The Washington PostDemocracy Dies in Darkness

Overblown claims of deaths and waiting times at the VA

The VA health care center in Phoenix. (Ross D. Franklin/Associated Press)

“What we know is that people died…. Look what the public got. Forty veterans died; this is what the public got.”

— Rep. Jackie Walorski (R-Ind.), at a congressional hearing, May 28, 2014

“The only thing that’s clear right now is that there are 40 brave soldiers that served their country proudly that died while waiting on a list. That’s the only thing that’s clear.”

— Rep. Jeff Denham (R-Calif.), at same hearing

“I think that’s why Phoenix resonates throughout this country, beyond the tragedy of apparently 40 veterans losing their lives because of gross negligence within that facility.”

— Rep. Beto O’Rourke (D-Tex.), at same hearing

 “I had a great weekend traveling the district and attending various Memorial Day parades and ceremonies to honor our fallen heroes. At each of these events, I talked to veterans about the incompetence and deplorable conditions that led to the death of at least 40 veterans in Phoenix, Arizona and suggest a systemic problem nationwide. Like all of you, I am outraged at these reports.”

— Rep. Richard Hudson (R-N.C.), opinion article, Independent Tribune, June 1, 2014

 “As a direct result of such practices, the deaths of over 40 veterans have come to light.”

— Reps. David Schweikert, Trent Franks and Matt Salmon, all Arizona Republicans, in a letter, April 29, 2014

“Those delays led to the untimely deaths of many veterans, including 40 at just one facility in Arizona.”

— Rep. Steve Stockman (R-Tex.), May 19, 2014

While The Fact Checker was on vacation, the Office of the Inspector General (OIG) at the Department of Veterans Affairs issued a report on claims that about 40 veterans had died while on a waiting list at the VA facility in Phoenix. Here’s a sampling of some of the headlines:

Probe: No Proof VA Delays Caused Phoenix Veterans To Die

VA Hospital Delays Didn’t Cause Deaths, Investigators Say

No proof deaths caused by delay in VA care, IG says

IG: Shoddy care by VA didn’t cause Phoenix deaths

The report was highly critical of the VA, noting that “as a result of using inappropriate scheduling practices, reported wait times were unreliable, and OIG could not obtain reasonable assurance that all veterans seeking care received the care they needed.” But the most explosive allegation about the VA — that veterans had died because they could not get an appointment — was not proven.

So we wondered: Do any of these lawmakers have regrets about jumping to conclusions not warranted by the facts?

The Facts

The “40” figure appears to have its roots in a statement made by Rep. Jeff Miller (R-Fla.), chairman of the House Committee on Veterans’ Affairs, in April: “It appears as though there could be as many as 40 veterans whose deaths could be related to delays in care.”

That, in turn, was based on a letter to the OIG by a retired VA doctor, Sam Foote, that said that investigators knew of 22 veterans who died while on an electronic waiting list for appointments and that 18 more died while on waiting lists for consultations with specialists. CNN reported allegations by another whistleblower that records were changed to hide the fact that veterans died while waiting for care.

But there is a difference between allegations and facts. Certainly, when claims of this nature are made, it is worthy of congressional investigation and questioning. Many mainstream news organizations (such as The Washington Post) reported the figure as an allegation. As far as we can tell, Miller and many members of the House Committee on Veterans’ Affairs were careful to keep the caveats in place.

But it turns out that some lawmakers, as shown in the quotes above, went too far. The OIG investigators did find, after reviewing the records of 3,409 patients from a variety of sources, 44 patients who died while on the electronic waiting list. But just because someone is on a waiting list when they died does not mean they died because they were on a waiting list.

In all, the OIG found 28 instances of “clinically significant delays in care associated with access to care or patient scheduling.” Of that group, six are deceased. It also found “17 care deficiencies that were unrelated to access or scheduling,” and of those, 14 are dead.

So, within the universe of more than 3,400 patients, only six patients died while experiencing significant delays in scheduling. But “while the case reviews in this report document poor quality of care, we are unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans,” the OIG said.

It’s important to keep these numbers in context. We have embedded below a briefing provided to congressional staff about the investigation, which offers more detail on the numbers than the report itself. Of the 3,409 unique cases examined, there were 293 deaths. A substantial percentage of those deaths — 25 percent — were suicides. The six suspect deaths possibly related to scheduling amount to less than 2/10th of 1 percent of the deaths examined. All deaths related to substandard care amount to 6/10th of 1 percent.

Briefing–Review of Alleged Patient Deaths

Few of the lawmakers responded to a request for comment, even on background. However, Schweikert provided the following statement:

Perhaps you have not had a chance to read the report because what I read is a report that found that the majority of the veterans reviewed were on official or unofficial wait lists and experienced delays accessing primary care. The report confirms that PVAHCS senior administrative and clinical leadership were aware of unofficial wait lists and that access delays existed.  Do I regret standing up for Phoenix veterans and their families? Absolutely not.
If the media does not accurately portray the condemning nature of that report, and allows Phoenix VA leadership to walk out on their responsibility to serve the American people, I’m deeply disappointed.  The fact of the matter is that families, like yours and mine, deserve better than the poor quality of service they have and are receiving from the VA. The VA Office of the Inspector General is not the FBI or a local law enforcement agency so they cannot make a definite legal determination that the VA killed 40 people.  That being said, they listed detailed circumstances behind 45 veteran deaths which reflect unacceptable and troubling lapses in follow-up, coordination, quality, and continuity of care. To begin to restore the faith of Arizona families in our system, the leadership at the Phoenix VA was rightfully replaced.

The Pinocchio Test

The OIG report is highly critical of VA practices and care, but the fact remains that the central allegation that has generated numerous headlines was unproven. Let’s remember that the number was based on a single source, Foote. (To be fair, he has questioned the results of the OIG investigation and called for a broader review.)

Lawmakers have a responsibility to make sure their statements are rooted in proven facts. The known facts about deficiencies in VA care are alarming enough that there is little need to rely on unproven — and difficult to prove — claims of deaths linked to being on waiting lists.

We wavered on whether these statements merited Two or Three Pinocchios. We realize that additional investigation may shed more light on these incidents, but for the moment we will lean toward Three. A single-source allegation is no excuse for scare-mongering.

Three Pinocchios

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