Internal VA documents show the depth of fraudulent scheduling, manipulation of data and in some cases intimidation of staff to hide delays in medical care to veterans in the 6-million patient national system.

Results from an internal VA audit show that one-third of employees at Puget Sound VA facilities said they were instructed to falsify appointment wait times. Employees were asked if they had been told to enter a different date for a patient's preferred appointment than what the patient actually requested. The intent may have been to make wait times data look better than it actually was.

Michael Murphy, director of the Puget Sound Veterans Health Care System, said Wednesday that the audit findings could be the result of confusion on a scheduler's behalf, not necessarily a scheduler being told to falsify scheduling information.

Nonetheless, the important thing for us, and for me personally, is to ensure that our schedulers continue to receive training, Murphy said, They need to understand how to properly schedule, but most importantly that we create a psychologically safe environment for these schedulers so that they can step forward if they think that somebody is asking them to do something that is improper.

As of July 1, veterans seeking new primary care appointments at VA Puget Sound Health Care System facilities waited an average of 57.11 days for an appointment, according to VA data compiled earlier this month by USA TODAY. The wait time was down slightly from June 15, when veterans waited an average of 58.87 days for a general care appointment.

Murphy said the wait list for new appointments had declined from a peak of 1,400 in May to 157 as of July 30. The backlog was improved in part, he said, by increasing the number of patients assigned to each primary care doctor in the Puget Sound system's network.

Related:Wait times remain high at Puget Sound VAfacilities

Murphy said the top challenge facing the VA in the Seattle area is having enough trained staff.

Our biggest challenge, quite frankly, is provider shortages. If there's no provider, clearly you can't schedule an appointment, he said.

Rob Lougee of the DAV's Seattle office made the same point: The problem is actually staffing them [the VA] with enough health care providers to meet the need. You can enroll as many people in the system as you want ... [but] the problem is you get your waiting list and timeliness issues because you don't have enough health care providers.

The same audit of VA employees found that half of Puget Sound region workers said they believe steps had been taken to improve wait times.

Auditors interviewed more than 3,200 employees at more than 700 clinics and hospitals to gather their findings.

In Region 20, which includes all of Washington s VA facilities as well as centers in Alaska, Idaho and Oregon, 38 facilities were visited and 177 employees were surveyed.

Nationally, the audit found at least one appointment scheduler at 109 VA medical centers who said wait times for veterans had been falsified, according to a USA TODAY analysis of internal VA survey data made public Tuesday. To keep evidence of delayed care out of the VA's official electronic tracking system, secret lists were maintained at 110 facilities, the analysis shows.

Workers at the Department of Veterans Affairs outpatient clinic in Wilmington, N.C., told auditors they were fearful of retaliation if they did not manipulate appointment data.

At the Edward HInes Jr. VA hospital in Hines, Ill., near Chicago, staff felt they would be subject to disciplinary action if appointment records were not changed, one report shows.

Managers instructed or encouraged schedulers to falsify appointment data at such VA medical facilities as those in Leeds, Mass.; Jacksonville, N.C.; Virginia Beach and Cleveland, according to the documents.

The audit by the VA's Veterans Health Administration was ordered earlier this year by then-VA Secretary Eric Shinseki. The results were provided to President Obama on May 30, the day Shinseki resigned.

The House overwhelmingly approved a landmark bill Wednesday to help veterans avoid long waits for health care that have plagued the Veterans Affairs Department for years.

The $16.3 billion measure also would allow the VA to hire thousands of doctors and nurses and rewrite employment rules to make it easier to fire senior executives judged to be negligent or performing poorly.

The 420-5 vote sends the bill to the Senate, where approval is expected by Friday.

The bill includes $10 billion in emergency spending to help veterans who can't get prompt appointments with VA doctors to obtain outside care; $5 billion to hire doctors, nurses and other medical staff and about $1.3 billion to lease 27 new clinics across the country.

The Senate on Tuesday confirmed Obama's nomination of former Procter & Gamble CEO Robert McDonald as Shinseki's successor. McDonald, 61, of Cincinnati, was approved on a 97-0 vote to replace Acting VA Secretary Sloan Gibson, who took over after Shinseki resigned.

Reporting by by Gregg Zoroya and Meghan Hoyer of USA TODAY, Russ Walker of KING 5, and the Associated Press.

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