Ex-VA hospital official faults mental health care

WASHINGTON (AP) — Veterans are waiting too long for mental health care and are unaware that hospitals sometimes manipulate records in an attempt to make it appear that standards are being met, a former Veterans Affairs hospital official told senators Wednesday.

Hospitals are "gaming the system," with administrators so focused on achieving performance targets, in part to get bonuses, that they don't always do what's best for the patient, said Nicholas Tolentino, former mental health administrative officer at the VA medical center in Manchester, N.H.

Tolentino told the Senate Veterans' Affairs Committee that he knew the problems were not unique to Manchester because of the work he did with other hospital officials nationwide.

Department policy requires that veterans receive a mental health treatment appointment within 14 days of their desired date. Tolentino said his hospital met that target by simply eliminating the opportunity for patients to state a desired appointment date. Instead, the veteran was told when the next appointment was available. Then, that appointment, often weeks or months away, was entered into the VA's records as the desired date.

"If that's being done, it's totally unacceptable," William Schoenhard, a deputy undersecretary, told the committee.

Tolentino no longer works at the hospital. He said he resigned about four months ago when he said it did not take meaningful action against a pharmacologist who appeared to be intoxicated while providing patient care. Jim Blue, a spokesman for the VA's New England region, said the VA would thoroughly review the allegations. "But let's be clear: The employees (at Manchester) take the quality of mental health care they provide very seriously. When problems are identified they are promptly addressed," Blue said.

The department's inspector general released a report two days ago disputing the VA's claim that 95 percent of veterans seeking mental health care get personal evaluations with 14 days of their initial request. The report characterized VA data as unreliable and said only about half the patients are seen that quickly. The other half have to wait an average of 50 days, according to the investigation.

Congress is particularly concerned about patient wait-times. Lawmakers say the stories they hear from veterans contradict the rosier reports they get from the department.

Investigators said at the hearing that VA schedulers were not following proper procedure when setting appointments, which made the data unreliable and inaccurate.

Schoenhard did not disputing the report's findings. He promised lawmakers to work with investigators on putting in place more reliable measurements.

"We fully embrace that our performance measurement system needs to be revised," he said.

Schoenhard also noted that the VA will be adding 1,600 mental health workers as well as 300 support staff. VA officials said that additional hiring is already underway and that they plan for the additional hires to be completed over the next five to nine months.

Lawmakers said the department doesn't have a reliable model to determine exactly where those workers should be placed and noted that it's already struggling to fill some 1,500 openings.

Sen. Patty Murray, who heads the committee, said VA care providers are delaying follow-up appointments with mental health patients because their schedules are too full. She complained the department has been slow to tackle the problem.

"VA is failing to meet its own mandates for timeliness, and instead is finding ways to make the data look like they're complying," said Murray, D-Wash.

VA officials point out that they've invested heavily in mental health care over the past few years. Staffing is up 45 percent since 2005, but the patient load has increased by almost that amount.

Dr. John Daigh, assistant inspector general for health care inspections, said he agreed that the quality of care that veterans receive from VA facilities is excellent, but he said that obtaining access to that care is a different story.

Sen. Scott Brown, R-Mass., said the problems pointed out by investigators were "mind-boggling" and pointed to what he called culture problems at the VA. "The gaming of the system has to stop," he said.

Brown suggested VA officials let private providers handle more of the mental health treatment. He said that the department has authority to pay for outside care but only does so about 2 percent of the time.

Schoenhard said the VA does send patients to outside providers when it can, but he seemed to resist Brown's proposal. "I think we can take this on in our system," he said.