Updated at 2:10 p.m. June 9, 2014
The Department of Veterans Affairs wait-time scandal that metastasized from Phoenix has apparently infected a VA clinic in Escondido.According to a nationwide audit released Monday, the nonemergency clinic at 815 E. Pennsylvania Ave. requires “further review based on assessment of site team reports.”
The Escondido outpatient clinic is one of 31 nationwide getting extra attention. The audit didn’t specify why the clinics needed a second look. An additional 81 sites, from a phase-one review, also are being scrutinized.
No other San Diego County VA medical center or clinic required further review, according to the audit. Inspections began May 12 and concluded June 3.
Dave Bayard, a VA spokesman, told Times of San Diego that being flagged for further review does not necessarily mean that any improprieties were found.
“It could be a minor training issue or a major systematic failure,” Bayard said via email.
But he noted that the audit report says:
“Out of the 229 site reports indicating some degree of concern, 112 (or roughly 19 percent of all reports) were flagged because of concerns that indicated undesired scheduling practices or because detailed responses by interviewed staff indicated they had received instruction to modify scheduling dates (or similar concerns).
“This initial assessment of sites requiring further review is based on a review of qualitative responses by front-line staff to questions and comments contained in site audit reports,” the audit said. “The listing of these sites should be understood as a preliminary step, and further actions will be taken after the determination of the extent of issues related to scheduling and access management practices.”
U-T San Diego reported that 830 San Diego VA patients were still waiting for an appointment requested when they enrolled in the system.
“And 334 new patients have been told they can’t get a requested appointment in the next three months,” the U-T said.
The VA released results from its nationwide access audit, along with facility-level patient access data, medical center quality and efficiency data, and mental health provider survey data for all veteran health facilities.
Full details follow acting Veterans Affairs Secretary Sloan Gibson’s commitment last week in Phoenix and San Antonio to provide timely access to quality health care veterans have earned and deserved.
“It is our duty and our privilege to provide veterans the care they have earned through their service and sacrifice,” Gibson said. “As the president has said, as [former VA Secretary Eric K. Shinseki] said, and as I stated plainly last week, we must work together to fix the unacceptable, systemic problems in accessing VA health care.
“Today,” he continued, “we’re providing the details to offer transparency into the scale of our challenges, and of our system itself. I’ll repeat: this data shows the extent of the systemic problems we face, problems that demand immediate actions.”
As of Monday, Gibson said, VA has contacted 50,000 veterans across the country to get them off of wait lists and into clinics.
Gibson also announced a series of additional actions in response to today’s audit findings and data, including:
- Establishing a new patient satisfaction measurement program. He has directed the Veterans Health Administration to immediately begin developing a new patient satisfaction measurement program to provide real-time, robust, location-by-location information on patient satisfaction, to include satisfaction data of those Veterans attempting to access VA healthcare for the first time. This program will be developed with input from veterans service organizations, outside health care organizations, and other entities, officials said, to ensure VA collects an additional set of data directly from the veteran’s perspective to understand how VA is doing throughout the system.
- Holding senior leaders accountable. Where audited sites identify concerns within the parent facility or its affiliated clinics, VA will trigger administrative procedures to ascertain the appropriate follow-on personnel actions for specific individuals.
- Ordering an immediate Veterans Health Administration Central Office and Veterans Integrated Service Networks Office hiring freeze. Gibson has ordered the hiring freeze at the VHA central office here and at VHA’s 21 regional VISN offices, except for critical positions to be approved by the secretary on a case-by-case basis. This will begin to remove bureaucratic obstacles and establish responsive, forward-leaning leadership, VA officials said.
- Removing the 14-day scheduling goal from employee performance contracts. This action will eliminate incentives to engage in inappropriate scheduling practices or behaviors, officials said.
- Increasing transparency by posting data twice monthly. VHA will post regular updates to the access data released today at the middle and end of each month at http://VA.gov. Twice-monthly data updates will enhance transparency and provide the most immediate information to veterans and the public on veterans’ access to quality health care, officials said.
- Initiating an independent, external audit of scheduling practices throughout the VHA system.
- Sending an additional frontline team to Phoenix. Following his trip to the Phoenix VA Medical Center last week, Gibson directed a VHA frontline team to travel there immediately to address scheduling, access, and resource requirements needed to provide veterans with timely, quality health care.
- Using high-performing facilities to help those that need improvement. VA will formalize a process in which high-performing facilities provide direct assistance and share best practices with facilities that require improvement on medical center quality and efficiency performance measures.
- Applying immediate access reforms announced in Phoenix to most challenged VA facilities. Last week, Gibson announced measures to address health care access problems in Phoenix. Today, he announced he’ll apply the same reforms to facilities with the most access problems from the results of the audit.
VA also is deploying teams of dedicated human resource employees to accelerate the hiring of additional staff and is using temporary staffing measures, along with clinical and administrative support, to ensure veterans receive care.
The department also will send mobile medical units to facilities to immediately provide services to patients and veterans awaiting care.
In addition, VA will modify local contract operations to be able to offer more community-based care to veterans waiting to be seen by a doctor.
Noting that Gibson is committed to using all authority at VA’s disposal to enforce accountability among senior leaders, officials said, VA will initiate the process of removing senior leaders where appropriate. The department also has suspended all VHA senior executive performance awards for fiscal year 2014.
Over the course of the next several weeks, officials said, Gibson will travel to a series of VA facilities across the country to hear directly from veterans and employees about obstacles to providing timely, quality care and how VA can address them immediately.
— A VA news release contributed to this report.
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