Still waiting

PHOENIX—On a hot summer day here, Kelly Arrington—​a walk-in patient, because “getting an appointment is very difficult”—sat in the mostly empty waiting room of the Turquoise Clinic at the Phoenix VA Hospital. The hospital’s high-ceilinged hallways open into a series of cramped, clone-like outpatient clinics, each named for a different precious stone. Each clinic has its own staff of primary care doctors and nurse practitioners.

Last August, President Barack Obama signed into law the Choice Act, meant to solve the problem of veterans having to wait longer than 30 days for appointments in the Veterans Affairs healthcare system. Almost a year later, the problem has worsened: Veteran wait times have increased by 50 percent, according to The New York Times. I spoke with veterans who say the VA continues to use bureaucratic strategies to disguise the size of the problem.

Arrington is one of them. She says each time she calls, hospital staffers tell her they’ll call her back. In November, while suffering from a sinus infection, she left 10 to 12 messages requesting an appointment before the clinic finally scheduled her. (Even then, she maintains she only got a call back because her OB-GYN pulled some strings with a primary care doctor.)

Other disappointed vets have joined an advocacy group, Concerned Veterans for America. Some say VA staffers tell patients “we’ll have somebody call you back,” and others say they receive appointments within 30 days only to be told, “canceled.” The result is the same—waiting months for appointments—but the second way allows the VA to say it had scheduled appointments in a timely manner.

Glen Grippen, interim director of the Phoenix VA, said he hoped dishonest scheduling practices were not occurring in Phoenix, but said the hospital has a very large staff so he couldn’t say the practice didn’t happen. The Choice Act’s solution, Choice Cards, hasn’t worked. The cards are supposed to allow veterans to receive VA-subsidized care from outside doctors if they have to wait longer than 30 days for an appointment. But VA officials barely speak of the cards, and VA Secretary Robert McDonald tried unsuccessfully to persuade the Obama administration to defund the program in its 2016 VA budget.

To qualify for a Choice Card, veterans need VA approval, which depends on showing they are unable to get an appointment within 30 days. They also need private doctors willing both to accept the card and to communicate with the VA about the patient throughout the process. If a doctor then recommends the vet see a specialist, there’s no guarantee the Choice Card will cover that.

The Phoenix VA’s Grippen says Congress needs to make the Choice Card process more user-friendly, but he doesn’t think it would change much in Phoenix because he says vets love their VA doctors too much to switch. That’s true for patients like Dann Murray, who sat in gym shorts in the mostly empty waiting room of the Emerald Clinic, waiting to see a doctor for a nasty cold.

A hoarse Murray said the Phoenix VA medical staff is exceptional. He particularly likes the nurse practitioner who has satisfied his outpatient needs for years. The hospital has only canceled on him once, he said, when his doctor was sick, and the most he’s ever waited for an appointment is three to four weeks. But others, like Harold Bolieu, have a different story. He has nerve damage in his arm, walks with a cane, and recently waited hours in the Phoenix VA Emergency Room with pneumonia. Twice.

Bolieu and his wife, Irma, sat in the Emerald Clinic waiting for an appointment they hoped would result in permission for Harold to receive care from a neurosurgeon outside the VA. The couple said the only tangible change they noticed in the VA after last year’s scandal was wait times in the emergency room shortened dramatically for a few months, but soon they crept back up. Now the Bolieus are desperate. They worry that after months of waiting for the right type of neurological consult for Harold, his condition might deteriorate beyond repair.

Harold said Irma is his secretary when it comes to scheduling VA appointments: “She stays on the phone for me for a long time.” Irma has become aggressive in trying to set up appointments for her husband. “I’m not angry,” she said with an embarrassed smile. “I’m just a little more firm.”

Choice Act funding is allowing the Phoenix VA to hire more staff members, and through June it had added 165 medical professionals. But for the Bolieus, fixes to the broken system might be too little, too late. “We’re here on our last-ditch effort,” Irma said. If the doctor doesn’t approve their petition to go elsewhere, they’ll do it anyway, she said. “Our sons offered to lend us the money.”

—Maria Baer is a graduate of the World Journalism Institute’s mid-career course