The Van Zandt VA Medical Center seems to be doing a "good, solid job," said U.S. Rep. Bill Shuster Monday, after meeting with the hospital's associate director to discuss unfavorable reports that surfaced last month on the hospital's handling of patient appointments - which have been the subject of an ongoing national scandal in the VA.
Shuster cited the hospital's explanation that misunderstandings were the likely cause of the findings, which were based on a national VA audit by hospital officials visiting other hospitals and asking questions of employees.
Shuster, however, said he planned to "keep a close eye" on the hospital's performance to ensure it's doing well by veterans.
"I wouldn't say I'm satisfied," he said.
Almost one-fourth of Van Zandt schedulers told auditors that the hospital instructed them to record patient requests for appointments in a way that ensured the appointments would meet VA criteria for responsive action, entering "a desired date other than the date a veteran asks to be seen," according to details first released to a Congressional committee.
Schedulers also told auditors they used "tracking logs" to manage their Electronic Waiting List, correctly using the EWL only 40 percent of the time.
The hospital doesn't believe the audit results mean the schedulers were doing anything dishonest, said Van Zandt spokeswoman Andrea Young after the Shuster meeting.
Rather, a misunderstanding of the questions could have been responsible for the findings - although officials need to make "assumptions," because they don't know which of the schedulers were interviewed by the auditors, Young said.
Schedulers could have told auditors they were expected to manipulate appointments to meet VA response criteria based on situations that were innocent - such as when they fixed an appointment to match a doctor's orders, instead of a patient's preference, Young said.
A doctor might want to see a patient in four weeks, to see whether a prescribed treatment is working, and it would make sense to schedule an appointment accordingly, even if a patient wanted to see the doctor in two weeks, she said.
Schedulers are often inexperienced, as they perform an entry-level job and frequently try to move up, which makes for high turnover, Young said.
Moreover, the scheduling software is complicated, she said.
The inexperience and difficulty of the work could lead to the misunderstandings, she said.
Schedulers also could have labeled as "tracking logs" the spreadsheets they keep to track phone calls made to new enrollees who haven't received an appointment yet, Young said.
Those spreadsheets are not examples of the notorious "secret lists" that have become part of the national scandal, she said.
"More of a working tool," she said.
In response to the audit findings and the scandal in general, leadership has been working closely with schedulers, training them, explaining in detail the necessary procedures and monitoring their performance, according to Young.
Van Zandt hasn't had a serious backlog problem - as 96 percent of patients got appointments within 30 days, according to Young and a statement released by the hospital early this month.
Thus, there was no incentive to manipulate appointment records, Young said.
"In some areas where they had a problem (the manipulations) were meant to hide it," he said. "But we really didn't have anything to hide."
The goal for appointments was initially 14 days, but is now 30 days, she said.
Van Zandt officials, who initially indicated their hospital wasn't implicated in the national scandal, did not know of the unfavorable audit findings until July, Young said.
VA whistleblower Karen Santoro, who has worked with the Pittsburgh Tribune-Review - formerly an employee of the VA's University Drive Campus in Pittsburgh - rejects the Van Zandt officials' explanations for the findings.
"Lies from beginning to end," she said.
Since the scandal began, the VA has eliminated bonuses that were incentives to post appointment records that made the VA look more responsive than it was, she said.
But the massive scrutiny resulting from the scandal is motivation enough for the manipulation to continue, she said.
The technology hasn't changed, which will allow it to continue, said Santoro, who worked as a scheduler.
And the VA shortfall in healthcare providers continues to make it impossible for the system to meet its responsiveness goals, she said.
The VA has masked that impossibility by simply focusing on service to the formerly underserved group - new enrollees - while shortchanging current patients, she said.
Technically, the manipulation isn't hard to do, she said.
Schedulers simply shift the date by which a patient asks to be seen forward to fall within 30 days of when the patient can actually be seen, thus meeting the response criteria, she said.
For example, if the patient asks to be seen today, and there's no opening for 45 days, the scheduler merely records a date 15 days from today to meet the 30-day grace period, she said.
The patient doesn't need to know, she said.
And if the patient should suspect, "it's your word against the patient's," she said.
There's pressure to do it, she said.
Otherwise, schedulers get in trouble, she said.
The answer to the problem is for Congress to force the VA to import a private-sector expert to revise the technology to make such manipulation impossible, she said.
Mirror Staff Writer William Kibler is at 949-7038.