June 21, 2018
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Watchdog finds Maine VA mishandled mental health care

By Jackie Farwell, BDN Staff

AUGUSTA, Maine — Maine’s Veterans Affairs health care system mishandled referrals and appointment scheduling for mental health treatment, leaving some patients without requested care or waiting too long for visits, a government watchdog has found.

The inappropriate practices uncovered in Maine reflect “systemic problems” plaguing the VA health facilities throughout the country, the VA’s Office of Inspector General stated in a report released Wednesday, culminating from a six-month investigation.

The report comes nearly a year after the Veterans’ Health Administration was rocked by scandal over falsified records covering up long patient delays at VA hospitals and clinics. Investigations found 35 patients died while waiting for care through the Phoenix VA health system, sparking widening reviews at VA facilities in other states.

In Maine, investigators found no evidence of serious patient harm or staff purposely misreporting wait times but raised concerns about scheduling, the availability of mental health appointments, staff turnover and vacancies, and low morale.

The VA Maine Healthcare System serves roughly 10,000 patients a year at the Togus VA hospital near Augusta and at outpatient clinics throughout the state.

The investigation substantiated allegations about problems with an electronic patient record system, which improperly directed doctors not to request consultations with VA mental health providers if patients declined to be seen within 14 days.

VA policy requires patients receive an appointment within two weeks. The agency monitors its health facilities to ensure they meet that benchmark.

In some cases, staff closed out requests for referrals before patients actually received care, the investigation found. As a result, staff failed to follow up with some patients who canceled or failed to appear for scheduled visits for mental health treatment.

The Maine VA’s management of mental health services “made it difficult to track whether patients’ requests for services were met,” with some referrals appearing “to have been overlooked,” the report states.

The Office of Inspector General interviewed more than 40 individuals and groups as part of the review, which covered Sept. 29, 2014 through March 31, 2015, including a site visit from Oct. 27 to 29, 2014.

Former U.S. Rep. Mike Michaud, then ranking member of the House Committee on Veterans’ Affairs, requested the investigation. Togus employees also contacted U.S. Rep. Chellie Pingree last year to raise concerns about practices in the mental health department, according to her office.

Some of the alleged practices persisted even after previous reviews, investigators found.

Interviewees acknowledged the mishandled referrals may leave some patients “slipping through the cracks,” according to the report. One man in his 30s with post-traumatic stress disorder waited eight months for a visit with a therapist after his psychologist improperly documented a referral, investigators found.

Most of the allegations were unsubstantiated, including reports staff were directed to manipulate wait time data. But additional concerns were brought to investigators’ attention during the review.

Many mental health providers had limited availability to see patients because of delays in filling vacant positions, staff turnover, insufficient targets for staffing levels and some patients’ unwillingness to seek care outside the VA system, the report found.

“Numerous interviewees described chronically low morale among staff and a pervasive fear of reprisal should they raise concerns to management,” the report states.

The findings drew sharp criticism of Togus from two members of Maine’s congressional delegation.

Pingree, who was briefed Wednesday morning by the VA officials who conducted the investigation, said she was “deeply disappointed.”

“Timely mental health care is critical for veterans and their families, and they should not be made to wait for it — or even worse, get lost in the system,” the Democratic congresswoman said in a statement. “But this report shows that is exactly what is happening. The inspector general found that because Togus isn’t following the rules, we don’t know how long the wait is for some patients.”

Pingree added that mental health providers at Togus offer excellent care, even with insufficient budgets.

Republican Rep. Bruce Poliquin said he was troubled to learn of the issues, despite reassurances by executive staff during a February tour of the Togus medical center.

“This report, clearly, shows that Togus has failed to give our veterans the proper health care they were promised, earned and deserve. … While I am thankful for the mental health providers working at Togus, this report raises more questions to be asked. Who was aware that Togus was not following proper protocols and why did they not fix it before the Office of Inspector General pointed it out? Are there any other mismanagements within Togus?”

Ryan Lilly, director of the VA Maine Healthcare System, said the findings reflect only a fraction of overall referrals, and the organization is committed to following the report’s recommendations for improvement. Any mistakes generally resulted from either an outdated scheduling system or a lack of understanding about “complex and frequently changing administrative rules for handling consults and other referrals.”

“I am proud of the outstanding service that the dedicated men and women of the VA Maine Healthcare System provide each day,” Lilly said in a statement. “We take any opportunity to improve our service seriously and remain dedicated to the commitment to provide outstanding care to every patient, every day. The Veterans of Maine are justifiably proud of our system of care, and we are honored to continue to provide that care to them.”

The Maine VA plans to hire 17 additional mental health staff members, including nine who will join the system by Sept. 30, according to the report.

The “confusing language” in the computerized patient record system that led to referral problems has been fixed, according to Lilly.

He acknowledged morale issues, described by numerous interviewees who reported a “pervasive fear of reprisal should they raise concerns to management.” Some past statements and actions by VA Maine’s chief of mental health “could have been interpreted as threatening,” but relations between managers and staff in the department have improved, Lilly told investigators.

Some of that department chief’s correspondence with staff “emphasized meeting performance measures” and expressed an “effort to try to fly under the radar,” the report stated.

The Maine VA is committed to addressing the shortcomings cited in the investigation, Lilly said.

“We have concurred with those recommendations and begun implementing corrective actions to strengthen our services,” he said. “Many have already been completed, and those that are still in progress are well on their way to completion.”

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