The Department of Veterans Affairs promises sweeping changes — and ample contrition — in a prepared response to an inspector general's report due this week on a scandal over delayed health care for veterans.
The VA response — copies of which were obtained by USA TODAY — includes talking points that reveal at least one crucial finding by investigators: No deaths of veterans at a Phoenix VA hospital could be "conclusively" linked to delays in care at that facility.
The talking points emphasize "it is important to note" this finding.
Sam Foote, a retired doctor who worked at the Phoenix facility, raised the issue of 40 deaths occurring among veterans whose care was delayed.
The allegation of deaths, which surfaced in April, focused considerable media attention on VA management problems in Phoenix. A preliminary inspector general's report in late May concluded that delays in care and manipulation of scheduling records were systemic in the sprawling VA system of 150 hospitals and 820 clinics.
The scandal drove VA Secretary Eric Shinseki to resign May 30, hours after he lamented that he had found a "totally unacceptable lack of integrity" within the system.
The Senate confirmed Robert McDonald as the new secretary late last month.
In a news release the VA prepared for when the inspector general's report is published, McDonald says, "We sincerely apologize to all veterans who experienced unacceptable delays in receiving care. … We will work hard to rebuild trust with veterans and the American public."
Since the scandal broke, the VA has sent more than 190,000 veterans to private doctors to get them timely health care.
The inspector general report due this week takes a comprehensive look at health care delays in Phoenix, how rules were broken to hide delays, whether patient care was sacrificed for the sake of appearances and the extent of problems in the VA.
An earlier effort by VA officials to pinpoint agency shortcomings found systemwide problems and a pervasive, "corrosive culture" of low morale, distrust and poor management. At the heart of the issue were efforts by managers to improve their performance numbers even if it meant falsifying data on how long veterans waited to be seen by doctors, investigators found.
In response to the scandal, Congress approved $17 billion to expand health care resources at the VA.
"The lessons of Phoenix have provided a major impetus ... to re-examine (the) entire process of setting performance expectations for its leaders and managers," say the internal documents obtained by USA TODAY. "We are taking vigorous action to ensure that a 'date-driven' approach does not have the unintended impact of diverting attention from our primary goal of providing veterans with ... health care."
Other steps outlined by VA:
•Outside experts in ethics will be hired to recommend how to "select and hire ethical leadership and staff (and) how to communicate expectations around ethical behavior."
•Across the entire VA system, $400 million must be spent on staff overtime or private doctors to ensure veterans are treated quickly. As of Aug. 6, the VA had allocated $128 million in private care costs for 83,000 veterans.
•8,248 VA schedulers across the country have been trained in appropriate ways of scheduling patients, including 764 Phoenix workers.
•An internal investigation board will be created to identify managers at the Phoenix hospital responsible for wrongdoing and what disciplinary actions should be taken.
•Nearly $17 million has been spent in Phoenix to send veterans to private doctors for speedier care.
•Mental health resources have been expanded in Phoenix by filling all but three of 13 psychiatric vacancies and six of seven psychologist positions and adding four social workers. The hospital's primary care staff has been expanded by 53 doctors, nurses and other caregivers. Twenty-seven temporary examination rooms have been opened, and two new outpatient clinics are planned with an additional 30,000 square feet of space.