Lawsuits, claims against Phoenix VA released – CBS 5 – KPHO

The US Department of Veterans Affairs received nearly 200 claims of wrongful death or injury at the Phoenix VA Medical Center since 2004, according to documents CBS 5 News obtained through a federal public records request.

The VA’s Office of General Counsel released a list detailing each claim against the embattled Phoenix VA Medical Center including accusations of misdiagnosis, malpractice and failure to diagnose or treat a patient in a timely manner.

Tammy Digiacomo believes the Phoenix VA Medical Center is responsible for her father’s death. Dominic Digiacomo, a Korean War veteran, died after receiving services from the Phoenix VA Medical Center.

“My father’s case, it really is inexcusable,” Digiacomo said.

Digiacomo claims her father was originally misdiagnosed then doctors at the Phoenix VA Medical Center failed to treat complications, ultimately resulting in his death.

In total, CBS 5’s investigation revealed 188 cases were opened at the Phoenix VA Medical Center since 2004. Of those cases, the VA settled lawsuits on 31 of them and paid $6.9 million to patients who got ill or died since 2005. However, the majority of the claims were denied or dismissed by the VA’s Regional or General Counsels.

via Lawsuits, claims against Phoenix VA released – CBS 5 – KPHO.


Top 10 VA Boondoggles


The Department of Veterans Affairs has the money to reform its health care system. In fact, the Veteran’s

Health Administration’s budget this year is $57.28 billion, which is equal to $6,300 per veteran

served. The following examples highlight instances where the VA carelessly wasted its resources:

1. $600 Million + “Crown Jewel” Hospital in Nevada Not Living Up To Its Name

The VA constructed a new $600 million plus (actual costs were reported as closer to $1 billion)

hospital in North Las Vegas that was coined “the Crown Jewel of the VA Healthcare System.”

However, since its opening in 2012, the VA is now paying an additional $16 million to expand

and update the emergency room as the original ER was insufficient to meet patient

needs. Further, the VA hospital has been unable to adequately staff the medical facility with

physicians, and many Nevada veterans still have to travel to different states for certain services

and procedures.

2. VA Pays Out $845 Million in Ten Years for Malpractice and Wrongful Death Claims

Over the past ten years, the VA has paid out $845 million in malpractice claims. $200 million of

these malpractice costs were in the form of wrongful death payments in an attempt to compensate

families of veterans’ who died at the Department’s expense. $36 million was used to settle 167

claims in which the words “delay in treatment” were used to describe the alleged malpractice.

3. VA Construction Projects Rack Up Billions in Cost Overruns

In 2013, four major VA construction projects ended up costing significantly more than projected,

accounting for combined cost overruns of nearly $1.5 billion. Scheduling delays for 4 projects –

in Las Vegas, Orlando, Denver and New Orleans – ranged from 14 to 74 months. On average,

each individual VA medical facility construction project is 35 months late and $360 million over


4. VA Spends Almost $500 Million on Conference Rooms and Curtains

Over a four-and-a-half year period, the VA spent $489 million on embellishing its office spaces.

Highlights of these “office makeovers” include $6.8 million to construct one conference room in

Illinois, $1.8 million on office furniture in Puerto Rico, and $10.7 million on curtains and

draperies nationwide.

5. VA Spends Billions on IT with Mixed Results

The VA has spent $3.9 billion on 32 IT investments this fiscal year (many of which are behind

schedule and over cost – though the data is limited because of inconsistent updates and

discrepancies within the VA’s internal project management dashboard). In 2007, an investigation

found the VA had the worst track record in the entire government for estimating the cost of IT

projects. Over 90 percent of the time, VA IT projects ran over their initial budget estimates.

6. VA Pays Millions to Department Employees to Perform Union Duties

Many VA employees spend their days not caring for veterans, but rather themselves. “Official

time” is a statutory entitlement that allows paid time off for government workers from assigned governmental duties in order to represent a union or its bargaining unit employees. As of

February 2013, there were 277 VA employees performing as union representatives on 100

percent official time. In 2011, the VA spent $42,565,000 in costs related to maintaining official

time employees (this number includes payroll costs, salary, and benefits).

7. VA Spends Millions on Lavish Conferences

While veterans suffer waiting to receive medical care, benefits, and other services, VA employees

are squandering funds appropriated to the Department. In 2011, the Department spent over

$220,000 on an 11-day conference VA employees at a Scottsdale, Arizona resort. That same

year, the VA held two more training conferences in Orlando, costing a combined $6.1 million –

with at least $762,000 wasted. Questionable purchases at the Orlando conference included

karaoke machines and artisan cheese displays, $184,000 worth of breakfast sandwiches, $16,500

for the production of “happy face” videos featuring daily recaps of conference events, close to

$100,000 worth of promotional favors, and $50,000 for the production of a video parody.

o Note: While VA employees are lining up in buffet lines at conferences in luxury hotels,

more than one in four veterans who served in Iraq and Afghanistan are going hungry. A

recent study surveyed 922 United States veterans and shockingly discovered that 27

percent reported they were not able to feed themselves three times a day. This number is

“drastically higher” than the 14.5 percent national average.

8. VA Spends Millions on Employee Travel

In 2010, the VA spent $80 million on travel-related expenses for its employees. VA spending on

employee travel was brought to light in 2011 when the IG revealed that a senior VA administrator

billed the federal government more than $130,000 for his weekly commute to Washington. The

VA not only paid for the official’s weekly commute, but it also picked up hotel and meal

expenses so the individual would not have to relocate.

9. VA Spends Over $500,000 on Artwork and Photographs to Decorate its Facilities

In 2013, the VA purchased $562,000 worth of artwork to decorate various agency facilities. A

VA spokesperson described the art as “motivational and calming, professionally designed to

enhance clinical operations.”

10. VA Spends Millions on Vacant, Dilapidated, and Unused Properties

VA maintains thousands of buildings throughout the country, many of which are empty, unused,

or too rundown to utilize – some of them are even considered to be health hazards. Despite this,

the VA continues to shell out millions of dollars to maintain these abandoned and dilapidated

buildings, including a pink octagonal monkey house in Dayton, Ohio. In 2013, VA estimates it

spent approximately $20.2 million on 922 vacant and underutilized properties.

Beyond the Waiting Lists, New Senate Report Reveals a Culture of Crime, Cover-Up and Coercion within the VA – Right Now – Tom Coburn, M.D., United States Senator from Oklahoma

Beyond the Waiting Lists, New Senate Report Reveals a Culture of Crime, Cover-Up and Coercion within the VA – Right Now – Tom Coburn, M.D., United States Senator from Oklahoma.

(WASHINGTON, D.C.) – U.S. Senator and doctor Tom Coburn, M.D. (R-OK), today released his new oversight report “Friendly Fire: Death, Delay, and Dismay at the VA.”  The report is based on a year-long investigation of VA hospitals around the nation that chronicled the inappropriate conduct and incompetence within the VA that led to well-documented deaths and delays.  The report also exposes the inept congressional and agency oversight that allowed rampant misconduct to grow unchecked.

“This report shows the problems at the VA are worse than anyone imagined.  The scope of the VA’s incompetence – and Congress’ indifferent oversight – is breathtaking and disturbing.  This investigation found the problems at the VA are far deeper than just scheduling.  Over the past decade, more than 1,000 veterans may have died as a result of the VA’s misconduct and the VA has paid out nearly $1 billion to veterans and their families for its medical malpractice.  As is typical with any bureaucracy, the excuse for not being able to meet goals is a lack of resources.  But this is not the case at the VA where spending has increased rapidly in recent years,” Dr. Coburn said.

“The Administration and Congress have failed to ensure our nation is living up to the promises we have made to our veterans,” Dr. Coburn added.  “As a physician who has personally cared for hundreds of Oklahoma veterans, this is intolerable.  As a senator, I’m determined to address the structural challenges of the Department of Veterans Affairs so we can end this national disgrace and improve quality and access to health care for our veterans.  But make no mistake.  Whatever bill Congress passes cannot ignore the findings of this report.  While it is good that Congress feels a sense of urgency we are at this point because Congress has ignored or glossed over too many similar warnings in the past.  Our sense of urgency should come from the scope of the problem, not our proximity to an election.”

Key findings in the report include:


  • The cover up of waiting lists for doctor’s appointments at the VA is just the tip of the iceberg, reflecting a perverse culture within the department where veterans are not always the priority and data and employees are manipulated to maintain an appearance that all is well.
  • Bad employees are rewarded with bonuses and paid leave while whistleblowers, health care providers, and even veterans and their families are subjected to bullying, sexual harassment, abuse, and neglect.  For example, female patients received unnecessary pelvic and breast exams from a sex offender, a noose was left on the desk of a minority employee by a co-worker, and a nurse who murdered a veteran harassed the family of the deceased to get them to admit guilt for the death.
  • The care at more centers is getting worse and some VA health care providers have lost their medical licenses, and the VA is hiding this information from patients.
  • Delays exist for more than just doctors’ appointments—disability claims, construction, urgent care, and registries are also slow or behind schedule.
  • Despite a nursing shortage, many VA nurses spend their days conducting union activities to advocate for better conditions for themselves rather than veterans.


  • As waiting lines were growing, the VA expanded eligibility in 2009 to those who already had insurance without any service related injuries, making the delays longer.
  • Despite having the authority to do so, the VA was reluctant to let vets off the waiting lists by freeing them go to doctors outside of its system while sitting on hundreds of millions of dollars intended for health care that went unspent year to year.
  • VA doctors are seeing far fewer patients than private doctors and some even leave work early.


  • Criminal activity at the department is pervasive, including drug dealing, theft, and even murder.  A VA police chief even conspired to kidnap, rape and murder women and children.
  • Many VA doctors and staff are overpaid and underworked, some are paid not to work and more and more employees are not even showing up for work.


  • The report identifies $20 billion in waste and mismanagement that could have been better spent providing health care to veterans.
  • The federal government has paid out $845 million for VA medical malpractice since 2001.
  • Most VA construction projects are over budget and behind schedule, inflating costs by billions of dollars.


Top 10 Outrageous VA Behaviors

Top 10 Outrageous VA Behaviors
In addition to “cooking the books,” botching and covering-up appointment wait time records, and handing out undeserved bonus awards, misconduct within the Department of Veterans Affairs extends to everything from sexual abuse to skipping work to theft to drug distribution. Some examples of the Department’s most egregious employee misconduct are highlighted below:
1. Veteran Patients Suffer Sexual Abuse by VA Doctors
A male neurologist at the Colmery-O’Neil VA Medical Center in Kansas violated at least 5 female patients during his time as a physician there by conducting unnecessary “breast examinations” and at least one unnecessary “pelvic examination.” It took the VA more than 2 years to fire him and he is now a registered sex offender.
2. VA Employee Sells Cocaine and Ecstasy to Patients Recovering from Substance Abuse
A VA employee in Massachusetts sold cocaine to patients receiving treatment for substance abuse problems. 28 year-old Patrick McNulty sold cocaine, marijuana and ecstasy to the veterans he was treating on VA property. He was also recorded talking about his drug sales, once stating “I can get coke like it’s nothing. I can get more coke all day.” He was sentenced to three months community confinement in a halfway house, followed by three months of home confinement and three years of probation.
3. VA Employees Skip Work More Than Other Federal Employees
VA employees fail to show up for work unexcused – termed “absent without leave” (AWOL) – at a rate exceeding every other federal department and agency. AWOL can include anything from being late to work to disappearing from the office for months at a time. In one instance, lack of supervision enabled a VA employee to be absent without leave on more than 25 separate occasions. This employee took advantage of the “unlimited freedom” allowed by his supervisors and “admitted that his misconduct negatively affected his performance.”
4. Nurse Aide Steals Gold Crucifix Off the Neck of Dying Veteran
A nurse’s aide at a VA medical facility in Pennsylvania was arrested for stealing a 14-carat gold chain with a crucifix off of the neck of a dying veteran who was in hospice care. He attempted to sell the valuable necklace at a jewelry store; the veteran died the next day.
5. Child Pornography
On more than one occasion, employees at multiple VA medical centers were found to have used their work computers to watch child pornography. Examples include accessing child pornography websites on VA systems while on the job and possessing child pornography on the grounds of VA property.
6. VA Police Force Chief Plots to Kidnap, Rape, and Murder Women and Children
The chief of police of the Bedford VA Medical Center was arrested by the FBI and convicted of conspiring with a member of a cohort of the New York “Cannibal Cop” to kidnap, rape, and murder women and children. He pled guilty in January 2014 and “now stands convicted of serious federal crimes.”
7. VA Rehires Employee After He Drives Drunk and Kills His Co-Worker
During a business trip to Texas, VA employee Jed Fillingim was arrested after a night of heavy drinking. Fillingim admitted to driving a government trunk while intoxicated, during which his colleague, Amy Wheat, fell from the moving government vehicle and died. Fillingim eventually resigned from his job but the VA rehired him – to a different position in a different office – just months after his resignation. He has remained at that job ever since, making over $100,000 a year, despite being the subject of an ongoing criminal investigation into the Texas incident.
8. Lax Security Controls
VA had the most security incidents of any government agency last year, reporting 11,368 in 2013. “Security incidents” include anything from a stolen laptop to a computer virus download to the mishandling of documents. In one instance, a former VA employee was sentenced to six years in federal prison for aggravated identity theft. Former VA employee David Lewis accessed veterans’ personal information “in exchange for crack cocaine,” allowing this identifying information to be used to file fraudulent tax returns and apply for fraudulent lines of credit.
9. VA Employees Bills Department for Excessive Travel Expenses, Uses VA Laptop To Send Personal “Sexts”
A VA employee was placed on paid administrative leave after being caught charging his jet-setting lifestyle to the VA and only showing up for work when and if he pleased. He conducted personal business during his VA workday and took advantage of the lack of supervision. This employee also “downloaded and installed unapproved software to his VA-issued laptop for the purpose of sexting—defined as the sending of sexually explicit photos, images, text messages, or emails using a mobile device.” He downloaded Skype software on his VA work computer, using it to sext his friends, admitting his behavior was “out of control.”
10. VA Whistleblower Employee Suspended Without Pay When She Refused to Hide Wait Times
Lisa Lee, a former Navy reservist, was a whistleblower who sparked the Office of Special Counsel’s investigation into “cooking the books” scheduling abuses at the Fort Collins VA clinic in Colorado. The VA suspended Lee without pay for two weeks when she refused to cover up appointment wait times and relocated her to another VA medical center with lower pay. She said her supervisors claimed her “performance had delayed patient care.”

Auditor that Accredited VA Hospitals Where Patients Died to Review Same Hospitals | Washington Free Beacon

The same independent auditor who accredited Veterans Affairs hospitals where multiple patients died from delays in care—and in some cases named them as “top performers”—has been chosen by the VA to complete a new review of those same hospitals.

Earlier this month, new VA Secretary Robert McDonald announced that the Joint Commission, a hospital accreditor, would review scheduling practices across the VA system.

“VA is committed to instilling integrity into our scheduling practices to deliver the timely care that veterans deserve,” McDonald said in a statement. “It is important that our scheduling practices be reviewed by a respected, independent source to help restore trust in our system, and I’m grateful to the Joint Commission for taking on this critical task.”

via Auditor that Accredited VA Hospitals Where Patients Died to Review Same Hospitals | Washington Free Beacon.

Healthcare Inspection Results for Quality of Care and Staffing Concerns, Salem VAMC, Salem, Virginia

Healthcare Inspection Results for Quality of Care and Staffing Concerns, Salem VAMC, Salem, Virginia

OIG conducted an inspection in response to quality of care and staffing concerns at the

Salem VAMC, Salem, VA. OIG substantiated that post-operative complications for orthopedic and podiatry surgery cases increased in FY 2013. The VAMC has implemented corrective actions and is monitoring for effectiveness. OIG did not substantiate that bowel perforations occurred during surgery requiring ostomies; that a number of outpatients having lung biopsies required chest tube placements and admissions; that patients were being told that they had a spot on their lung and months later were told they had Stage IV lung cancer; or that a dying patient was inappropriately transferred from the emergency department to a medical/surgical unit. OIG also did not substantiate that the administrative officer of the day was admitting patients to units that could not properly care for them resulting in those patients being transferred within minutes of arrival. However, OIG did identify inefficiencies in the admission process and inter-unit transfer patterns. OIG substantiated the subject unit had been staffed for 20 patients. In 2013, the unit’s bed capacity increased from 20 to 24 patients

Poor Management of High Risk Patient’s Medications Contributed to Accidental

Drug Overdose at Tuscaloosa, Alabama, VAMC

OIG conducted an evaluation in response to allegations that providers at the Tuscaloosa VAMC mismanaged opioid therapy for a high-risk patient and that facility managers did not take appropriate actions after the patient’s death. OIG substantiated that facility providers collectively prescribed oxycodone, methadone, and benzodiazepines to a high-risk patient who died of an accidental multi-drug overdose.

Three factors contributed to this outcome: (1) the patient’s primary care provider (PCP)

did not consistently complete key elements of the pain assessment, initiate an opioid pain care agreement, ensure adequate patient monitoring and follow-up after prescribing methadone, or document patient education regarding the specific dangers of methadone; (2) the facility did not ensure access to an interdisciplinary pain management team or Pain Clinic to provide needed services to this patient; and (3) the

PCP, MH provider, and Suicide Prevention Coordinator did not ensure communication and coordination of care for this high-risk patient. OIG did not substantiate that the facility covered up the patient’s subsequent visit to the facility or delayed the autopsy report. However, the facility did not comply with selected aspects of VHA Directives on clinical reviews and patient safety processes. OIG made seven recommendations.

[Click here to access report.]

Two Employees Of Veterans Affairs Hospital, Including Logistics Warehouse And Mail Center Supervisor, Charged With Conspiracy To Distribute Cocaine

Two Employees Of Veterans Affairs Hospital, Including Logistics Warehouse And Mail Center Supervisor, Charged With Conspiracy To Distribute Cocaine

FOR IMMEDIATE RELEASE Wednesday, September 3, 2014

Preet Bharara, the United States Attorney for the Southern District of New York, Philip R. Bartlett, the Inspector-in-Charge of the New York Office of the U.S. Postal Inspection Service (“USPIS”), Jeffrey G. Hughes, Special Agent-in-Charge, Northeast Field Office, of the Department of Veterans Affairs, Office of Inspector General (“VA-OIG”), and Albert Aviles, Chief of the Department of Veterans Affairs Police Detachment in Bronx, New York, announced that ROBERT TUCKER, of Bronx, New York, and ERIK CASIANO, of West Orange, New Jersey, were arrested yesterday for allegedly engaging in a conspiracy to distribute more than five kilograms of cocaine. The defendants will be presented in Manhattan federal court this afternoon before U.S. Magistrate Judge Ronald L. Ellis.

U.S. Attorney Preet Bharara said: “As alleged, the defendants used the cover of a facility dedicated to caring for our nation’s heroes to further a scheme to distribute large amounts of cocaine. I would like to thank the United States Postal Inspection Service, the Department of Veterans Affairs, Office of Inspector General, and the Department of Veterans Affairs Police for their outstanding work on this case.”

USPIS Inspector-in-Charge Philip R. Bartlett said: “These employees allegedly took advantage of the trust placed in them by their employer and the US Government. Criminals involved in drug trafficking should take note, U.S. Postal Inspectors will vigorously pursue, arrest and bring to justice anyone who uses the US Mail to facilitate the transport of illegal drugs, firearms or drug proceeds.”

via Two Employees Of Veterans Affairs Hospital, Including Logistics Warehouse And Mail Center Supervisor, Charged With Conspiracy To Distribute Cocaine.

MMQB: Minneapolis VA At Center Of Medical Records Fraud

Two whistleblowers at the Minneapolis VA Medical Center were terminated after coming forward with outrageous stories of medical record fraud related to cancer treatments for sick veterans.

Most alarming were claims that agency managers required staff to falsify medical records that could be used against a harmed veteran in a medical malpractice lawsuit. Specifically, VA staff were told to write down that veterans declined treatment when the treatment option was never presented. This act is a violation of HIPAA, VA rules and is a clear ethics scandal.

Pay attention. Across the country, VA employees have come forward with details highlighting the depths of the frauds committed by VA employees to cook the books. In many instances, the fraud and ethics violations impact cancer detection and treatment. We intend to continue our coverage that includes a unique look at how frauds like these affect every day veterans like you.

Hi and welcome to another edition of Monday Morning Quarterback for Veterans. I am your host, Benjamin Krause, facilitator of the community surrounding and creator of the website. This is the leading resource of benefits information and news about the Department of Veterans Affairs.

We have a lot of videos for you to enjoy and get caught up to speed on stories related to veteran mistreatment and abuses. The first three are from investigations by KARE 11 news that chronicle the unfolding of medical record fraud that is likely going on across VA nationwide:

Two Minneapolis VA Whistleblowers Terminated

Minnesota Congressman Burnt By VA Fraud Cover-up

Corrupt Record Keeping, “They Lied”

Delayed Treatment Let Cancer Harm One Washington Veteran

Minneapolis VA Town Hall

via MMQB: Minneapolis VA At Center Of Medical Records Fraud.

Dorn: Some Veterans’ Info May be Compromised

Columbia,SC WLTX – The Dorn Veterans Administration Hospital in Columbia says some old records are missing, and is warning veterans that their personal information could be compromised.According to Dorn officials, four boxes of pathology reports that were stored in a locked area in the medical center laboratory are gone. The loss of the records was first noticed by staff back on July 14th, when they were getting ready to ship them to a long-term records storage facility.The records include patients’ names, Social Security numbers, and pathology reports. The records are from the years 1999, 2000, and 2002 only.Dorn officials say they’re in the process of notifying 2,179 veterans that could be affected.

via Dorn: Some Veterans’ Info May be Compromised.