Three years ago Edward Laird, a 76-year-old Navy veteran, noticed two small blemishes on his nose. His doctor at the Veterans Affairs hospital in Phoenix ordered a biopsy, but month after month, as the blemishes grew larger, Laird couldn't get an appointment.
Laird filed a formal complaint and, nearly two years after the biopsy was ordered, got to see a specialist — who determined that no biopsy was needed. Incredulous, Laird successfully appealed to the head of the VA in Phoenix. But by then, it was too late. The blemishes were cancerous. Half his nose had to be cut away.
"Now I have no nose and I have to put an ice cream stick up my nose at night ... so I can breathe," Laird said. "I look back at how they treated me over the years, but what can I do? I'm too old to punch them in the face."
The Phoenix VA Health Care System is under a federal Justice Department investigation for reports that it maintained a secret waiting list to conceal the extent of its patient delays, in part because of complaints such as Laird's. But there are now clear signs that veterans' health centers across the U.S. are juggling appointments and sometimes manipulating wait lists to disguise long delays for primary and follow-up appointments, according to federal reports, congressional investigators and interviews with VA employees and patients.
The growing evidence suggests a VA system with overworked physicians, high turnover and schedulers who are often hiding the extent to which patients are forced to wait for medical care.
The 1,700 hospitals and clinics in the VA system — the nation's largest integrated healthcare network — now handle 80 million outpatient visits a year. Veterans Affairs Secretary Eric K. Shinseki promised to solve growing problems with patient access when he took over in 2009, and he has been successful in some respects: Iraq and Afghanistan veterans are using VA healthcare at rates never seen in past generations of veterans, and a growing number of Vietnam veterans are receiving VA care as they age.
The agency reports it also made substantial progress in reducing wait periods last year, 93% of the time meeting its goal of scheduling outpatient appointments within 14 days of the "desired date."
But several VA employees have said the agency has been manipulating the data.
"The performance data the VA puts out is garbage — it's designed to make the VA look good on paper. It's their 'everything is awesome' approach," said Dr. Jose Mathews, chief of psychiatry at the VA St. Louis Health Care System. "There's a 'don't ask, don't tell' policy. Those who ask tough questions are punished, and the others know not to tell."
Mathews was put under administrative investigation in September after he alleged that long wait times led to poor patient care and what he said were two preventable deaths. He said a suicide attempt by a veteran at the facility was covered up by the hospital after a VA psychiatrist failed to provide follow-up treatment.
Several VA schedulers have told investigators that agency staffers were "gaming the system" by making it appear that appointments set for weeks or months in the future were "desired dates" requested by veterans. In fact, they said, veterans grudgingly accepted future appointments because they felt they had no other choice.
"We found people that were told to change the [appointment] dates to make it look like it was in line with VA guidelines," said Debra Draper, who was part of a team from the Government Accountability Office that interviewed 19 appointment schedulers at four VA medical centers in 2012. The team found that more than half of them failed to correctly record the appointment date patients originally requested.
VA officials say that manipulation of wait lists has occurred only in isolated cases and that the majority of patients get timely access to quality care. VA hospitals since 2004 have consistently ranked higher in customer satisfaction surveys than their counterparts in the private sector, they note, with more than 90% of patients offering positive assessments of their care.
"As we know from the veteran community, most veterans are satisfied with the quality of their VA care, but we must do more to improve timely access to that care," Shinseki said Friday as he announced the resignation of the VA's undersecretary for health, Dr. Robert Petzel, a departure that had been in the works before the recent revelations.
But veterans and current and former agency employees interviewed last week described a dysfunctional bureaucracy in which turnover is high, the number of doctors is insufficient, and patients may be left dangling even when facing life-threatening health problems.
"The evidence is there. They're never going to be able to hide it," said Brian Turner, a military veteran who has worked as a scheduling clerk in VA facilities in Austin and San Antonio.
In Washington state, Navy veteran Walter "Burgie" Burkhartsmeier, 73, had to wait two months to get an MRI exam at a VA facility in Seattle for shooting pains down his left arm. Eighteen months passed before someone read the MRI results — which showed bony projections on his spinal cord that put him at risk of paralysis if he were struck in the back.
In Texas, Carolyn Richardson, 70, said a VA doctor last year ordered "immediate" chemotherapy for her husband, Army veteran Anson "Dale" Richardson, 66, but a two-month delay robbed him of the chance to fight the throat cancer that killed him Nov. 4.
In Phoenix, Thomas Breen, 71, a Navy veteran with a history of bladder cancer, waited two months last fall for a follow-up appointment at the VA facility there after discovering blood in his urine. His family finally took him to a private hospital that diagnosed him with terminal bladder cancer. He died Nov. 30.
Six days later, a clerk from the VA in Phoenix called Breen's daughter-in-law, Sally Barnes-Breen, to schedule an appointment.