Despite a clean bill of health on scheduling for the Van Zandt VA Medical Center in Altoona from the federal government earlier this summer, further results may show a different picture.
According to data released last week, almost one-fourth of the center's 118 schedulers told auditors they were instructed to falsify scheduling dates for area veterans, congressional sources said.
According to the latest results released to the congressional committee that is in charge of veterans affairs, Van Zandt schedulers said that, 22 percent of the time, they felt they received "instruction from the facility to enter a desired date other than the date a veteran asks to be seen." Schedulers also reported using other "tracking logs" to manage their Electronic Waiting List. The audit further showed that the schedulers correctly used the Electronic Waiting List only 40 percent of the time.
U.S. Department of Veterans Affairs officials had said in June that the hospital had a 99 percent success rate of scheduling veterans' appointments within 30 days. A statement released by Van Zandt Thursday said "most recent data indicate that 96.2% of our patients are scheduled within 30 days and no patients were scheduled between 61 and 90 days."
"The report released to members of Congress (last) week gives us a preliminary look at what some of the concerns were when the auditors visited Altoona in May," the statement said. "However, since May our medical center leadership has taken an active role by reviewing all of our systems and having open meetings and discussions with front-line scheduling staff."
Local veterans had mixed but generally favorable reactions to the most recent audit revelations.
Robert Russler of Altoona, commander of the James L. Noble VFW Post 3 in Altoona, said he has never had a problem with scheduling appointments at Van Zandt. Russler said he's also never heard any complaints about scheduling from any of the post's 225 members, who like Russler are primarily veterans from the Vietnam era.
"Actually, for being in the military, they're really efficient," he said. "They bombard you with letters, phone calls to make sure you show up for your appointments."
Another member of the James L. Noble post, Paul Misko of Altoona, agreed with Russler's assessment.
"I don't have a big concern with the VA as far as scheduling goes," Misko said.
However, he said he wasn't surprised to hear that some Van Zandt schedulers had told auditors they were told to falsify scheduling dates.
"They're judged by their books," said the former Marine. "Who doesn't want to make themselves look better?"
Van Zandt is one of about 100 VA medical centers across the country where auditors found problems with fraudulent scheduling and related problems, congressional sources said. The auditors uncovered the problems after the VA launched a systemwide review of its centers last spring.
Dr. John Reinhardt is an Army veteran who said in his 7,000-patient practice in Altoona that he sees many veterans. He said he believes the Van Zandt center is a good facility. But he also said he has no problem believing the results of the most recent audit, either.
"They have to make the numbers look good," he said. "They get rated from the top down, from above and not below."
Unlike Reinhardt's practice, in which patients would complain and leave his office for another doctor if they couldn't get an appointment when they wanted, the VA system on which Van Zandt is based operates within the confines of a regimented structure defined by the government, he said. Schedulers don't have the luxury like his office personnel to be flexible with scheduling times, he said.
"It's a very different world than what you or I operate in," Reinhardt said. "The VA system lives and dies on levels of bureaucracy."
Reinhardt, who is the medical director at the Hollidaysburg Veterans Home, said another issue that complicates the picture is that the veterans are often dealing with health care systems in both the public and private sector simultaneously. He said that veterans will seek care at the VA but perhaps also ask for prescription medications or other types of services from a private sector doctor.
Both Reinhardt and state Sen. John H. Eichelberger Jr., R-Blair, who is a member of the home's Advisory Council, agreed that for several years the home had significant problems getting residents into Van Zandt for treatment and had to reroute them to other facilities. But they both said that has changed in recent times.
"Maybe the hospital wasn't operating as effectively as it should have, but for whatever reason, it was a nightmare," Eichelberger said. "But it has gotten better, and it seems like we're fixing the problems."
Van Zandt spokeswoman Andrea Young said the medical center has a limited number of beds and specialized doctors, unlike the larger UPMC Altoona hospital.
"When a patient falls ill at the Hollidaysburg State Veterans Home and we are not able to (meet) the complexity of patient (care) in our acute care unit, they are taken to UPMC Altoona to receive care," she said.
Van Zandt officials said they are awaiting final audit results due this month from the VA Office of the Inspector General "before making final judgment." But Young offered an explanation about why the new audit information showed problems with scheduling, saying the employees who do the scheduling didn't intentionally falsify records.
She said most of the center's appointments are scheduled within 30 days and therefore don't go into the Electronic Wait List system, but go into another scheduling system. The Electronic Wait List system is only for veterans who can't be scheduled for appointments within 90 days.
"This EWL is managed by just a few people in the medical center in order to maintain its accuracy and integrity, so many of the schedulers would not have familiarity with the EWL," she said.
They also keep a separate list, a spreadsheet, for new veterans who ask for appointments, which she said some of the schedulers might have called the "other tracking logs" that the audit discusses.
"Our medical staff has met with all of the scheduling staff to determine where any additional training or support is needed," Young said. "Our scheduling staff is extremely dedicated, and they have always done everything in their power to get veterans into care in as timely a fashion as they can."