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Shreveport V.A. Whistleblower: "This behavior is built into the - KTBS.com - Shreveport, LA News, Weather and Sports

Shreveport V.A. Whistleblower: "This behavior is built into the foundation."

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SHREVEPORT, La - Part 1 The Secret List

Part 2Wait Times Manipulated

Part 3:
Ever since allegations that veterans died waiting for care came out of phoenix, we've all been asking, why, and how could an organization aimed at helping our servicemen and women foster an atmosphere where this has gone on for so long? 

Whistleblower Shea Wilkes - a current employee at Shreveport's V.A. Medical Center has opened up to KTBS about the existence of an alleged secret wait list and manipulated appointment times. He explains the hospital as fostering a culture where you learn to adapt - or keep quiet - that has allowed the manipulation of wait times to continue. “This is a system where a lot of this behavior is built into the foundation, and it has been for a while."

Wilkes says it goes beyond manipulating wait times and secret appointment lists.

“The folks that do this are very crafty. They are in leadership. They manipulate hiring practices to put others that will do this stuff in positions to help them....they're going to put your morals and ethics at risk."

He says in a system where this has gone on for so long, he's not sure some front line employees even know it's wrong. But for those who do, it's not an environment that welcomes challenges to the way things are done. “There are so many good employees there that really care. They have fallen in there and they say you know it doesn't matter what I say, they're going to do what they want to anyway."

But change could be on the way. After a team of auditors came through Overton Brooks on May 13th, our facility has been flagged for further review. “I have a lot more confidence in the Inspector General now,” says Wilkes. “A lot of truth is coming out and I hadn't heard that, I haven't heard it. I'm gonna be honest with you all, I’m very hopeful."

At this time, we don't yet know when or who will conduct any further investigation. “It'll all be worth it when we get this thing going right,” says Wilkes.

“There's so many good people in the V.A. I mean I tell you, there are. You're all there, you have a team and you want to help veterans and your ideas are there and everybody's together it's just an amazing organization. But like I said, there's good care, and there's a fine line to becoming great. This is where we want to be we want to provide great care, and we can. There's no doubt in my mind. It's just, we need to, I hate to say it, we need to change and start over in a lot of different areas.”

If you'd like your voice heard, veterans living in Northwest Louisiana are invited to attend a "Veterans Health Care Town Hall Meeting" hosted by State Representative Jeff Thompson on Thursday, June 19th at the Bossier Parish Community College Performing Arts Theater, building C, beginning from 5:30-7 p.m.  David LeCerte, Secretary of the Louisiana Department of Veterans Affairs will be participating in the event, as will representatives of Senator David Vitter and Congressman John Fleming's offices.

KTBS poured through years of V.A. audits to find instances of improper scheduling practices and lack of Mental Health follow-up similar to what Shea Wilkes describes is occurring at Overton Brooks Veterans Administration Medical Center in Shreveport, Louisiana.

“For the first time I had some hope,” Shea Wilkes said. Shea Wilkes reached out to KTBS the morning after watching Richard Griffin’s recent Congressional testimony (he was inspired by Griffin’s honesty and hopes help is on the way to fix these problems).

“That’s going on here,” Shea Wilkes. Shea Wilkes worked in the Mental Health divisions at Overton Brooks VA Medical Center. He began realizing the scope of the deceitful scheduling practices after the Atlanta scandal broke in 2011. That audit found here.

We substantiated that several MH clinics had significantly high numbers of patients on their EWLs over a period of months in fiscal year (FY) 2010, and we substantiated that facility managers were aware of the EWLs but were slow in taking actions to address the condition. We are unaware of any completed suicides; however, we did find evidence of MH EWL patients who attempted suicide, were hospitalized, or presented to the emergency department. We did not evaluate whether these events occurred as a direct result of being placed on MH EWLs, or whether they would have occurred in the course of regular, ongoing treatment.

“The list has at least 500 patients that need a follow up,” Shea Wilkes. The secret list Wilkes saw at Overton Brooks was a list of Mental Health patients who had been seen (at least once) but needed follow up appointments. That list was at least 500 patients when Wilkes saw it, but has now allegedly grown to include over 600 Mental Health patients in need of follow up care. The 2011 Atlanta audit noted that performance was based on if a veteran had an initial appointment, and that wait times measures didn’t take into consideration the need for ongoing mental health follow-up.

We noted that the Veterans Health Administration’s performance measure on MH clinic access refers only to the first MH clinic evaluation; it does not measure ongoing access to MH services. As such, some Veterans Health Administration’s facilities may be fully compliant with the performance measure but may not be providing timely and ongoing treatment and services critical to this population’s MH maintenance and recovery.

I’m an Army guy; I tried to handle this internally. I had no other option.” Shea Wilkes claims to have first tried to address the problems of wait times with higher ups within the Overton Brooks Facility on multiple occasions. Then he reached out to the Inspector General through an electronic complaint. As the fraudulent scheduling practices continued (as recently as May 2014,) he reached out to KTBS. This pattern is similar to another confidential informant from Atlanta Mental Health. In January 2010, a confidential complainant reported to the OIG that facility managers were not adequately addressing EWLs in the MH clinics (In Atlanta.)
    The complainant specifically alleged that:
-A high number of patients were on various MH clinic EWLs, which may place some patients at risk for negative events or outcomes.  
-Despite VISN and facility management being aware of the risk to patients, no actions had been taken to resolve the issue.

“I wouldn’t trust any numbers from the V.A.”. Wilkes  alleges that the wait time manipulation is so ingrained in the culture and has been going on for so long, that reported wait times are meaningless.
    We found evidence of this at another VA Mental Health clinic; in a 2012 audit the Inspector General found:
    -VHA’s Mental Health Performance Data Is Not Accurate or Reliable. VHA does not have a reliable and accurate method of determining whether they are providing patients timely access to mental health care services. VHA did not provide first-time patients with timely mental health evaluations and existing patients often waited more than 14 days past their desired date of care for their treatment appointment.
    -VHA’s Measurement of a First-Time Patient’s Access to a Full Mental Health Evaluation was not a Meaningful Measure of Waiting Time. In VA’s FY 2011 Performance and Accountability Report (PAR), VHA reported 95 percent of first-time patients received a full mental health evaluation within 14 days. However, this measure had no real value as VHA measured how long it took VHA to VA Office of Inspector General Review of Veterans’ Access to Mental Health Care conduct the evaluation, not how long the patient waited to receive an evaluation. For example, if a patient’s primary care provider referred the patient to mental health service on September 15 and the medical facility scheduled and completed the evaluation on October 1, VHA’s data showed the veteran waited 0-days for their evaluation. In reality, the veteran waited 15 days for their evaluation.

Gaming the system is part of the culture.” Shea Wilkes described reasons for schedule manipulation to KTBS. To better understand the motivations for schedule manipulation, and how ingrained in the culture this is, KTBS reviewed investigations going back almost a decade, and found the following: 2005 audit on Scheduling Practices.
    WHY DO THEY WANT TO LIE?
1) MAKE THEIR PERFORMANCE LOOK BETTER (65 percent) were scheduled within 30 days of the desired date—well below the VHA goal of 90 percent and the medical facilities directors’ reported accomplishment of 81 percent. Although the recalculated average waiting time of 30.1 days was consistent with VHA’s goal of scheduling appointments within 30 days, it was 44 percent more than the reported average waiting time of 20.9 days.
2) AVOID HAVING TO PAY FOR VETS TO GO OUTSIDE OF V.A. FOR CARE VHA requires that veterans with service-connected disabilities receive priority access to medical care. Because schedulers did not use the correct scheduling procedures, actual waiting times were understated, resulting in medical facility directors being unaware that 2,009 service-connected veterans waited longer than 30 days from their desired date of care. VHA requires medical facility directors to arrange for veterans to receive care at another VHA medical facility or fee basis care from a non-VA provider at VA expense if the needed care cannot be provided within 30 days.

     WHO TELLS THEM TO LIE?
    1) Managers or Supervisors
    2) Lack of training, even for trainers! According to 7 percent of the survey respondents, managers or supervisors directed or encouraged them to schedule appointments contrary to established procedures. Also, 81 percent of the survey respondents told us they had received no training on the use of the electronic waiting list and only 45 percent of the survey respondents had received any formal training on the use of the VistA scheduling module. Survey respondents who identified themselves as trainers often did not know the correct scheduling procedures.

“We’re putting a band-aid on a gaping wound. They can’t see that we need more providers.” Shea’s sentiments are shown in a 2012 Mental Health audit: Measuring Access to VHA Mental Health Care The data and measures needed by decision makers for effective planning and service provision may differ at the national, Veterans Integrated Service Network, and facility level. No measure of access is perfect or paints a complete picture in isolation. Meaningful analysis and decision making requires reliable data, on not only the timeliness of access but also on trends in demand for mental health services, treatments, and providers; the availability and mix of mental health staffing; provider productivity; and treatment capacity. These demand and supply variables in turn feedback upon a system’s ability to provide treatment that is patient centered and timely. VHA’s 14-day follow-up measure provides decision makers with a limited picture of a new patient’s ability to access and begin mental health treatment. Additionally, depending on a veteran’s point of access, this metric does not truly measure VHA’s stated objective “to ensure timely access for all veterans who are new to mental health.”

    WHAT CONSEQUENCE LYING?
    - CAN’T SEE HOW MANY PEOPLE REALLY ARE WAITING.
    -NO CONFIDENCE IN NUMBERS MASKS NEED FOR MORE PROVIDERS MASKS NEED FOR VETS TO BE SENT OUT OF V.A. TO BE SEEN.

“This is nothing new.” These problems may have reached a fever pitch, but Congress has known about it for years. A Congressional Hearing over a year ago, March 14, 2013, documented that this issue has been public since 2001:
     Improving access to health care is a continuous effort by VHA, and it is not surprising that we are here today. Excessive wait times and the failures of scheduling processes have been longstanding problems with the Veterans Health Administration. The Government Accountability Office has been reporting on this issue for over a decade. In 2001, the GAO reported that two-thirds of the specialty care had wait times longer than 30 days. In 2007, the VA Office of Inspector General reported that VHA facilities did not always follow VHA's scheduling policies and process. In 2012, the VA OIG reported that VHA was not providing all new veterans with timely access to full mental health evaluations. In that same year, the GAO again examined the issue and found that, among other things, there was inconsistent implementation of VHA's scheduling policy that could result in increased wait times or delays in scheduling timely medical appointments. (Hon. Ann Kirkpatrick)
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