Confessions of a Whistleblower

Foote saw a growing demand for services, a harbinger of today's problems. In the 1990s, as the population of World War II veterans shrank, the VA opened eligibility for health care to more veterans. Between 1997 and 2001, the number of veterans using VA health care services jumped 40 percent, to 3.7 million. The wars in Afghanistan and Iraq brought more patients into the overburdened system.

VA Crisis

The recession beginning in 2007 led to another surge in patients. "Whenever the economy tanks, more people go to the VA," Foote says. "People would come in and say, 'This is the first time I've used my benefits because I was on my wife's insurance' or 'I had my own insurance and I lost my job.' "

Between 2002 and 2012, the number of VA health care enrollees climbed nationwide by a third, to 9 million. Outpatient visits to VA facilities nearly doubled to 83 million per year. In the last three years alone, primary care visits shot up 50 percent, but the number of primary care providers like Foote grew only by 9 percent. With demand outpacing resources, veterans waited longer for care.

Foote recalls a meeting in 2012 to discuss strategies for meeting a crisis in demand for services for which there seemed to be no answer. "But they came up with one: Fake the numbers. Simple. That was the solution."

Long wait times were nothing new at the VA. Since 2005, the inspector general had issued 18 reports documenting delays in care nationwide. In 2011 the VA had set a goal that patients should be seen within 14 days of requesting an appointment. Phoenix and many other VA facilities found an easy way around this. Say a veteran requested an appointment and the first available slot was five months away, Foote explains. If the veteran agreed to that time — even though he had wanted care much sooner — a VA scheduler could mark the wait time as zero days.

But Foote uncovered a more devious tactic for making wait times disappear: secret, off-the-books lists. "No one was allowed to make new patient appointments in the computer," Foote says. Instead, appointment requests were kept on separate, unofficial lists until an opening drew close, when they were moved onto the official list, giving the illusion of efficiency.

Foote knew of other tricks. "Let's say you have 10 patients you see a day in your clinic. You want to have an easy day? Have your staff make appointments for people who are dead," he said. Doctors and staff also might call a patient the night before an appointment, tell him he needed to bring additional paperwork, and reschedule his appointment for three weeks later. Foote and a colleague eventually gathered the names of patients waiting for care and turned the names over to the inspector general. Only when scheduling clerks called the patients to make an appointment did they learn that many had been waiting months for an appointment — and some had died.

Startling Revelations

Foote was familiar with the VA's Office of Inspector General, a resource for employees who suspect wrongdoing within the organization. In 2011, he had written a letter alleging financial mismanagement within the Phoenix VA health care system. A subsequent investigation confirmed the allegations. To learn more about the long wait times, he turned in the spring of 2013 to the employees who had helped him understand the scope of the earlier financial problems. "I'd been there 23 years. I had a good reputation of problem solving. We started looking into everything, asking questions," he says.

In June 2013, while reviewing new-patient appointments as an outpatient clinic director, Foote's staff found two veterans in dire need of care. One had gone to the emergency room with chest pains that January, after waiting several months for care. An EKG showed heart damage, which should have made him a priority for follow-up care, but he was given an appointment for October. Foote found the man's heart damage had worsened and sent him for urgent bypass surgery. The other veteran, a diabetic, had gone to the emergency room in March with dangerously high blood sugar and had also been given a follow-up appointment for October before Foote intervened.

Those patients lived. But in the late summer of 2013, Foote heard that others had died. He also learned that thousands of veterans in the system did not have primary care providers, meaning they, too, had long wait times or had been forgotten. He wrote a letter to the inspector general last fall detailing the wait-list scheme and charging that several veterans died awaiting care. The IG sent a team to Phoenix in December to investigate, but Foote heard little. He sent another letter in March. "Patients are still dying," he wrote.

Investigators found conditions worse than Foote had alleged: 1,400 veterans had waited at least three months for a first appointment. Forty or more veterans died awaiting care. Foote felt vindicated. While his charges angered some VA colleagues, many others thanked him. More whistleblowers came forward, and investigators uncovered problems nationwide.

Rep. Jeff Miller (R-Fla.), chairman of the House Committee on Veterans' Affairs, praised the actions of Foote and others who spoke out. "At great risk to themselves and their families, whistleblowers dare to speak truth to power," Miller said.

No Easy Fix

But a long-term fix won't be easy, Foote says. "Providers aren't available. That's the side of the equation no one understands," he says. "It's going to be scarce for everybody.

"The VA has got to decide, either we go back to what our mission used to be — chronic care for combat veterans, and maybe a safety net for low-income veterans — or do we fix what's wrong with the system," Foote says. "But how much effort, how much money can you put to it?"

Despite all the trauma of the past year, Foote would do it again. "I certainly sleep better at night knowing I've done all I can do," he says. "The biggest regret is throwing rocks at an institution I worked at for so long. But I didn't think there was any other way."

Brian Mockenhaupt is a former Army infantryman who served two tours in Iraq.