Updated May 28, 2014 11:16 p.m. ET
Veterans Affairs Secretary Eric Shinseki testified on Capitol Hill on May 15. Accusations of delayed or denied care appointments have led to calls for an investigation of the department. Associated Press
A watchdog's report found systemic problems at Department of Veterans Affairs health-care facilities, including improper procedures for scheduling patient appointments and efforts to hide excessive wait times, increasing the pressure on embattled VA Secretary Eric Shinseki.
The interim report by the VA's independent inspector general focuses on the Phoenix VA Health Care System in Arizona, where wait times for patient appointments were improperly reported, but also points to widespread scheduling problems throughout the VA health-care system.
"Our reviews at more VA medical facilities…have confirmed that inappropriate scheduling practices are systemic," the report said. The inspector general said it had identified potential criminal and civil violations, and is coordinating efforts with the Justice Department.
The Veterans Administration's inspector general found systemic scheduling problems in its review of 42 hospitals across the country, according to an interim report. How did schedulers in Phoenix cook the books? WSJ's Jason Bellini has #TheShortAnswer.
The report led to new calls in Congress for Mr. Shinseki to step down. A senior administration official said President Barack Obama's recent comments indicate Mr. Shinseki is on probation—and that hasn't changed. Mr. Shinseki didn't comment on his plans Wednesday, but in the past has said he doesn't plan to leave office.
Release of the report sparked an immediate bipartisan outpouring of calls for Mr. Shinseki's resignation. For the first time, Democratic senators, including Sens. Mark Udall (D., Colo.) and John Walsh (D., Mont.), joined Republicans such as Sen. John McCain (R., Ariz.) in urging the former general to step aside.
On Wednesday evening, three top VA officials under threat of subpoena faced hours of withering bipartisan criticism from members on the House Committee on Veterans' Affairs.
"What I don't understand is, as a veteran, as a doctor, as a practitioner, how you can look at yourself in the mirror and shave in the morning," Rep. Phil Roe (R., Tenn.) told Thomas Lynch, assistant deputy under secretary for health for clinical operations at the VA, who carried out the department's initial review of the problems in Phoenix.
Mr. Lynch described the review's conclusions as "unacceptable" and conceded that the VA should have taken a more critical look at the problems. "I think people lost sight of the real goal of the VA—which is treating veterans," he said.
The White House said Mr. Obama found the interim report "extremely troubling" and wants the Veterans Administration to take immediate steps to improve access to care, a spokesman said Wednesday.
In Phoenix, 1,700 veterans were found to be waiting for primary-care appointments, yet didn't appear on the official electronic wait list, the report said. Inspectors found paper printouts representing hundreds of veterans who requested a primary-care appointment but who were never entered into the VA's appointment software. These and other unauthorized records might be the "secret" waiting lists that have been alleged to be used at the facility, the IG report said.
The lack of officially tabulated wait times led the Phoenix VA leadership to have "significantly understated" the time new patients wait for an appointment, "which is one of the factors considered for awards and salary increases," the report said.
"I respect the independent review and recommendations of the Office of Inspector General regarding systemic issues with patient scheduling and access," Mr. Shinseki said in a statement. "I have reviewed the interim report, and the findings are reprehensible to me, to this department and to veterans." He said in the statement he has ordered the Phoenix VA to provide timely care to the 1,700 veterans who weren't on the electronic wait list.
In 2011, the VA revamped its targets for the time patients must wait to be seen, setting a target for 14 days between when a patient requests an appointment and when that patient is seen. On Saturday, The Wall Street Journal reported the VA's then-undersecretary for health, Robert Petzel, told veterans advocates at a May 14 meeting that 14-day wait times might have been "unrealistic." Mr. Petzel left his post two days later.
Sen. John McCain, left, was at a forum earlier this month in Phoenix discussing lapses in care by the Phoenix VA Health Care System. Associated Press
The IG report notes a variety of scheduling improprieties at the Phoenix facility, including actual wait times months longer than those reported. The Phoenix VA reported average wait times of 24 days for appointments. But the IG found patient wait times were actually some three months longer, averaging 115 days. And 84% of patients had to wait longer than the 14-day target.
Because of improper scheduling procedures, Phoenix was reporting wait times of zero days for many primary-care appointments. The inspector general hasn't determined any management involvement in manipulating these wait times.
The Phoenix VA has been under fire since mid-April when a former physician from the facility and the House Committee on Veterans affairs alleged that as many as 40 veterans died while waiting for appointments. At a May 15 Senate hearing, Richard Griffin, the VA's acting inspector general, said that out of 17 cases reviewed to that point, there was no evidence of patient deaths tied to excessive wait times.
Mr. Shinseki placed the director of the Phoenix VA, Sharon Helman, on administrative leave on May 1, pending the results of the inspector general's review. She has said that she didn't know of any secret wait lists, and that she understood Mr. Shinseki's decision to place her on leave. A spokesman for Ms. Helman declined to comment.
In 2010, a VA memo listed a variety of "gaming" strategies used to exploit loopholes in the scheduling system. In its most recent reviews, the IG has identified these same schemes in use in Phoenix and other VA facilities.
Scheduling personnel told the IG that in a number of cases when veterans called a help line for an appointment, the scheduler would just print out a screenshot of the data. The printouts were eventually destroyed, and the IG "could not identify these veterans or confirm they were ever provided with an appointment."
Another problem with the system: the Phoenix VA simply had switched off a number of audit controls within the scheduling software. As a result, neither the VA nor the IG were able to tell if "malicious manipulation" of appointment data had occurred.
The IG is also reviewing allegations of sexual harassment and bullying at the Phoenix facility.
In 2013, the VA health-care system had 8.92 million enrollees, being treated at more than 800 outpatient clinics, 300 VA centers and 150 hospitals. Not all veterans rely on VA care, often using private insurance, Medicare and Medicaid, and not all qualify for care. To receive VA care, a veteran typically has to have retired from the military or suffer from a long-term injury sustained while in the service. Combat veterans of Iraq and Afghanistan can qualify for five years of health care in the VA system after an honorable discharge.
—Colleen McCain Nelson, Michael Crittenden, Jeffrey Sparshott and Dion Nissenbaum contributed to this article.
Write to Ben Kesling at benjamin.kesling@wsj.com
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