Email warned VA leadership about unethical scheduling

Editor's note: If you're a veteran that would like to share your VA treatment issues, contact Kala Kachmar (kkachmar@gannett.com).

The director of the Central Alabama Veterans Health Care System was alerted to concerns about changes being made in scheduling records to create falsified wait times for veterans more than eight months before he took action, according to emails obtained by the Montgomery Advertiser.

In June, an audit by the U.S. Department of Veterans Affairs Office of Inspector General showed that employees in the central Alabama system, including Montgomery and Tuskegee, had manipulated records to conceal long waiting periods for veterans seeking medical care.

In a June 6 email to all CAVHCS employees, director James Talton said the facilities were identified for investigation based on information employees provided during access review visits from the inspector general's office about three week earlier.

But April 2013 emails obtained by the Advertiser show that an employee emailed Talton after a doctor expressed concerns that scheduling records were being done so it appeared veterans received faster access to care than they actually did.

On Tuesday, Talton said any "ambiguous statements" staff members emailed him about scheduling problems were "not actionable."

"If I'm going to take action or investigate something, there has to be something to chase," Talton said. "The numbers are wrong based on — what? They can be wrong for a variety of reasons. The schedulers need to be trained so the numbers appear accurately."

Talton said the first time he received anything he could take action on was in the last week of December, when an employee brought to his attention paper waiting lists being used by staff to keep track of patients seeking appointments.

Using paper lists and delaying the scheduling until a slot is available instead of entering appointments into the scheduling system right away makes it look like the patient demand is being met when it's not.

Talton said in January after the holidays, he initiated a fact-finding investigation on the paper waiting lists. He said administrative action was taken against some employees, and in some cases, those actions are still pending. Some were reassigned from their managerial positions, he said.

Talton said to his knowledge, the use of paper lists was discontinued. He also said it was only happening in primary care, not in any other areas, such as specialty care or mental health.

Two employees who work at CAVHCS, who did not want to be identified for fear of losing their jobs, said paper waiting lists were also being used for scheduling dental and mental health appointments.

"You'll find pockets of compliance and outliers also," he said. "Will I swear up and down that no one is using them? No."

Talton also said paper waiting lists have been in existence for years, and that it's not a new problem. He said his calendar has a one-hour block for "management by walking around," and he's never seen a paper waiting list during his inspections of the facilities.

"The thing about paper waiting lists that people miss is you don't know they exist until you see them," he said. "The idea that the VA is sitting back and letting paper wait lists [be used] — that's just not true."

Talton said the primary reason for the long waiting lists is a shortage of providers, which includes doctors, nurse practitioners and physicians' assistants.

Even with the manipulated records, the CAVHCS has the eighth-longest average wait time out of 141 VA systems nationwide, according to the audit. The central Alabama system is one of 84 VA facilities nationwide identified by the audit for unethical scheduling practices.

Talton, who has been working at CAVHCS since 2011, said he began working on improving wait times and access problems as soon as he started.

He said the access has improved significantly since he took over, but it's been worse in the last six months because of a loss of providers, he said.

When he took the job, Talton said he knew he was "walking into a mess." But he said he's been focused on achieving the best outcomes for veterans, improving access, improving employee processes and improving employee performance.

Talton said the media attention CAVHCS has been getting is helping him get a more in-depth look at the action he needs to take to appropriately lead the organization. But he said employees are feeling the additional workload.

"The amount of additional workload in responding to the requests and the additional correspondence is taking a lot of work out of the organization," Talton said. "The staff feels it and work is slowing down in some areas."

One example, he said, is if there are a number of complaints regarding clinical care, the clinical staff has to stop taking care of patients to research and respond to the complaint.

"I want to be able to continue taking care of veterans," he said. "We're here to take care of veterans and I don't care about anything else."