VA admits delays in healthcare caused death of veterans

In a contentious hearing before Congress, a senior official from the Department of Veterans Affairs’ watchdog agency acknowledged for the first time on Wednesday that delays in care had contributed to the deaths of patients at the department’s medical center in Phoenix.  http://www.nytimes.com/2014/09/18/us/va-officials-acknowledge-link-between-delays-and-patient-deaths.html?ref=us
The disclosure by an official from the department’s inspector general’s office, coming after more than two hours of tough, sometimes confrontational exchanges with members of the House Veterans Affairs Committee, was a significant development in what has become a heated dispute over the quality of care at the Phoenix hospital, where revelations of secret waiting lists and other schemes to disguise long delays in care turned into a national scandal.
Republicans characterized the acknowledgment as an about-face, and expressed frustration and some anger that a report on the Phoenix hospital issued by the inspector general last month contained language widely viewed as playing down concerns about a link between the medical-care delays and veterans’ deaths.
As the waiting-list scandal began to break in Phoenix this spring — and soon became a national controversy that led to the ouster of the department’s secretary, Eric Shinseki, and the suspension of the hospital’s director — claims were made by whistle-blowers and on Capitol Hill that the deaths of as many as 40 veterans could be attributed to delays in care.
In its report last month, however, the inspector general said that while it found that 28 veterans in Phoenix, including six who died, had experienced “clinically significant” delays in care, its investigators were unable to “conclusively assert” that any deaths had actually been caused by the waiting-list delays.
That language was added after department officials reviewed an initial draft — standard practice with such reports. Some congressional Republicans objected to the late-stage inclusion of the language, arguing that it appeared to improperly exonerate the department. They also asked whether senior department officials had pushed to include the language. But officials from the inspector general’s office said no such request had been made.
At Wednesday’s hearing, the acting Veterans Affairs inspector general, Richard J. Griffin, stood firmly by the wording of the report.
But under questioning by Representative David Jolly, Republican of Florida, Dr. John D. Daigh, the assistant inspector general for health care inspections, conceded that medical-care delays in Phoenix had contributed to some patient deaths.
“Would you be willing to say that wait lists contributed to deaths of veterans?” Mr. Jolly asked.
“No problem with that,” Dr. Daigh replied. “The issue is cause.”
Dr. Daigh did not say how many times he believed medical-care delays had contributed to deaths in Phoenix. In addition to the six veterans who died after experiencing clinically significant delays, the inspector general’s office revealed Wednesday that 293 veterans had died out of 3,409 cases it reviewed in Phoenix.
“We can play with semantics all we want,” Mr. Jolly said, “but right here at the table it was acknowledged by the I.G.’s office that the wait lists contributed to the deaths of veterans.”
Mr. Griffin, a former deputy director of the Secret Service, told Mr. Jolly that a careful reader of his report would have understood that delays might have contributed to deaths. “A careful reading would show that in some of those cases, we say that they might have lived longer,” Mr. Griffin said.
Mr. Jolly asserted that Mr. Griffin was undercutting “the confidence we have in the I.G. by not being able to answer that very simple question: Did it contribute to the deaths of veterans, yes or no?”
“It could have,” Mr. Griffin replied.
Representative Jeff Miller, Republican of Florida, who is the chairman of the committee, said, “The confirmation from I.G. officials today that delays contributed to the deaths of Phoenix-area veterans, and I.G. officials’ admission that they couldn’t rule out the possibility that delays caused deaths, changes the entire bottom line of the I.G.’s Phoenix report.” Mr. Miller added: “Absent these qualifying statements, the I.G.’s previous
assertions that it could not ‘conclusively assert’ that delays caused deaths are completely misleading. It’s absolutely inexplicable and outrageous that the I.G.’s Phoenix report failed to clearly make these distinctions.”
Earlier in the hearing, Mr. Griffin defended the addition of the disputed sentence in the final report, saying that changes were common between drafts of inspector general reports in all departments of the federal government.
He also emphasized that medical conclusions drawn by his office were overseen by board-certified physicians on his staff, and restated that he stood by the findings of last month’s report. To say definitively that some patients would have lived had they gotten care sooner “was a bridge too far for our clinicians,” he said.
Also on Wednesday, the department took a step toward remedying the main cause of long delays at many medical centers — shortages of doctors, who can make more at private hospitals — by proposing raising physician and dentist salaries by $20,000 to $35,000.

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