A year ago, the U.S. Department of Veterans Affairs was consumed by scandal that shook the public’s confidence in the nation’s largest integrated health care system and prompted the agency’s leader to resign.
In Phoenix, the VA’s inspector general revealed 1,700 veterans were on a secret, off-the-books waitlist for medical appointments, making it appear as though the region’s VA system had shorter wait times and better access to care than it actually did. Forty veterans died while awaiting appointments, including many placed on the secret waitlist.
The VA Maine Healthcare System was never implicated in such wrongdoing. In fact, Maine’s VA system consistently has outperformed the VA as a whole on one key measure of patient access to care: As of June 1, Maine patients had been able to schedule 96 percent of their pending appointments — compared with 93 percent nationally — within 30 days or fewer of requesting them.
Still, the Maine VA hasn’t proven immune to the forces at the root of wrongdoing in Phoenix and at other VA hospitals:
— A shortage of providers who can offer patients the care they need
— Pressure to meet agency-wide performance benchmarks seemingly at all costs
— A culture in which employees are impelled to paper over, instead of confronting systemic problems.
A VA Inspector General report released last week found that staff in the Maine VA’s mental health services unit regularly, per managers’ orders, sidestepped protocols when referring patients for outpatient mental health care.
They often closed case files before care was delivered, didn’t use the VA’s official electronic waitlist that tracks wait times for appointments, or didn’t document referrals using the official consult system. The inspector general didn’t find examples of these practices directly harming patients, but the investigative team noted they made it more difficult to track patients and ensure they received needed care.
The patients in question often were seeking treatment for post-traumatic stress disorder after returning from combat or conditions such as psychosis. Some were deemed high suicide risks.
The inspector general — who didn’t question the quality of care — highlighted individual cases in which wait times for individual therapy lasted eight months, 10 months and more than a year and a half. In the interim, patients met with psychologists or received group therapy — treatments that might have been inappropriate or insufficient.
The inspector general reported Maine VA managers emphasized to staff a need to meet performance benchmarks for scheduling appointments in a timely manner, but investigators didn’t find evidence this emphasis resulted in systemic wrongdoing as it did in Phoenix. Several violations of VA protocols, the inspector general reported, were the result of staff misunderstanding complicated and poorly implemented VA scheduling guidelines and managers never confronting and correcting the errors.
The inspector general also highlighted a general culture that allowed such errors to occur and that Maine’s VA leadership must work to correct.
“Numerous interviewees described chronically low morale among staff and a pervasive fear of reprisal should they raise concerns to management,” the inspector general wrote.
The VA Maine Healthcare System plans to hire 17 new staff members — nine of them by Sept. 30 — to expand access to mental health services, particularly case management and psychotherapy, using funding approved by Congress last year. These new hires can address several pervasive access issues causing long wait times for needed therapy.
But it won’t be easy for the Maine VA to find needed staff. Nine of Maine’s 16 counties have federally designated mental health care provider shortage areas. Nationwide, the picture isn’t much better.
As much as new hires will help the situation, it is just as important the Maine VA take steps to ensure staff are properly trained in admittedly awkward VA scheduling and referral protocols. It also is critical the health care network take a look inward and make it a priority to reform a culture where it sometimes is easier to work around instead of confront significant problems.
