Why the Phony Outrage Over the VA Scandal, Congress?

The continuing saga of false and misleading operations at various Department of Veterans Affairs hospitals throughout the country hit a new level last week. While we know that there has been a critical backlog of veterans waiting for healthcare services, the backlog itself is not the scandal. What’s got everyone upset is misconduct by VA employees who input false and misleading information into the Veterans Health Information Systems and Technology Architecture (VistA), the system used to electronically log appointment requests. The public is outraged, and rightly so, but Congress is acting just as surprised as the rest of us, and therein lies the issue. The real question the public needs to ask is, why the phony outrage Congress?

Due to public outcry, the House Veterans Affairs Committee held a hearing on June 9, 2014 entitled Oversight Hearing on Data Manipulation and Access to VA Healthcare: Testimony from GAO, IG, and VA. Assistant Deputy Undersecretary of the VA Philip Matkovsky was asked about the technology used to schedule appointments, to which he answered, “Our scheduling system made its first appointment in April of 1985…it has not changed in any appreciable manner since that date.”  Yes, you read that right. The technology currently used by the VA is more than 30 years old. Technology changes significantly each year. It’s completely unacceptable to think using a system that old would increase efficiency and remain effective. As the hearing continued, Richard J. Griffin, acting VA Inspector Generalm testified that, “Since 2005 the OIG has issued 18 reports that identified at both the national and local level, deficiencies in scheduling resulting in lengthy wait times and negative impact on patient care.”

The Veterans Administration has been championed as a pioneer in healthcare information technology. In a 2005 Senate Veterans Affairs Committee hearing entitled Information and Technology at the VA – Is It ready for the 21st Century, Deputy Secretary of Veterans Affairs Gordon Mansfield testified that his department had seen significant changes in IT operations.  A major reason this hearing was held was to discuss the VA’s use of more than $2 billion in appropriated funds to update information technology. (It should also be noted that 1,200 information technology service contracts valued at approximately $5.2 billion were awarded between October 2010 through June 2012.)  Mr. Mansfield pointed to editorials, professional journal publications, and even remarks from a speech delivered by President George W. Bush on April 27, 2004 describing his intentions to expand the VA’s electronic health records beyond the VA as examples of the great progress made. Although this testimony may seem to substantiate Congress’ claims of being unaware of the technology issues the VA faced, it does not explain why the Chairman of the Senate Veterans Affairs Committee personally requested an audit of Veterans Integrated Service Network 3 in 2008.

The Veterans Affairs Department breaks up the entire country into Veterans Integrated Service Networks to identify the clinics and hospitals Veterans are eligible to visit in their area.  VISN 3 represents portions of New York and New Jersey.  In 2008 the VA Office of the Inspector General conducted an audit on VISN 3 and this report uncovered the manipulation practices of the scheduling system that have also been identified in the current scandal. The report was sent to Michael J. Kussman, the Undersecretary of Health with recommendations; however, Mr. Kussman had this to say in response:

I have carefully reviewed your report on scheduling practices within VISN 3, and I do not concur with your conclusions and recommendations. Because the issues you cite reflect the need for national solutions to acknowledged policy-related concerns that VHA is already addressing in response to your previous reports, it is counterproductive to single out VISN 3 in your recommendations for accountability issues that apply to every other VISN, as well.

The Assistant Inspector General wasn’t going to take that lying down and responded with the following:

Contrary to the Under Secretary’s statement, we did not single out VISN 3 for this review. The Chairman of the Senate Veterans’ Affairs Committee requested we conduct this audit based on serious allegations the committee received that VISN 3 was intentionally distorting the numbers on waiting times. We also take exception to the Under Secretary’s non-concurrence with the report’s conclusions and recommendations based merely on the fact that the issues we reported reflect the need for national policy solutions that VHA claims they are already addressing. Our exception is based on the fact that VHA has recognized the need to improve the accuracy of waiting times data, yet has taken no meaningful action to achieve this goal to date. We can only conclude that VHA’s stated intention to correct recognized and long-standing problems is not sincere.

 

After reading several of the OIG reports it is clear that the VistA technology has a major flaw. Since the first report in 2005, the VA uncovered that scheduling can be manipulated by overwriting the Electronic Waiting List system and scheduling appointments on top of an already existing one. Overwriting the system does two things.

1. It changes the originally created date to the current date of entry, and changes the desired date to the date of the appointment, reducing the reported wait time.
2. The cancellation of the original date of creation is never recorded.  

In an attempt to make the logs appear to meet scheduling requirements, employees are able to overwrite the system to show they are in compliance with scheduling procedures even when they’re not. This has made it increasingly more difficult to identify when a request was originally created and interferes with the Veteran Affairs Department’s ability to accurately report the true wait time based on electronic waiting lists.

The OIG reports recommend stopping this employee behavior by providing training to employees to ensure compliance with scheduling systems standards. Surprisingly, there was never a recommendation for using a portion of the appropriated billions of dollars the VA Department was given on an entirely new scheduling system.

The VA’s Office of the Inspector General has issued 18 reports, each sent to Congress, and at least one of which was personally requested by a Senate Committee Chairman. Even if all 535 members of Congress weren’t aware, the members of the House and Senate Veterans Affairs Committees most certainly were. Of the several billions of dollars appropriated to the VA Department for IT operations, it’s astounding to me that nobody thought to update the technology or at the very least get rid of the overwriting loophole the employees uncovered in the system.  As seen in the 2008 report, the VA knew the problem and chose to fight among themselves instead of fixing it. Then legislators responsible for oversight of the Department pretended to be completely unaware of what was going on once the truth was reported to the public. The general public, and Veterans especially, should be upset that this was allowed to continue.  But again I must ask Congress, why the phony outrage?

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Teerah Goodrum (@AisleNotes), is a recent Graduate of Howard University with a Masters degree in Public Administration and Public Policy. Her time on Capitol Hill as a Science and Technology Legislative Assistant has given her insight into the tech community. In her spare time she enjoys visiting her favorite city, Seattle, and playing fantasy football.

Featured image courtesy of [DVIDSHUB via Flickr]

Teerah Goodrum

Teerah Goodrum is a Graduate of Howard University with a Masters degree in Public Administration and Public Policy. Her time on Capitol Hill as a Science and Technology Legislative Assistant has given her insight into the tech community. In her spare time she enjoys visiting her favorite city, Seattle, and playing fantasy football. Contact Teerah at staff@LawStreetMedia.com.