PHOENIX - A cancer patient hopes his secretly recorded visit to a VA physician will raise awareness about unresolved problems at the restructured government healthcare agency.
Retired Sgt. 1st Class Steve Cooper served in the U.S. Army for two decades as an infantryman and law enforcement officer. The 45-year-old entrepreneur was diagnosed with prostate cancer in 2012. Since then he has filed a lawsuit against the VA, alleging the agency failed to diagnose his late-stage prostate cancer. A trial is set for January.
Cooper has been an outspoken critic of the agency. On June 28, he secretly recorded his doctor’s visit to the Southeast VA Clinic in Gilbert. The purpose of the visit was to obtain referrals for outside specialists under the Veterans Choice Act, passed by Congress in 2014. 12 News is airing the recordings while distorting the voices of the doctor and nurse involved.
The most notable moments throughout the 30 minutes of recorded conversations include the following:
- A nurse calls the patient phone scheduling system “a nightmare,” admitting that even as an employee she can’t get a person on the phone line.
- The doctor who saw Cooper admitted he’s “not a fan of the VA” and complained his patient load doesn’t allow him enough time with patients.
- The doctor said that, as a new employee, he is still trying to understand how the “Choice” program works.
- The doctor expressed a desire to check Cooper’s heart and lungs but said he misplaced his stethoscope. The doctor ended up not using a stethoscope at all, but nonetheless stated that “key exam findings” on Cooper were negative.
“I especially have a problem with it because earlier the nurse said my blood pressure was high,” Cooper said in an interview with 12 News. “And the excuse that a doctor says he can’t find his stethoscope just doesn’t work when you’re a doctor making six figures working for the Phoenix VA.”
Cooper says he believes the audio reflects ongoing issues at the Phoenix VA Healthcare System first identified two years ago.
“Post two-years since the crisis broke, the audio is valuable. It’s valuable to hear from the employees themselves that the system doesn’t work because of the infrastructure,” Cooper said during an interview with 12 News.
Response to the audio recording
Regarding the audio recording, Phoenix VA Medical Director Deborah Amdur said the agency is looking into the matter.
“Our Veterans deserve the very best care possible. We will address these allegations and, if wrong doing is substantiated, take appropriate actions with the providers involved,” Amdur wrote in an email statement to 12 News.
Amdur declined to provide an interview about the issue. However, her written statement also included an acknowledgement that the actions by the employees recorded were not acceptable.
“The Phoenix VA Health Care System is committed to providing the highest level of patient care, and all employees are expected to uphold our core values. It appears the manner in which our provider staff communicated and interacted with this patient on this day was not in keeping with our values,” Amdur wrote.
Is it possible the audio recording is an anomaly in a system that is otherwise making vast improvements?
"I think it’s a fair question because there are many sides to every story," Cooper said. "But as you know, I’m not the only one talking about this."
Congressman Matt Salmon, who represents the 5th District which includes the Southeast VA Clinic, told 12 News he was “disappointed” by what the audio recording revealed and does not consider it an anomaly.
“With this tape it was very, very clear the doctor he was dealing with did not understand the choice system. And I think the doctor frankly was not doing his job the way he needs to,” Rep. Salmon said.
"Calling here... is a nightmare"
Cooper says he decided to record his visit in order to document his experience and to be able to recall later details given to him by doctors and nurses. The initial barrier for care, he said, was that he had to physically appear at the Gilbert-area VA facility to secure an appointment because he could not reach someone by phone.
The nurse who attended Steve seemed to agree there are lingering issues with veterans being able to reach an actual person by phone:
Nurse: “If you’ve ever tried calling here, it is a nightmare.”
Cooper: “Yeah it does not work and there’s no number to press for primary care.”
Nurse: “No. And it just irritates the living hell out of me.”
Later the nurse says:
Nurse: “I started out here two years ago May 1. I called from downtown. No answer. I called another department. This is an employee! No answer. I finally got in the car and drove over here because it was so ridiculous. You just cannot get through.”
“I think we’re entitled when we call the VA someone answers the phone. We know that was an issue two years ago, and it’s still an issue,” Cooper told 12 News.
The Choice Act
Congressman Salmon has acted as a liaison between Cooper and the VA in an attempt to help Cooper resolve his concerns. The congressman voted in favor of the Choice Act – describing it as “one of the best ideas that has come forward because the veterans ought to be able to vote with their feet” – but said it has not yet fulfilled its promises.
“It’s (the Choice Act) just not working the way we all envisioned it would work. There are a lot of problems,” Salmon said.
A component of the act, which was passed with bipartisan support, is intended to allow patients to receive care from outside providers.
"I think the best way to get the people at the VA to meet the needs of veterans is to give them choice, real choice," Salmon said.
But the referral process has been criticized as cumbersome and in need of reforms. According to the law, a veteran who qualifies can obtain treatment from the private sector if circumstances and geographical distance prevent him or her from getting adequate care within the existing VA system. But the process involves a back-and-forth volley of information with a third-party contractor authorized to process referrals. In Arizona, that processor is Tri-West.
“We’ve received one report recently that states it may be time to scrap the middle man,” Salmon said, adding the referral system needs to be "streamlined."
During the recording, the doctor discusses his frustration balancing his caseload and the required paperwork for the choice referral program. Cooper presents to the doctor a list of a dozen specialists he would like to visit and explains why he believes he qualifies for the choice program. The doctor explains he is still learning about the system. He asks two nurses to help him out.
“I’ve only been here three months. It’s hard enough to learn how the whole VA works,” the doctor states. During the interaction both sides seem to complain about a system layered with bureaucracy. At one point, the doctor expresses his desire to help Cooper but simply states, “It’s just I’m so lost in what to do.”
"When a doctor acknowledges that, it’s actually infuriating. Because we already know the V.A. is broken and then to have the doctors acknowledge that, there’s nothing left, right?" Cooper said.
"I'm not a big fan of the VA."
Another exchange between the doctor and Cooper:
Doctor: “Is the VA the best system in the world? No. …I can only do what I can do… I (inaudible) given five hundred patients on May 23rd. Five hundred… So it’s impossible.”
Cooper: “Sir I appreciate that but I think you can appreciate my perspective. I’m dying of stage four prostate Cancer. I don’t care frankly sir. I just need to get the quality care, right? I think that’s part of the VA’s problem. Is there’s something wrong.”
Doctor: “There’s a lot wrong… I’m not a big fan of the VA. I try to do a good job.”
From Cooper's perspective, the audio is another example of why he believes the VA needs to be replaced altogether.
"I've probably been the biggest advocate to shut the VA down," Cooper said. "To me it's simple. We need to make it a Medicare system. Let Medicare manage this."
Salmon said while there are pressing matters facing the agency, he is optimistic new leadership can help turn it around.
"I have nothing but praise for Director Amdur who is running the (Phoenix) VA. I think she is a breath of fresh air," Salmon said. "But the problem is so many people who still work there are the people that were there when the problem was created and getting rid of people that don’t do the job the way they are supposed to is almost impossible in the VA."
Salmon said the VA's HR system needs to be revamped in order to recruit higher-quality employees.
"It needs to be streamlined so that when they find good doctors they are able to hire them quickly," Salmon said.
Cooper says he decided to record his visit in order to document his experience and to be able to recall later details given to him by doctors and nurses. He has not recorded other visits, Cooper said.
Copyright 2016 KPNX