By Sandra Basu

WASHINGTON—Two years after the Phoenix Healthcare System came under fire for delayed patient care and wait lists, a recent VA Inspector General’s (IG) report has found that patients continue to encounter delays in care at the hospital.

As of August 2015, more than 22,000 individual patients had 34,769 open consults at PVAHCS, according to the report. Of all the open consults at that time, about 4,800 patients had nearly 5,500 consults for appointments within PVAHCS that exceeded 30 days from their clinically indicated appointment date. In addition, more than 10,000 patients had nearly 12,000 community care consults that exceeded 30 days.

“PVAHCS continues to have a high number of open consults because providers are not always receiving and reviewing consults to their clinics timely, staff had not scheduled patients’ appointments in a timely manner (or had not rescheduled canceled appointments), a clinic could not find lab results, and staff did not properly link completed appointment notes to the corresponding consults,” the report pointed out.

The VA IG initiated its review of alleged consult management issues at the PVAHCS in response to allegations reported to the OIG by the House Committee on Veterans’ Affairs in July 2015.

As part of its investigation, the VA OIG also sought to determine whether patients died waiting for consultative appointments. The VA OIG was provided a copy of a report that listed 87 deceased patients and 116 open consults. It expanded its investigation to 294 facility consults for 215 patients, who had open consult requests at the time of their death.

Ultimately, it determined that untimely care from PVAHC might have contributed to the death of one patient.

“This patient never received an appointment for a cardiology exam that could have prompted further definitive testing and interventions that could have forestalled his death,” the report noted.

It determined that “the remaining patients’ records reviewed did not die because they did not receive the requested consult in a timely fashion before they died.”

Also among the report’s findings was that staff inappropriately discontinued consults. The report found that staff inappropriately discontinued 74 of the 309 specialty care consults (24%) it reviewed in 2015.

“This occurred because staff were generally unclear about specific consult management procedures, and services varied in their procedures and consult management responsibilities. As a result, patients did not receive the requested care or they encountered delays in care,” according to the report authors.

VA Response

One of the VA OIG report recommendation’s was that the VA needs to update the VHA consult policy, something accomplished in August of last year.

In an attached memorandum to the VA OIG report, VA officials explained that, throughout the healthcare system, it “has taken many actions during the past three years to improve how we handle consultations for clinical care.”

“Our efforts have effectively decreased the number of consults for clinical care open more than 90 days by 64 percent In December 2013, VHA had 270,740 consults open for more than 90 days; as of August 2016, VHA has 98,757,” the agency explained.

Meanwhile, Republican lawmakers voiced their outrage over the findings of the report. Sens. John McCain (R-AZ) and Jeff Flake (R-AZ) said in a joint statement that everyone should “be alarmed that more than two years after the scandal in care first erupted at the Phoenix VA, such reprehensible behavior continues to take place, putting the health of our veterans at risk.”

They said the findings “underscore the need to give our veterans a choice in where and when they receive care.” Last year, McCain had introduced a bill that would extend the Choice Program indefinitely and would give all veterans enrolled in VA the option to use the Choice Program.

House Committee on Veterans’ Affairs Chairman Rep. Jeff Miller (R-FL) said, meanwhile, the report is “proof” that many of the Phoenix VA’s original problems remain.

“Unfortunately, given that this report is largely devoid of clear lines of accountability to those responsible for Phoenix VAHCS’s current problems, it is unlikely these issues will be solved anytime soon,” he said.