The Department of Veterans Affairs' internal watchdog testified Wednesday that delayed treatment for thousands of Arizona veterans may have contributed to some deaths, a strikingly different emphasis than in an August report on the Phoenix VA medical center that emphasized that delayed care had not conclusively caused patient fatalities.

In a frequently contentious hearing before the House Committee on Veterans' Affairs, acting Inspector General Richard Griffin defended his Aug. 26 report on the Phoenix VA Health Care System against criticism that the findings amounted to a "whitewash" to downplay the impact of delayed medical care on Arizona patients.

"We are scrupulous about our independence and take pride in the performance of our mission," Griffin insisted while being grilled by lawmakers.

Some members of Congress, as well as Phoenix whistle-blowers, have asserted that the Office of Inspector General report, which verified mismanagement and fraudulent delays in care, misrepresented the damage done to veterans.

They noted that a key phrase in the final document — which said there was no conclusive proof patients had died because of untimely care — was inserted after drafts were submitted to VA administrators for review.

Griffin testified that the language was not altered at the request of VA officials, but by his inspectors to clarify their findings.

Under direct questioning, however, he acknowledged that the VA's broken appointment system "may have contributed" to patient deaths, and that "some might have lived longer" if they had received timely treatment.

Those conclusions did not appear in the inspector general's report, which was widely treated by national media as an exoneration of the VA system.

Committee Chairman Jeff Miller, R-Fla., released a statement after the hearing saying, "The confirmation from IG officials today that delays in VA medical care contributed to the deaths of Phoenix-area veterans and IG officials' admission that they couldn't rule out the possibility that delays caused deaths changes the entire bottom line of the IG's Phoenix report. Absent these qualifying statements, the OIG's previous assertions that it could not 'conclusively assert' that delays caused deaths are completely misleading."

Miller also said it was "absolutely inexplicable and outrageous that the IG's Phoenix report failed to clearly make these distinctions. While I am pleased IG officials finally cleared up these glaring inconsistencies, I regret that they only did so several weeks after the release of the Phoenix report and after hours of intense questioning. Getting the whole story out of inspectors general should not be this difficult."

Miller interrogated Griffin about changes to the August report and about whether House members were given early drafts. If the inspector general did not like being challenged, Miller added, that was "tough."

Griffin attempted to respond and appeared upset when he was cut off moments later. "Do you want the truth?" Griffin demanded.

Later, Rep. Tim Huelskamp, R-Kan., noted that the Office of Inspector General reviewed about 3,400 Arizona cases involving patients who were backlogged on improper wait lists but that roughly 5,000 others were not checked because the patients could not get enrolled in the VA system.

"Thousands and thousands and thousands of veterans were waiting for care," Huelskamp said, "and your report says, 'Well, we don't count them.' I fear there are more veterans who died."

Rep. David Roe, R-Tenn., also chastised Griffin for issuing a report that seemed to soft-pedal the impact of delayed care. "If this was your dad there," he said, referring to a patient with chest pains who did not get care, "would you be happy with the explanation you just gave of his death? ... You can't wave a redder flag than that."

Rep. David Schweikert, R-Ariz., who is not a member of the House committee, also questioned Griffin. "How do we never, ever, ever have these types of hearings again ... and I never have to sit down with a widow whose story breaks my heart, ever again?" he asked.

Committee members pressed Griffin and VA Secretary Robert McDonald, who also testified, to change VA culture by holding wrongdoers accountable and increasing transparency.

Rep. David Jolly, R-Fla., repeatedly asked McDonald if he believes VA health-care delays and negligence contributed to patient deaths. McDonald responded indirectly, stressing his responsibility to run the department but acknowledging that "not getting proper care has adverse effects."

"I'm committing to you that I'm going to fix it," the secretary said.

Jolly and others pointed out that no VA employee has been fired or charged criminally in connection with the scandal. Griffin and McDonald responded that 19 disciplinary actions are in process and that inspector general investigators are working with the FBI and the Justice Department on possible prosecutions.

"Believe me, we have no desire to see people escape who deserve criminal charges," Griffin said.

The inspector general report verified that delays in care had a clinically significant impact on some patients. However, it emphasized that inspectors could not "conclusively assert" that any veteran deaths were "caused by" untimely care.

That sentence was added after drafts were provided to VA administrators for review. Critics have noted it is medically impossible for delayed care to cause death and have questioned whether Griffin was pressured to insert that language to downplay the impact of wrongdoing.

Griffin declined to answer Arizona Republic questions about the report or why he used a standard of proof in Phoenix that previously has never been employed by his office.

During the review process by VA bosses, Griffin's findings also were revised to include a sentence declaring that the primary Phoenix whistle-blower, retired VA physician Sam Foote, did not provide inspectors a list of 40 names of patients who died awaiting care.

Foote, seated next to Griffin during Wednesday's hearing, ripped the inspector general findings, saying it misrepresented his interaction with investigators and downplayed the damage done to patients in Arizona. "At its best, this report is a whitewash," he said. "At its worst, it is a feeble attempt at a cover-up."

Dr. Katherine Mitchell, another VA physician and whistle-blower, also bashed the report, saying its final language did not reflect the effect of delayed care, not only on veterans who died awaiting appointments but on those who might have lived longer or suffered less had they received timely care.

Foote said he repeatedly sent letters and e-mails to the Office of Inspector General, but got no adequate response until he submitted his complaints about VA mismanagement and fraud to Congress and the press.

Mitchell, now medical director of a Phoenix VA transition program for veterans who served in Iraq and Afghanistan, previously worked as an emergency department supervisor at the Phoenix VA hospital. She filed complaints last year about fraudulent wait times, patient endangerment, management bullying and whistle-blower retaliation.

Since their criticisms were made public in April by The Republic, the VA has been embroiled in a national controversy. Audits and inspector general investigations at more than 80 VA medical centers verified that administrators were "gaming the system" by producing phony appointment data while veterans waited months for doctor appointments. The investigations also verified a corrupt culture, including a lack of transparency and a pattern of reprisal against those who reported wrongdoing.

VA Secretary Eric Shinseki resigned under pressure, replaced by McDonald. Three top administrators at the Phoenix VA were suspended pending possible termination. Among them was Director Sharon Helman.

Congress set aside partisan differences to adopt a broad VA-reform bill that provided funding for more medical workers and empowered the secretary to more expediently fire subordinates for wrongdoing or incompetence.

On Tuesday, Republican Arizona Sens. John McCain and Jeff Flake heaped more pressure on McDonald, demanding to know why he had not begun carrying out the reform legislation.

McCain and Flake wrote McDonald that "to date, no guidelines have been issued and no plan of action or associated milestones announced that would ensure that our veterans will receive the care they need through the Choice Card — as required under the new law. Senior VA leaders have, likewise, not been held accountable for delaying and denying patient care, silencing and intimidating whistle-blowers, and enriching themselves by manipulating wait-time statistics to receive undeserved performance bonuses."

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