VA standards say incoming mail must be opened and processed within four to six hours, and that medical records have to be processed and scanned into the system within five business days. The consequences of not doing so can be critical.
One medical staffer told investigators that delaying health record entries could hinder patient care if clinicians don’t have necessary information. Missing records could also slow referrals to specialists or delay prescriptions.
Delays could also cause duplication of services such as lab tests or imaging that might have been performed but not entered into the system. The report says medical decisions could be made with incomplete information, and staff could waste time searching for the lost records.
A September story by The Atlanta Journal-Constitution triggered the investigation, the report says. A VA employee sent the newspaper a tip and a photo of pallets at the hospital, which is in Decatur, stacked with mail nearly to the ceiling. The Atlanta VA said then the problem stemmed from mail being reassigned from a group responsible for payments to the mailroom. But it did not answer questions about how it was allowed to stack up for months.
After the story, the hospital cleared the backlog in matter of days.
“…If the Atlanta facility was capable of coordinating staff to open and process this mail in September, then it could have processed the mail and cleared this backlog months earlier,” the report says. It ordered the Atlanta hospital to try to determine the number of veterans wronged.
A document in the report shows the desperation of one affected veteran. Scrawled across a medical bill he or she had mailed in was the plea “PLEASE HELP ME.”
The AJC is requesting more information from the hospital about affected veterans and disciplinary actions taken by the VA.
An initial statement from the Atlanta VA notes it is acting on the inspector general’s recommendations, and deployed a plan to ensure prompt processing of all mail. The Atlanta VA also said it has improved training, clarified reporting mechanisms to improve workload management efficiency, and updated the personnel and leadership structure of the mailroom to increase oversight and accountability.
... officials in Atlanta were aware that the backlog was accumulating as early as January 2021 but did not take adequate steps to reduce the backlog until after the Atlanta Journal-Constitution drew public attention to the problem."
- From the VA inspector general’s report
‘Knock on wood’
Veterans have complained to the newspaper for years that mail sent to the Atlanta VA hospital often disappears.
Jill Lamb, the wife and advocate for her husband John Lamb, a 65-year-old veteran said she was unsurprised by the inspector general’s findings. The AJC was not able to ascertain if his mail was among the backlog. And the Lambs recently moved from Cherokee County to South Carolina.
“The only thing, knock on wood, we have had success with is medications,” she said. “Other than that, correspondence or asking for records or anything from the VA, you just don’t get it. You don’t even get phone calls back half the time.”
The inspector general’s report says the problem started when hospital medical staffers wanted to use space occupied by a VA payments group. In November 2020, managers cut a verbal deal. The payments team agreed to give up its space if the medical center mailroom staff would take over the payments group’s mail.
But the hospital managers had no idea how complex the mail was to process, they didn’t involve mailroom staff in the discussion and didn’t know if mailroom staff had the training or manpower to process it, the report said.
The problems became obvious within days, with mailroom staff pushing back on the new duties, and the payments group refusing to help or retake its duties. By January, the chief of supply chain management said the mail was just “sitting in the basement,” the report says.
The volume, meanwhile, continued to grow. Mail was sent to Birmingham then to a Tampa location for processing. But those VA facilities sent it back.
Neither the Atlanta mailroom staff nor the payments group would take responsibility for processing it, the report said.
‘A day late and a dollar short’
If the VA doesn’t pay outside doctors who provide services to veterans, the responsibility and bill collection falls on the veterans themselves, causing financial hardships and frustration.
Bobby Fisk, a Pickens County veteran, knows that pain too well. Fisk was once hounded by bill collectors and denied a home loan because of medical bills that went unpaid by the VA.
“They are still about as backward as you can get. Always a day late and a dollar short,” Fisk said.
And if those outside doctors don’t get paid, they may stop serving veterans, the report says.
A workers at the Atlanta VA hospital in Decatur tipped the AJC in September 2021 that unopened mail and parcels were stacking up in the basement. The newspaper wrote an initial story and followed up with two more, triggering a Veterans Affairs inspector general investigation. It found the Atlanta VA mismanaged the situation and allowed the mail to languish more than 10 months. That could negatively affect the care veterans receive. The Atlanta hospital is one of the largest in the Southeast, serving more than 100,000 veterans.