The Phoenix Veterans Affairs Healthcare System in 2012 finally installed an electronic waitlist system that an internal manual reveals had been available and deployed elsewhere in the Veterans Affairs Department since at least 2002.
CNN reported on April 30 that the Phoenix VA hospital, known as PVAHCS, created a “secret” waitlist of 1,400 to 1,600 sick veterans who were forced to wait months for treatment, including some 40 patients who died during the wait.
The electronic waitlist, or EWL, that was deployed across the Veterans Health Administration in 2002 aimed to do away with “ad hoc” waitlists, like the one discovered by CNN in Phoenix 12 years later.
“Ad hoc ‘waiting lists’ of new veteran enrollees to be entered into the scheduling system are known to exist, and waiting times for new enrollees seeking care are anecdotally reported to be long,” Laura Miller, then-VA deputy undersecretary of health operations and maintenance, wrote in a 2002 memo quoted in the manual. “We will attempt to formalize an ‘electronic waiting list’ in VistA [Veterans Health Information Systems and Technology Architecture electronic health record] to more consistently and accurately reflect demand across VHA, and reduce the risk to enrollees lost to follow-up due to clerical error.”
In a letter earlier this week to Rep. Jeff Miller, R-Fla., who chairs the House Veterans Affairs Committee, VA Secretary Eric Shinseki said Phoenix was not in compliance with agency policy before it installed the electronic waitlist in 2012.
“As is VHA policy, new patients who cannot be provided clinical appointments within 90 days of the date of the request should be placed on the EWL,” Shinseki said. “At this juncture, it does not appear that PVACHS patients who were not able to be seen within 90 days were handled consistently prior to the arrival of the current management team in 2012. Patients appear to have been scheduled beyond 90 days and not placed on the EWL, contrary to VHA’s policy for new patients. When the existing leadership came on board in 2012, they initiated VHA’s current national standard policy and the use of the EWL.”
A March 19, 2014 update to the EWL now allows scheduling more than 120 days from the desired appointment date. VA is supposed to provide care to patients in a timely manner, within 14 to 30 days.
Ozzie Garza, a VA spokesman, said the EWL has actually been in use by VA since 2001. "In the past, some facilities listed both new and established patients on the EWL. In an effort to remedy this inconsistency, VHA issued a clear policy statement in March, 2013," he said. "Only new patients should be placed on the EWL. With minor exceptions, new patients are defined as those who have not been seen in the clinic for which the appointment is requested for the past 24 months.
"VHA endeavors to schedule new patients within 30 days of their desired date. However, when this cannot be accomplished due to clinic capacity, and the patient cannot be accommodated within the 90 days, the facility is required to place that individual on the EWL," Garza said.
According to a former VA official, each of the 152 VA hospitals decided when to use the EWL application “and Phoenix was one of the very last to deploy.” He added, “Transition from a paper based system to the electronic one was not handled well. From what I hear, there was a great deal of resistance from staff as well.”
This story was updated with VA comment.