam Foote just retired after spending 24 years with the VA system in Phoenix. The veteran doctor told CNN in an exclusive interview that the Phoenix VA works off two lists for patient appointments:

There's an "official" list that's shared with officials in Washington and shows the VA has been providing timely appointments, which Foote calls a sham list. And then there's the real list that's hidden from outsiders, where wait times can last more than a year.

Veterans dying waiting for healthcare

Are we fulfilling our promise to veterans?

Deliberate scheme, shredded evidence

"The scheme was deliberately put in place to avoid the VA's own internal rules," said Foote in Phoenix. "They developed the secret waiting list," said Foote, a respected local physician.

The VA requires its hospitals to provide care to patients in a timely manner, typically within 14 to 30 days, Foote said.

According to Foote, the elaborate scheme in Phoenix involved shredding evidence to hide the long list of veterans waiting for appointments and care. Officials at the VA, Foote says, instructed their staff to not actually make doctor's appointments for veterans within the computer system.

Instead, Foote says, when a veteran comes in seeking an appointment, "they enter information into the computer and do a screen capture hard copy printout. They then do not save what was put into the computer so there's no record that you were ever here," he said.

According to Foote, the information was gathered on the secret electronic list and then the information that would show when veterans first began waiting for an appointment was actually destroyed.

"That hard copy, if you will, that has the patient demographic information is then taken and placed onto a secret electronic waiting list, and then the data that is on that paper is shredded," Foote said.

"So the only record that you have ever been there requesting care was on that secret list," he said. "And they wouldn't take you off that secret list until you had an appointment time that was less than 14 days so it would give the appearance that they were improving greatly the waiting times, when in fact they were not."

I feel very sorry for the people who work at the Phoenix VA. They all wish they could leave 'cause they know what they're doing is wrong.
Dr. Sam Foote

Foote estimates right now the number of veterans waiting on the "secret list" to see a primary care physician is somewhere between 1,400 and 1,600.

Doctor: It's a 'frustrated' staff

"I feel very sorry for the people who work at the Phoenix VA," said Foote. "They're all frustrated. They're all upset. They all wish they could leave 'cause they know what they're doing is wrong.

"But they have families, they have mortgages and if they speak out or say anything to anybody about it, they will be fired and they know that."

Several other high-level VA staff confirmed Foote's description to CNN and confirmed this is exactly how the secret list works in Phoenix.

Foote says the Phoenix wait times reported back to Washington were entirely fictitious. "So then when they did that, they would report to Washington, 'Oh yeah. We're makin' our appointments within -- within 10 days, within the 14-day frame,' when in reality it had been six, nine, in some cases 21 months," he said.

November: A dire situation in South Carolina

Thomas Breen was so proud of his time in the Navy that he wanted to be treated only at a VA facility, his family says.
Thomas Breen was so proud of his time in the Navy that he wanted to be treated only at a VA facility, his family says.

In the case of 71-year-old Navy veteran Thomas Breen, the wait on the secret list ended much sooner.

"We had noticed that he started to have bleeding in his urine," said Teddy Barnes-Breen, his son. "So I was like, 'Listen, we gotta get you to the doctor.' "

Teddy says his Brooklyn-raised father was so proud of his military service that he would go nowhere but the VA for treatment. On September 28, 2013, with blood in his urine and a history of cancer, Teddy and his wife, Sally, rushed his father to the Phoenix VA emergency room, where he was examined and sent home to wait.

"They wrote on his chart that it was urgent," said Sally, her father-in-law's main caretaker. The family has obtained the chart from the VA that clearly states the "urgency" as "one week" for Breen to see a primary care doctor or at least a urologist, for the concerns about the blood in the urine.

"And they sent him home," says Teddy, incredulously.

Sally and Teddy say Thomas Breen was given an appointment with a rheumatologist to look at his prosthetic leg but was given no appointment for the main reason he went in.

The Breens wait ... and wait ... and wait ...

No one called from the VA with a primary care appointment. Sally says she and her father-in-law called "numerous times" in an effort to try to get an urgent appointment for him. She says the response they got was less than helpful.

"Well, you know, we have other patients that are critical as well," Sally says she was told. "It's a seven-month waiting list. And you're gonna have to have patience."

Sally says she kept calling, day after day, from late September to October. She kept up the calls through November. But then she no longer had reason to call.

Thomas Breen died on November 30. The death certificate shows that he died from Stage 4 bladder cancer. Months after the initial visit, Sally says she finally did get a call.

"They called me December 6. He's dead already."

Sally says the VA official told her, "We finally have that appointment. We have a primary for him.' I said, 'Really, you're a little too late, sweetheart.' "

At the end is when he suffered. He screamed. He cried.
Sally Brenn on the death of her father-in-law

Sally says her father-in-law realized toward the end he was not getting the care he needed.

"At the end is when he suffered. He screamed. He cried. And that's somethin' I'd never seen him do before, was cry. Never. Never. He cried in the kitchen right here. 'Don't let me die.' "

Teddy added his father said: "Why is this happening to me? Why won't anybody help me?"

Teddy added: "They didn't do the right thing." Sally said: "No. They neglected Pop."

First hidden -- and then removed

Foote says Breen is a perfect example of a veteran who needed an urgent appointment with a primary doctor and who was instead put on the secret waiting list -- where he remained hidden.

Foote adds that when veterans waiting on the secret list die, they are simply removed.

"They could just remove you from that list, and there's no record that you ever came to the VA and presented for care. ... It's pretty sad."

Foote said that the number of dead veterans who died waiting for care is at least 40.

"That's correct. The number's actually higher. ... I would say that 40, there's more than that that I know of, but 40's probably a good number."

CNN has obtained e-mails from July 2013 showing that top management, including Phoenix VA Director Sharon Helman, was well-aware about the actual wait times, knew about the electronic off-the-books list and even defended its use to her staff.

I think it's unfair to call any of this a success when Veterans are waiting 6 weeks on an electronic waiting list
From 2013 Phoenix VA e-mail obtained by CNN

In one internal Phoenix VA e-mail dated July 3, 2013, one staffer raised concerns about the secret electronic list and raised alarms that Phoenix VA officials were praising its use.

"I have to say, I think it's unfair to call any of this a success when Veterans are waiting 6 weeks on an electronic waiting list before they're called to schedule their first PCP (primary care physician) appointment," the e-mail states. "Sure, when their appointment is created, it can be 14 days out, but we're making them wait 6-20 weeks to create that appointment."

The e-mail adds pointedly: "That is unethical and a disservice to our Veterans."

Last year and earlier this year, Foote also sent letters to officials at the VA Office of the Inspector General with details about the secret electronic waiting list and about the large number of veterans who died waiting for care, many hidden on the secret list. Foote and several other sources inside the Phoenix VA confirmed to CNN that IG inspectors have interviewed them about the allegations.

VA: 'It is disheartening to hear allegations'

CNN has made numerous requests to Helman and her staff for an interview about the secret list, the e-mails showing she was aware of it and the allegations of the 40 veterans who died waiting on the list, to no avail.

But CNN was sent a statement from VA officials in Texas, quoting Helman.

"It is disheartening to hear allegations about Veterans care being compromised," the statement from Helman reads, "and we are open to any collaborative discussion that assists in our goal to continually improve patient care."

Just before deadline Wednesday, the VA sent an additional comment to CNN.

It stated, in part: "We have conducted robust internal reviews since these allegations surfaced and welcome the results from the Office of Inspector General's review. We take these allegations seriously."

Read the full statement here

The VA statement to CNN added: "To ensure new Veterans waiting for appointments are managed appropriately, we maintain an Electronic Wait List (EWL) in accordance with the national VHA Scheduling Directive. The ability of new and established patients to get more timely care has showed significant improvement in the last two years which is attributable to increased budget, staffing, efficiency and infrastructure."

Foote says Helman's response in the first statement is stunning, explaining the entire secret list and the reason for its existence was planned and created by top management at the Phoenix VA, specifically to avoid detection of the long wait times by veterans there.

"This was a plan that involved the Pentad, which includes the director, the associate director, the assistant director, the chief of nursing, along with the medical chief of staff -- in collaboration with the chief of H.A.S."

Washington is paying attention

The Phoenix VA's "off the books" waiting list has now gotten the attention of the U.S. House Veterans Affairs Committee in Washington, whose chairman has been investigating delays in care at veterans hospitals across the country.

According to Rep. Jeff Miller, chairman of the House Committee on Veterans' Affairs, what was happening in Phoenix is even worse than veterans dying while waiting for care.

Even as CNN was working to report this story, the Florida Republican demanded the VA preserve all records in anticipation of a congressional investigation.

In a hearing on April 9, Miller learned even the undersecretary of health for the VA wasn't being told the truth about the secret list:

"It appears as though there could be as many as 40 veterans whose deaths could be related to delays in care. Were you made aware of these unofficial lists in any part of your look back?" asked Miller.

"Mr. Chairman, I was not," replied Dr. Thomas Lynch, assistant deputy undersecretary, Veterans Health Administration.

Congress has now ordered all records in Phoenix, secret or not, be preserved.

That would include the record of a 71-year-old Navy veteran named Thomas Breen.

Tears, angry accusations mark hearing on delayed VA care

January: Congress demands answers

http://www.cnn.com/2014/04/23/health/veterans-dying-health-care-del...

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Comment by Chalice on May 12, 2014 at 8:50am

I have moved the discussion about this to our Forum, so we can gather articles about the same topic in one location to discuss and post about.

Comment by SGT William A. Geresy (ret) on May 8, 2014 at 12:07am

Friends, what I am learning last week and this week is shocking!

It has become very clear that our Veterans are at the bottom of the bucket when it comes to health care aimed at what is best for the Veteran.  The care is aimed at preserving the jobs at VA facilities.  The Veteran is at the VA mercy.  The Veteran is required to travel a great many miles, many times at the Veteran's own expense passing by many civilian hospitals that could treat the Veteran much closer to home.  Why?  They are NOT VA facilities.  That is the ONLY reason. 

I applaud my American Legion for calling for the head of the VA to resign.  Sadly, that will not fix the problems.  That will just put a new license plate on a junk car.  The system is so entrenched in rules to protect itself and not the Veteran, little can change.

The VA must have a top down remaking that will put the Veteran's needs and care first.  Where the care takes place should never be an issue.  No Veteran should be forced to travel hundreds of round trip miles for care if local hospitals can treat the Veteran.

Put the Veteran FIRST!

Are the Veterans there to justify the existence of the VA?

Or is the VA there to help us Veterans?

More soon!

Comment by Chalice on May 5, 2014 at 6:04am

WOW, Bill... what a travesty

It is so much more expensive for them to separate your services like this.  

I spoke to Bill over the weekend and he tells me that he got sick from the medicine and is  still recovering.

He is okay, but I am really concerned about how he is forced to use such extreme measures just to get a standard procedure...

Comment by SGT William A. Geresy (ret) on April 28, 2014 at 4:50pm

I got a phone call from the Battle Creek VA on Monday, today.

Battle Creek set up an appointment for me on Wednesday.  I have to go in early for fasting blood tests and an EKG.  Grumble, grumble, I don't like these as I like my breakfasts!  I will find out about transportation and travel pay for a week ago then.  Battle Creek told me to call the Detroit VA to find out about the medicine they prescribed and I was unable to pick up. 

I called Detroit and the lady there said it was mailed.  I went outside a bit later and it was delivered.  Well, that is solved.

There is still a lot to sort out.

I don't plan on having anything to post on Tuesday.  I am sure I will have more to post later Wednesday.

Comment by SGT William A. Geresy (ret) on April 26, 2014 at 4:47pm

What happened Friday.

I called Detroit VA to find out what was going on.  They had called on Thursday saying I was to be at Battle Creek at 6:30AM on the 8th of May.  The problem is I am not supposed to drive.  Battle Creek VA is 20 miles away.  What am I supposed to do, WALK?  Detroit gave me a number to call for Battle Creek.

So I called Travel at Battle Creek.  No one would answer the phone.

I called Travel Pay at Battle Creek.  No one would answer the phone.  This was to find out about the Travel Pay for Detroit.

I called the medical team at Battle Creek.  Finally a warm body.  I was trying to find out about the medicine I am supposed to take for the Colonoscopy.  She said I was to have picked at Detroit.  The problem was the pharmacy was closed by the time my appointment was done.

Another problem that is yet to be solved is the blood tests I am to take before going to Detroit.

So no word on a ride to Battle Creek, Travel Pay for Detroit, the tests, or the medicines.

While the VA is quite interconnected with computers, it seems the computers don't "talk" to each other very well.  The information is hard to find.

The VA has a system for patients to get updates.  The problem is the information takes up to 30 days to be posted for us.

So the mess continues and continues.

Comment by SGT William A. Geresy (ret) on April 24, 2014 at 11:59pm

My Dear Chalice, I will be keeping Patriot's Heart updated on my "adventure" with the VA.  I have a call to make on Friday.  The VA has transportation for me from Battle Creek VA to Detroit VA.  The problem is how do I get to Battle Creek when I am not supposed to drive?  And how do I get home later?  That is sort of like telling the Apollo 11 astronauts that we have a way to get you from Earth orbit to the Moon and back to Earth orbit.  You guys have to figure out how to get to Earth orbit and then out of orbit back to the Earth.  

The sad part is none of this is really new.  I had a friend Larry Duff who lived just a short distance from me.  He got injured by Agent Orange in Vietnam.  Despite two court orders to have Larry declared 100% disabled, the VA refused to obey the rulings of the judge.  Larry died in 2002.

I have put this forward at the American Legion Post I belong to.  I will keep trying to get this very issue bumped up all the way to the National level of the Legion.  Then just maybe the American Legion will help on this issue.  I think I will take the two stories I have posted here to the next Legion meeting on May 14th.  I will see if this will help.

I am worried about my care too.

One more thing to think about.  If I was on Medicare, Medicaid, or Welfare, I would get care locally.  But not us Veterans using the VA.  Why are we treated this way?  WHY?  That is what really bugs me!

Chalice, good luck and prayers on the election integrity.  That is just as important!

Comment by Chalice on April 24, 2014 at 10:53am

This is so upsetting, Sarge.  I was reflecting on it after our phone call, and I really feel this is an issue we should take up on Patriot's Heart Network.

I am seriously worried about your care... Let's do a documentary of every contact you have, and record each event on your blog - Or I can open the forum and we can do it there.  I will also see if we can find other Vets who will do the same.  Le't build a place where vets can tell and record there stories of abuse...  

Your work for this wonderful nation is far from done, my noble friend...  We can make an impact on this issue.

And for those of us who are not dependent on the VA ... I say this... If you think the VA is bad... what do you think we will get from Obamacare?

I am headed out of town for the day to push for election integrity.  I will be praying for you!

Comment by SGT William A. Geresy (ret) on April 24, 2014 at 12:32am

The VA is KILLING our Veterans!  It is NOT with kindness either!

Tuesday, I had to drive about 150 miles ONE WAY to Detroit for a VA appointment!  That is not fun.  It was for a surgeon to look at my butt to due the pre-op for hemorrhoids.  He looked for only a few seconds.  They also want to do a colonoscopy at the same time.  They were running an hour late.  That is government for you!

Now to due a colonoscopy, they make you drink crap that makes you poop completely out before they look inside.  I do NOT look forward to riding for FOUR HOURS praying I don't have to poop NOW!  They couldn't care less!  They just don't care about what I have to go through!  You are just something for them to do something to I guess.

Tuesday, they were going to try to figure out how to get me there.  It is Wednesday night and no word on that!

I had to be away from the house this afternoon.  While I was away the VA called.  My Mom took the call.  The VA wants me back for a pre-op appointment!  I thought that was what I just did on Tuesday.  Doesn't the VA have a clue what they are doing?  I guess not!

I don't want to think about how many civilian hospitals there are between my home and Detroit.  But all are not allowed with the VA.  They care about themselves and not the veteran.  We are just a pawn they can push around at will.

My late Father was a Veteran from WWII.  He was wounded in action in Germany.  For just over the last year of his life he couldn't walk.  Mom applied to the VA for nursing home care.  She filled out page after page of paperwork to apply.  Then she was told the waiting list was EIGHTEEN months.  He died before he could go.

Did you know that unless an Air Force or Army National Guardsman is called to active duty for war, they are NOT considered a Veteran by the VA?  It is most true!  You can serve one enlistment or even a career and to the VA you are just another civilian that never served!

Now our wounded from the War on Terror are being pushed off to the VA for ongoing treatment instead of being kept at active duty hospitals!

The VA is NOT a good organization for helping Veterans.  It must be drastically changed.  The focus must be on veteran's care.  The VA must recognize that all this travel is wrong.  It in the end denies us the care we earned by serving.

I have been nominated to become the Post Service Officer for the American Legion Post I belong to.  With what just happened, I will accept the honor and be determined to help my fellow Veterans get what they have earned. 

I will be posting more on my battle with the VA here.

PHNM

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