St. Louis VA mental-health records questioned by watchdog

ST. LOUIS -- A federal watchdog says it has confirmed a whistleblower's claim Veterans Affairs sites in St. Louis marked appointments for mental-health patients as completed before they were seen, effectively boosting the appearance of the sites' productivity.

St. Louis VA Health Care System's records from October 2013 and June of last year showed an employee inappropriately marked 60 percent of the 20 consults reviewed as "complete" before those treatments were finished, according to a VA inspector general's report released Wednesday. Such misrepresentation "increases the risk that veterans may become lost in the system" if a patient misses a consult appointment or the clinic cancels it, according to the report.

The questioned employee, who was not named in the report, told investigators he never received formal training or was made aware of the policy on consult management.

Investigators also substantiated allegations the St. Louis VA's full-time outpatient psychiatrists benefited financially from productivity data, the report showed. During the 2013 fiscal year, the psychiatrists received an average of $13,710 in performance pay, and seven of them got an additional $2,920 on average for meeting or exceeding the productivity goal.

The report called remedies pursued by the St. Louis VA's acting chief "acceptable," and "we consider the recommendations closed."

St. Louis VA spokeswoman Marcena Gunter said Thursday the matter was "an isolated incident with one employee," who she said has been "re-educated" along with the providers about proper protocol.

"We're also doing monthly audits to ensure that we continue in that compliance," she said. "I think the most important thing we want the public to know is that the issue did not affect reported patient wait times. We certainly want our patients to get the best possible care, timely care and access to all the appointments they need."

The St. Louis VA system's former chief of psychiatry, Dr. Jose Mathews, publicly complained last year too few psychiatric patients were being seen, creating a delay in patient care. Mathews also alleged in a 2013 federal complaint he was demoted because of a staff "mutiny" that followed his efforts to make employees work harder and more efficiently.

Mathews, who took over as chief in November 2012, said last year he "could account for only a four-hour workday."

U.S. Sen. Claire McCaskill, a Democrat, said in a statement the report showed "bad training, not bad motives" at the St. Louis VA, adding her priority is to see a permanent director hired there "to help keep things moving in the right direction."

McCaskill's counterpart, Republican Sen. Roy Blunt, called the questioned records-keeping "inexcusable."

"It's my view that these problems are directly tied to the fact that the St. Louis VA has had a revolving door of acting directors with no clear or consistent leadership," Blunt said in a statement. "The VA does not seem to be getting better, and that is not something our veterans should have to endure. We owe our veterans more."