President Obama “won’t be far from the Phoenix VA facility, the epicenter of the VA scandal where dozens of veterans died while waiting for basic care.”
— House Speaker John Boehner (R-Ohio), news conference, Jan. 8, 2015
The Veterans Affairs scandal suddenly popped up again at House Speaker John Boehner’s news conference.
We had previously noted that many lawmakers, Republican and Democrat, had jumped the gun and had blamed the deaths of some 40 veterans on the fact they were still on waiting lists to get an appointment at the Phoenix VA facility. But a report released in August by the VA Office of Inspector General (OIG), while highly critical of VA practices that included unofficial waiting lists, said it could not conclusively link that many deaths to being on the wait list.
After reviewing the records of 3,409 patients from a variety of sources, OIG uncovered 44 deaths that took place while a patient was on an electronic waiting list. But in the complete list of patients, OIG found only 28 instances of “clinically significant delays in care associated with access to care or patient scheduling.” Of that group, six were deceased.
“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 report said.
So how does Boehner come up with “dozens”? The answer, it seems, relies on a single, carefully-chosen word — as well as a bit of backtracking by OIG under congressional pressure.
First of all, the OIG had difficulty in assigning blame because many of these patients were very sick to begin with — and the cause of the death would be the underlying disease. When one goes through the case studies of the deaths, it is clear that many patients had substantial health problems — and they were often also being treated at other non-VA facilities. Here’s a sampling:
- “A man in his late 60s had a history of homelessness, diabetes, head injury, hepatitis, and low back pain.”
- “A man in his late 60s had a history of homelessness, hypertension, diabetes, cirrhosis, congestive heart failure, and emphysema.”
- “A man in his mid-60s had a history of diabetes, hypertension, hyperlipidemia, cigarette smoking, and post-traumatic stress disorder (PTSD).”
- “A man in his late 70s had a history of hypertension, chronic alcohol abuse, and obesity.”
- “A man in his early 60s had a history of severe cardiomyopathy (disease of the heart muscle), hypertension, poorly controlled diabetes, hepatitis B, hepatitis C, and tobacco use.”
- “This man in his early 60s had a history of schizophrenia. He was released from prison after being incarcerated for 16 years following a conviction for manslaughter.”
- “A man in his late 50s had a history of bipolar disorder, alcohol dependence, and four suicide attempts.” (He committed suicide while on the waiting list.)
Sam Foote, the retired doctor who first alleged that some 40 patients died while on a waiting list for an appointment, was highly critical of the OIG report at a congressional hearing on Sept. 17, saying that in two cases in which he had personal knowledge, “the authors appeared to have downplayed facts and minimized the harm.”
Foote also pointed to one case (#29), in which a patient who died of cardiac arrest failed to get an implantable cardioverter defibrillator in a timely manner — and yet he was not included on the list of deaths related to patient scheduling. (This patient had been on an electronic waiting list for treatment of management of poorly controlled diabetes, but once given an appointment, he failed to go to it.)
Katherine Mitchell, medical director for the Iraq and Afghanistan post-deployment center in Phoenix, also disagreed with the OIG’s findings in the case studies. “In a minimum of five cases, I believe there was a very strong actual or potential causal relationship between delayed care or improper care in veteran death,” she testified. “In addition, health care delays contributed to the quality of life for five other veterans who were terminally ill, and shortened the lifespan of one of them.” She then cited numerous other cases in the report where she believed investigators played down the facts, including two suicides by patients while waiting for a mental-health referral.
The difficulty of making these judgments was demonstrated when OIG officials appeared to disagree at the hearing whether simply being on the wait lists contributed to the deaths of the patients. Two top officials were asked a “yes or no” question by Rep. David Jolly (R-Fla.):
JOLLY: “Would you be willing to say the wait lists contributed to the deaths?”
JOHN DAIGH JR., ASSISTANT VA INSPECTOR GENERAL FOR HEALTH-CARE INSPECTIONS: “Yes.”
JOLLY: “Would you agree that wait lists contributed to the deaths of veterans? Yes or no? Please, yes or no? Words mean something, and you need to…”
RICHARD GRIFFIN, ACTING VA INSPECTOR GENERAL: “No. I would say that it may have contributed to their death, but we can’t say conclusively it caused their death.”
Note that, unlike his colleague, Griffin refused to provide a definitive yes, but he gave himself a bit of wiggle room to say the wait list might have contributed to the deaths.
So this brings us to Boehner’s statement. His staff noted that he did not say dozens of veterans died because they were on the wait list; he said dozens died while they were waiting for care. That cleverly sidesteps the question of causality.
The Pinocchio Test
Initially we were inclined to believe that the speaker was exaggerating the number of deaths and ignoring the results of the OIG report. But OIG officials have acknowledged that wait lists might have contributed to the deaths, in effect negating the previous conclusion that just six deaths could be traced to scheduling delays. The OIG found 44 patients who died while on the electronic waiting list, so that certainly qualifies as “dozens.”
Meanwhile, unlike some of his colleagues, Boehner was careful not to say the deaths occurred because of wait lists. That put his statement in a bit of a gray area. One may never be able to make a direct link between the deaths and the care in Phoenix, especially given the poor health of the patients. Still, given that the OIG report was highly critical of the Phoenix facility’s practices in the first place, on balance that tips Boehner’s statement into Geppetto territory.
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