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VA checking status of 3,000 patients on ‘phantom’ wait list

Copyright © 2014 Albuquerque Journal

Veterans Affairs officials have ordered a check into the welfare of 3,000 New Mexico veterans who were left off the official wait list for assignment to a primary care physician in Albuquerque and instead placed on what some have called a “phantom panel.”

The practice at the VA’s Raymond G. Murphy Medical Center gave the appearance that veterans had been assigned a primary care doctor when they had not.

Interim VA medical center director Dr. James Robbins said in a Journal interview last week that he didn’t think the practice was a deliberate deception – although he acknowledged the veterans were not told they were assigned to a physician administrator who doesn’t see patients.

He also said he doesn’t know whether any patients on the unofficial list died while waiting for a primary care physician – as has been alleged at the VA Medical Center in Phoenix.

“As has Phoenix, we intend to look at this,” Robbins said. “Ideally, we need outside involvement for our own credibility.”

Dr. James Robbins, interim medical director of the VA's Raymond G. Murphy Medical Center in Albuquerque. (Adolphe Pierre-Louis/Albuquerque Journal)

Dr. James Robbins, interim medical director of the VA’s Raymond G. Murphy Medical Center in Albuquerque. (Adolphe Pierre-Louis/Albuquerque Journal)

Regional VA administrators are deciding how to do the review, which might include checking with the Office of Medical Investigator, Robbins said.

“We’re getting ready to pull the names and then we want to get a sense of the broad outline, have folks died, have folks been admitted (to the hospital)?”

The VA medical centers in Phoenix and New Mexico are supervised by a regional office of administrators in Phoenix, where Robbins serves as chief medical officer.

Robbins is assigned temporarily to head the New Mexico medical center until a new director is appointed. Former director George Marnell retired April 30.

The allegations of a secret wait list of veterans at the VA medical center in Phoenix triggered a massive audit last month of more than 216 VA sites, including in New Mexico. The revelations also fueled a scandal that led to the resignation of VA Secretary Eric Shinseki on May 30.

Hiding long patient waits, whether by fudging the official appointment times or keeping some veterans off official lists, has been linked to the VA practice of awarding bonuses and raises to top administrators for improved patient access to care. Those bonuses have been canceled for 2014.

The VA’s Office of Inspector General in an initial report released last month had not yet verified allegations that up to 40 veterans in Phoenix died while on the secret list.

But the inquiry found that 1,400 veterans were on the official electronic waiting list in Phoenix, while another 1,700 waiting for primary care appointments were not.

In New Mexico, up to 3,000 patients spent months on the alternative list waiting for a primary care doctor, but were not included on the medical center’s official electronic list, Robbins said. He said the practice is now under investigation.

The Journal reported last month that the veterans were assigned to a physician who is a an administrator and doesn’t treat patients.

“I don’t see this as a secret list or a phantom list or any kind of deception,” Robbins said. “This was a strategy to keep them from falling through the cracks completely.”

Robbins said he didn’t know about the alternate list until after it was reported by the Journal.

He said “senior leadership” at the VA in Albuquerque was aware of it, but veterans on the alleged “phantom panel” weren’t told they had been assigned to Dr. Phillip Wagner, the associate chief of staff for ambulatory care.

“There are probably things we could do better if we were to ever do this again, which I doubt we would do,” Robbins said. “But I think our notification could be better. It’s only fair to them (the patients) to know their doctor has changed.”

But Robbins said he and other VA officials in Albuquerque “have not found intentional misuse or deceitful misuse” of VA scheduling practices or the official electronic wait list.

Robbins said Wagner came up with the idea after two primary care physicians resigned.

Patients still had access to nurses and staff assigned to their former primary care physicians, he said.

Wagner at times filled requests for medication refills and would watch for alerts in the computer system that showed if a patient had been admitted to the hospital or there was a “reason for concern,” Robbins said.

If there was, Wagner would try to arrange for them to be seen by another doctor.

Wagner saw very few of the veterans, all of whom by February of this year had been reassigned to new primary care physicians, Robbins said.

Initially, VA officials reported that the practice began in the summer of 2012, but new information shows it began around April of 2013, Robbins told the Journal.

Asked whether Wagner should have seen patients before signing off on medication refills, in particular narcotic pain medications, Robbins said, “That’s an excellent question, and we just haven’t gotten around to looking at that part of it yet. We plan to.”

Wagner was preparing a new VA primary care initiative last week and was unavailable for comment, said spokeswoman Sonja Brown in an email to the Journal.

She added that, “Dr. Wagner’s prescribing of medications was within the standard of care for established patients in a health care system.”

Doctoring wait times

Robbins said New Mexico has another issue in common with the Phoenix VA: allegations that appointment records were altered to show that patients didn’t have to wait more than two weeks to see a doctor.

VA administrators here have previously reported that about 51 percent of new patients were seen within a 14-day target set by the VA. As many as 86 percent of established patients were reported having been seen within two weeks, Robbins said.

“But those are the very numbers that are (now) called into question,” Robbins said.

The Journal reported last month that VA schedulers in Albuquerque were allegedly directed to show patient appointment dates in the computer system as being within two weeks of the date desired. In fact, the delays were sometimes weeks or months.

The VA’s Office of Inspector General’s criminal investigators are looking into those allegations, among others.

Robbins said VA performance goals, such as measuring how often patients receive an aspirin after a heart attack, can be valuable to improve quality of care.

“I think a culture of measurement in that sense is a good thing. But I guess the dark side of that is, and I think we all realize that now, what are we really incentivizing people to do when we do that?

“I don’t want to give up this idea that we have a nice concrete way of looking at things, but we really do need to rethink the overall impact that’s having on the system.”

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