WASHINGTON • A new Inspector General’s report says an employee at the St. Louis Veterans Affairs Health Care System’s mental health area wrongly listed the status of patient consults “completed” before patients had seen a psychiatrist, bolstering a whistleblower’s claims of lax practices at the facility.
“We substantiated the allegation that the St. Louis VA HCS inappropriately changed the status of consults to ‘Complete’ prior to the provider actually completing the appointment with the patient,” the OIG report obtained Wednesday said.
The acting director of the St. Louis VA agreed with the report. She said the incorrect record-keeping was done by just one employee, and that employee was “removed from the consult group on June 20, 2014.”
The acting director, Patricia Ten Haaf, also said the VA’s St. Louis Health Care system “will ensure scheduling staff receive appropriate training and guidance on proper consult management.”
That mental health clinic nurse in charge of consult management, who was not named, told OIG investigators that “he never received formal training or the policy on consult management,” the report says.
Inappropriately recorded consults for appointments where a patient doesn’t show up or the clinic cancels the appointment “increases the risk that veterans may become lost in the system if they missed their consult appointment,” according to the report.
The VA has been besieged by allegations of long patient waiting lines, improper record-keeping and bureaucratic incompetence, and it has been the subject of numerous congressional probes. The St. Louis VA system has been further hampered because it has not been able to find a permanent director.
The OIG’s report does not say who brought the complaint. But last year, the chief of psychiatry at the St. Louis VA Health Care System told a congressional committee that he suffered retaliation from superiors after reporting that psychiatrists there were seeing patients less than four hours a day.
Dr. Jose Mathews told the House Veterans Affairs Committee that “it was as if there was an agreement amongst all the clinic employees to only work for less than half the time they are paid to work” and that there was “an agreement amongst administration and staff that on paper everyone would be ‘productive’ and that everyone would qualify for ‘performance’ bonuses.”
The OIG report obtained this week said eight full-time outpatient psychiatrists at the St. Louis VA site received an average $13,710 in “performance pay” and seven of the eight got an average of an additional $2,920 for meeting or exceeding a “productivity goal.”
The OIG report does not say there was anything wrong with those bonuses.
The OIG’s report recommended that the St. Louis VA “ensure staff receive appropriate training and guidance on consult management, and perform a follow-up analysis of completed consults to ensure they are not completed inappropriately.”
The OIG report essentially said it considered the actions taken by the St. Louis VA’s acting director “acceptable,” and that “we consider the recommendations closed.”
But Mathews said last year that the shoddy record-keeping and allegations that psychiatrists were not working full schedules “is very corrosive, very demoralizing ... to the ethical people there as well.”
Rep. William Lacy Clay, D-St. Louis, said the “troubling report substantiates allegations that mental health case records were incorrect and that the system appears to have been more concerned with generating bonuses than successfully completing patient care.”
He said he hopes leadership at “both Cochran VA Medical Center and Jefferson Barracks ... to fully comply with the Inspector General’s corrective recommendations without delay.”
Missouri’s two senators said the report highlighted the problem of getting a permanent VA director in St. Louis. Sen. Roy Blunt, a Republican, calling the report’s findings “inexcusable,” said “the VA does not seem to be getting better, and that is not something our veterans should have to endure.”
Sen. Claire McCaskill, a Democrat, said the report showed “bad training, not bad motives,” but that “it doesn’t detract from my sense of urgency to get a permanent director installed at the St. Louis VA to help keep things moving in the right direction.”
Rep. Ann Wagner, R-Ballwin, met with VA leadership last month and she said she “expressed my concern over VA’s continued problems with the consult management process, as well as lack of permanent leadership and the effect this has had on VA employees” and the veterans they serve.