WASHINGTON — Staff members at dozens of Department of Veterans Affairs hospitals across the country have objected for years to falsified patient appointment schedules and other improper practices, only to be rebuffed, disciplined or even fired after speaking up, according to interviews with current and former staff members and internal documents.
The growing V.A. scandal over long patient wait times and fake scheduling books is emboldening hundreds of employees to go to federal watchdogs, unions, lawmakers and outside whistle-blower groups to report continuing problems, officials for those various groups said.
In interviews with The New York Times, a half-dozen current and former staff members — four doctors, a nurse and an office manager in Delaware, Pennsylvania and Alaska — said they faced retaliation for reporting systemic problems. Their accounts, some corroborated by internal documents, portray a culture of silence and intimidation within the department and echo experiences detailed by other V.A. personnel in court filings, government investigations and congressional testimony, much of it largely unnoticed until now.
The department has a history of retaliating against whistle-blowers, which Sloan D. Gibson, the acting V.A. secretary, acknowledged this month at a news conference in San Antonio. “I understand that we’ve got a cultural issue there, and we’re going to deal with that cultural issue,” said Mr. Gibson, who replaced Eric K. Shinseki after Mr. Shinseki resigned over the scandal last month. Punishing whistle-blowers is “absolutely unacceptable,” Mr. Gibson said.
The federal Office of Special Counsel, which investigates whistle-blower complaints, is examining 37 claims of retaliation by V.A. employees in 19 states, and recently persuaded the V.A. to drop the disciplining of three staff members who had spoken out. Together with reports to other watchdog agencies and the Times interviews, the accounts by V.A. whistle-blowers cover several dozen hospitals, with complaints dating back seven years or longer.
Dr. Jacqueline Brecht, a former urologist at the Alaska V.A. Healthcare System in Anchorage, said in an interview that she had a heated argument with administrators at a staff meeting in 2008 when she objected to using phantom appointments to make wait times appear shorter, as they had instructed her. She said that the practice amounted to medical fraud, and complained about other patient care problems as well.
Days later, a top administrator came to Dr. Brecht’s clinic, put her on administrative leave, and had security officers walk her out of the building.
“It’s scary to think that people can try to stand up and do the right thing, and this is the reaction,” said Dr. Brecht, now in private practice in Massachusetts.
Her complaints were corroborated by other Alaska personnel and were the subject of an email that Dr. Brecht sent to a military doctor at the time. Dr. Brecht wrote that administrators “schedule fake patient appointments (i.e. commit FRAUD).” They do so, she wrote, “just so our numbers look good to DC (and the administrators get their bonuses for these numbers).”
Kathy Leatherwood, a nurse and unit manager at the Alaska V.A., said in an interview that she also objected in 2008 to the use of phantom appointments. She said administrators directed her to schedule fake appointments for new patients within 30 days without even notifying the patients. She was then supposed to mark the patient as a “no show” or a cancellation and schedule a real appointment for later, she said. That way, the official record would show the veteran was offered a quick appointment within the required turnaround period.
Ms. Leatherwood said that she, too, went to V.A. administrators to object.
“It’s my name that’s going to be on that chart,” she remembered telling one administrator. The administrator responded that if she was unwilling to carry out the policy, he would find someone who would, she said. When she continued objecting, he threatened to call security if she did not leave his office.
Kathleen Belmonti, who was a nurse there, said in an interview that she, too, was aware of staff concerns about scheduling and management practices.
Cynthia A. Joe, the chief of staff at the Alaska V.A. Healthcare System, said the facility had never used phantom scheduling and that, while some staff members had raised questions about scheduling practices, no one had protested or faced disciplining after raising concerns.
In court filings detailing the V.A. response to other problems, Dr. Ram Chaturvedi, formerly with the Dallas V.A. Medical Center, said that he began complaining in 2008 about shoddy patient care, including negligence by nurses who had marked the wrong kidney while preparing a patient for a procedure. In another instance, Dr. Chaturvedi said medical personnel had brought the wrong patient to an operating table.
A supervisor told Dr. Chaturvedi to “let some things slide” because of staffing problems, but he continued writing up complaints. Officials considered him disruptive and fired him in 2010.
At the V.A. Medical Center in Wilmington, Del., Michelle Washington, a psychologist treating soldiers with post-traumatic stress disorder, also found her worries unwelcome. She said in an interview that she faced retaliation when she testified in 2011 to a Senate committee about staffing shortages that she said left veterans waiting dangerously long for psychological help.
A week before her scheduled appearance, Dr. Washington said she received an evaluation downgrading her performance at the hospital from “outstanding” to “unsatisfactory,” citing management complaints she had never heard before. She was also stripped of some psychological treatment duties.
“I’m not sure how I went from outstanding to unsatisfactory in 30 days,” Dr. Washington said. “The only intervening thing was my testimony.”
In Pittsburgh, two V.A. doctors specializing in Legionnaires’ disease, Dr. Janet Stout and Dr. Victor Yu, said they were forced out after complaining about budget and salary matters in 2006. The V.A. then closed their lab and destroyed their specimens — decisions the doctors contend contributed to a 2011 outbreak of Legionnaires’ at the Pittsburgh hospital that killed six people.
“The V.A. isn’t a place where you speak out,” Dr. Stout said in an interview.
Dr. Yu called the department’s decision to close his lab “malicious,” and added in an interview that “I fall into a category that the V.A. absolutely abhors — whistle-blowers.”
The number of claims of retaliation by V.A. whistle-blowers are among the highest of any federal agency, said Carolyn Lerner, who runs the Office of Special Counsel, and have been documented by Congress going back at least two decades.
In 1992, a congressional report concluded that the V.A. discouraged employees from reporting problems by “harassing whistle-blowers or firing them.” In 1999, a House subcommittee hearing on “Whistleblowing and Retaliation in the Department of Veterans Affairs” found little had changed.
Today V.A. employees and whistle-blower lawyers say the problem has only gotten worse.
In Phoenix, Dr. Sam Foote, whose complaints triggered the current scandal, said hospital officials ignored him at first and then harassed him when he complained about administrators who were “cooking the books.” V.A. administrators “started coming after me,” he told The Arizona Republic. He decided to retire early last year as a result.
One way the V.A. has silenced whistle-blowers, their lawyers maintain, is by threatening to hold them in violation of patient privacy laws if they discuss medical cases. That happened in a 2007 case in Chicago, where Dr. Anil Parikh was fired after reporting “systematic problems” that he said delayed patient care. In terminating him, the V.A. charged that he had violated confidentiality laws by reporting his concerns to the inspector general and to Barack Obama, at the time a senator from Illinois, and other government officials, court filings show. After four years, a grievance panel reinstated Dr. Parikh with back pay.
Many employees, still fearing retaliation, are going outside the department to report what they say are systemic problems.
The Project on Government Oversight, a private group working with whistle-blowers, said it had received confidential complaints from about 175 current and former V.A. employees since the latest controversy began. Those complaints are of such interest to the government that the V.A. inspector general subpoenaed them last month, demanding all reports related to the Phoenix V.A. The group is resisting because of concerns about whistle-blower confidentiality.
“People are coming out of the woodwork,” said J. Ward Morrow, a lawyer for the American Federation of Government Employees, which has received recent reports of problems from more than 100 V.A. employees.
Dr. Brecht, the Alaska urologist who was put on leave in 2008, said she thought about calling a whistle-blower’s hotline at the time, but feared that administrators might take further steps to discredit her and risk her medical licensing.
“When I saw all this on the news the last few months, part of me felt this huge sense of relief,” Dr. Brecht said, “because it was like I wasn’t crazy after all.”