The plight of the whistleblower is well known. Retaliation. Loss of job. Loss of health. It’s what keeps many silent. So, why do they speak out? From the time Dr. Sam Foote was a young kid on the playground, he was standing up to bullies two or three years older than him. “I remember one time in fourth grade I took on two guys who had taken our ball,” says Foote. “They were fifth graders. They beat me pretty good, but I got a couple hits in. … I was just that way. I had an intolerance for bullies. I protected the kids who got bullied. I hate bullies.”
Of course, Foote didn’t plan to be a whistleblower. He didn’t even plan on being a doctor, let alone one in the U.S. Veterans Affairs Department (VA) during the height of scandal in Arizona. But the moon landing in 1969 altered the course of his future and potentially the lives of thousands of U.S. veterans.
Growing up, Foote had dreams of becoming an electrical engineer, just like his father. As a child, he built electronic kits and radio control model airplanes, and he studied chemistry, physics and math in school. “My father … started me with electricity at age six and electronics at age eight,” says Foote in a recent interview with Fraud Magazine.
However, after the moon landing, Foote says the public quickly lost interest in the space program and massive layoffs began throughout the aerospace industry. He knew that the company at which his father worked assisted the Air Force in launching spy satellites from Vandenberg AFB. His father’s company didn’t escape the layoffs, so Foote wasn’t surprised when his dad sat him down one day and said, “I don’t want this for you. There’s no future in this career, being an aerospace engineer, and you should do something else.” Foote says his dad rarely spoke about anything related to work (he held a top secret clearance at the time), so Foote listened and asked no questions. Foote explains that he decided if he couldn’t be an electrical engineer, perhaps he could become a “human engineer.” Foote would become a physician.
From the ER to the VA
Foote graduated from the Good Samaritan/Phoenix VA Internal Medicine Residency Program in 1984 and began working full time as an emergency physician for a local ER in East Mesa, Arizona. “I wanted to be an ER doc, but everybody told me that ER doctors burn out after five years,” he explains. Foote made it just a bit longer than that. He says he burned out after six years of grueling work and long hours.
Foote moved to the Phoenix VA in 1990 — the same year he earned his certification by the American Board of Emergency Medicine — and would enjoy nearly 23 satisfying, quiet years managing various parts of the medical center including the emergency department and the Platinum Primary Care Clinic.
Of course, working for a government-funded program created its own set of struggles at first. Equipment was antiquated or simply didn’t exist. Medical personnel would type patient reports on small pieces of paper, take them to the basement, paste them in patients’ charts and often not look at them again until the patients returned to the hospital for another appointment.
But over time, and with the help of an ambitious VA hospital director, John Fears, the center prospered by adding state-of-the-art monitoring equipment for the emergency room and a new onsite outpatient care center. They continued to update processes to improve patient care onsite and went in 50/50 with a local hospital to buy and use an MRI scanner (something they’d not had before).
Foote says patients were leaving other reputable health care alternatives to get their care at the Phoenix VA because of its growing reputation. “If you had told me in ’90 that people would quit the Mayo Clinic and Cigna Health Plans because they preferred the care at the Phoenix VA, I would have sent you straight to the psych ward,” says Foote, laughing.
The tides start to change
However, the good times ended, Foote says, when Gabriel Perez came to the Phoenix VA as the new director in 2010. According to Foote, tensions escalated as staff complained of sexual harassment and mismanagement of funds by Perez. Seven physicians left within a year, but Perez didn’t replace them. The wait list increased from a few hundred veterans to several thousand.
In 2011, Foote, then the director of the Thunderbird Primary Care Clinic, penned a letter to the VA Office of the Inspector General (OIG) to report waste, fraud and abuse by Perez. In his letter Foote accused Perez of personal misconduct and improperly spending millions of dollars. Foote wrote, “The rumor is that we are now $12 million in the hole.”
The national inspector general for the VA would investigate the allegations that same year. According to The Arizona Republic article,
VA official demoted after her testimony, by Dennis Wagner, March 29, 2013, the investigation looked into mismanagement in Arizona that cost taxpayers $11.4 million, due to excess spending on private care for patients. According to the article, that spending included $4.5 million in unauthorized payments and the VA report blamed “systemic and leadership failures for controls so weak that $56 million in medical fees were paid during 2010 without adequate review. The oversight failures caused a cutback in medical services and equipment for Phoenix veterans.” Perez retired while inquiries were underway.
Along comes Sharon Helman and her merry band of miscreants
Sharon Helman, who’d previously served as director of the VA hospital in Hines, Illinois, joined as head of the Phoenix VA in 2012, but she didn’t exactly right the ship. According to Foote, Helman pushed out Dr. Keith Piatt, the chief of ambulatory care, a physician who Foote refers to as “one of the best employees the VA has ever had” because he “wouldn’t lie, cheat or steal for Helman.” He was replaced by Dr. Christopher Burke.
Foote says he offered Burke solutions for reducing patient wait times, but Burke and Helman had ideas of their own. Foote says they wanted to clear more than a year’s backlog in the electronic records and nearly 1,600 veterans waiting for care, but they proposed pushing appointments for current patients waiting six months to nine and those waiting nine months to 12. This would open appointment slots for new patients, Foote says, but two or three months later they’d have to do it all again because new patients came in for care every day. Foote told them this would only cause the backlog to increase. “Dr. Burke made a crazy comment to me,” explains Foote. “He said, ‘Well, we’ll see about that.’ I thought to myself, ‘Wait a minute! What does he mean we’ll see about that? Does he not understand math?’ ” Foote was now suspicious.
In February 2013, secret patient wait lists popped up. Helman had been reporting decreasing wait times to the central VA office, but Foote’s clinic found patients were still waiting for appointments — some for up to 12 to 18 months. Foote confirmed his suspicions that the electronic list was being manipulated when he discovered paper lists — stored in boxes and drawers all over the hospital — that contradicted wait times in the hospital’s electronic database.
“In April of 2013, they made two lists: they made one electronic list that they would take on and off about 150 names that they actually reported to central office,” says Foote. “Then they had another electronic list that did not report to central office. The FBI knows the exact date and time that its reporting function was disabled.”
Brad Curry was the chief of the hospital’s Health Administration Service (HAS) and the “handler” of the electronic and paper lists. He’d type patient information into the hospital’s system, but he wouldn’t save the document — he’d just print a paper copy and place the patient’s name on the paper list, according to Foote, in
Doctor: Phoenix VA problems started in 2010, spiraled from there, by Mac & Gaydos, KTAR News, April 25, 2014.
But why did Curry and others fudge the numbers? What were they getting out of it? Bonuses. Helman, Curry and other administrators were claiming bonuses for decreased wait times and for every veteran who died while waiting. (See
The VA Scandal One Year Later, by Adam Andrzejewski, Forbes, May 24, 2015.)
Math + skepticism = a growing cause for concern
In the spring of 2013, Foote did more digging. He found that about 1,600 veterans were listed on the disabled electronic wait list along with a couple of thousand on a separate “Schedule a Consult with Primary Care” electronic list. Additionally, his team estimated that 2,000 to 3,000 veterans were on various paper lists scattered throughout the hospital. He did the math and thought, “Holy crap! There are probably 7,000 patients without providers!” In reality, the number was closer to 9,000, according to an eventual OIG investigation.
One of his sources that was working the Schedule a Consult with Primary Care backlog found at least 18 patients who’d died before the consults had even been scheduled. She told Foote that Dr. Daren Deering, the chief of staff, had ordered the HAS staff to “close out” all the consults on patients who’d died before being seen so that there wouldn’t be any record of them. Foote told this contact, “Don’t touch those, let someone else finish them. Write down the names and the Social Security numbers of the people who died, but don’t close those yourself.”
In late October 2013, Foote sent another letter to the OIG informing them of the secret waiting list that contained the names of 10 patients — those they could prove at the time — who’d died while waiting for appointments. Foote told the OIG of a second hidden backlog of patients contained in the consult lists that showed an unknown number of perished veterans. He implored the OIG to come to Phoenix to investigate his findings.
The San Diego OIG responded to Foote in December 2013, and its team came to investigate later that month. According to Foote, he, and others, told the OIG investigators about the unaddressed schedule for consults and shared their secret summary report that showed patients had been removed from the list because they’d died. However, they only had ten names of patients who’d died on the secret lists and two names of the deceased on the Schedule a Consult with Primary Care list because none of the employees had the electronic keys to go back into the computer system in time to find the deleted consults of those who’d died on the “scheduled a consult” list. Foote and his team asked the OIG inspectors if the investigators could get into the system, but they said they couldn’t, because they didn’t have “technical” investigators that could do it. The inspectors left Phoenix and over the next month, Foote says he would continue to contact them to report more veteran deaths. However, he says they wouldn’t provide him with even a working fax number that he could use to securely send them the information. (See the
Opening Statement of Samuel Henry Foote M.D. to the House Veterans Affairs Committee, September 2014.)
No good deed … until CNN shows up
During the fall of 2013, about the time he sent his letter to the OIG, the hospital substantially increased Foote’s patient list. He’d work about 13 hours each day and then would complete hours of paperwork at home on nights and weekends. Foote believes this was retaliation. “They forced me into resignation by exhausting me,” says Foote. “I would have liked to have worked a lot longer than I did, but there was no way I could. … I just couldn’t keep going.”
In January 2014, following Foote’s retirement, he contacted the Arizona Republic newspaper, but it said it wouldn’t be able to get to the story until at least the summer. Foote promised to keep them in the loop. He then sent letters to several individuals including Sen. John McCain, R-Ariz.; then Arizona Attorney General Tom Horne; then House Rep. Jeff Miller, R-Fla., the chairman of the Committee on Veterans’ Affairs; and others, but no one responded.
Foote was dejected. However, a trusted friend advised him to call Rick Romley, the former county attorney for Maricopa County, Arizona. Romley — a U.S. Marine Corps veteran, who lost both legs above the knee to a land mine during the Vietnam War, and a veterans’ activist — told Foote that his letter to federal authorities needed to catch their attention in its first two lines.
So, Foote sent a more arresting second letter to the authorities; the office of Miller responded. Foote sent Miller the names of the deceased veterans, which had grown to nearly 40. Miller put Foote in touch with a CNN producer who’d done other stories on inadequate VAs.
CNN wanted at least three sources for the story, but none of Foote’s “accomplices” wanted to be exposed. So, in the dark of night — in the back of Foote’s Chevy Tahoe on the move around Phoenix — two other VA employees shared their stories with CNN. However, on March 8, 2014, Malaysian Airlines flight 370 disappeared, and CNN went all-hands-on deck to cover the disappearance. Foote would have to sit tight.
Come April, Miller got tired of waiting. At a House VA committee hearing he announced evidence showing VA officials were falsifying records of care for veterans in Arizona. “It appears as though there could be as many as 40 veterans whose deaths could be related to delays in care,” he said at the hearing. (See The doctor who launched the VA scandal, by Dennis Wagner, The Arizona Republic.) On April 23, CNN broadcast an interview with Foote and the story went viral. (See,
VA Whistleblower tells his story, CNN.)
Sen. Jeffrey Flake, R-Ariz., and McCain sent a letter to leaders of the Senate Committee on Veterans Affairs asking for an inquiry and hearings. The OIG returned to Phoenix to redouble its investigation. (See
McCain, Flake call for Senate probe of Phoenix VA, by Dennis Wagner, azcentral.com, April 23, 2014.) By June 2014, VA internal investigations confirmed that 35 veterans had died while waiting for care.
On Sept. 17, 2014, lawmakers grilled the VA’s Acting Inspector General Richard Griffin about the findings of his August report that stated the investigation into 40 veterans’ deaths found “poor quality of care,” but the OIG was “unable to conclusively assert that the absence of timely care caused the death of these veterans.” (See
VA inspector general admits wait times contributed to vets’ deaths, by Curt Devine and Scott Bronstein, CNN Investigations, Sept. 18, 2014.)
Miller, however, said the report actually showed that 83 vets died while waiting for care, either on the hidden wait list or a scheduling wait list. And additional information provided by the OIG showed “an astonishing 293 total veteran deaths on all of the lists provided from multiple sources through this review,” according to Miller in the CNN article.
Miller also said bonuses created incentives for officials to hide long wait times. “I think that we’re gonna find the more we investigate, you’re gonna see where folks decided that they were going to try to game the system, fudge the numbers, if you will, cook the books, in order to get bonuses,” says Miller. (See
Despite scandal over waiting times, VA executives got bonuses, by Wyatt Andrews, CBS News, July 3, 2014.)
At the 28th Annual ACFE Global Fraud Conference, Foote, after receiving the 2017 ACFE Sentinel Award, told a chilling tale to attendees. “There’s a case I can remember, as flagrant as any,” shared Foote. “A gentleman had suffered sudden death, and he had been resuscitated by being shocked by the paramedics and it saved his life. He needed for his cardiac condition a pacemaker defibrillator. The VA stalled for months; the gentleman had another arrest, and he died from it. How can you possibly say this man’s death was not a result of a delay in care?”
In August 2014, President Barack Obama signed a $16.3 billion bill to overhaul the troubled Veterans Affairs Department, saying the country had a “sacred duty” to protect its military service members. The bill would allow veterans to seek private care outside VA facilities and would also provide money for the VA to hire more doctors and nurses. (See
Obama signs VA reform bill into law, by Martin Matishak, The Hill, Aug. 7, 2014.)
At the end of 2014, the Veterans Affairs Department fired Helman, nearly seven months after it placed her and two high-ranking officials on administrative leave. In December, an administrative judge upheld Helman’s firing based on findings that she improperly accepted gifts and perks from an industry lobbyist. (See,
Timeline: The road to the VA wait-time scandal, azcentral.com.) In 2015, Helman’s termination was temporarily overturned, and as of press time she now has a chance to appeal her dismissal despite a criminal conviction in a separate court case. (See
Former Phoenix VA director’s firing overturned by federal appeals court, by Dennis Wagner, azcentral.com, May 9.)
According to the azcentral.com timeline, in January 2015, two dozen employees who faced retaliation after filing whistleblower complaints about wrongdoing at VA hospitals and clinics nationwide were offered relief. In March 2015, President Obama and his VA secretary visited the Phoenix VA to receive an update on efforts to improve.
Later that year, a scathing report on urology care at the Phoenix VA hospital said some sick veterans died awaiting care, and hundreds were medically sidetracked or neglected because of short-staffing and mismanagement. (See
Inspector General report rips Phoenix VA urology care, by Dennis Wagner, azcentral.com, Oct. 15, 2015.)
In 2016, Brad Curry and Darren Deering were removed for “negligent performance of duties and failure to provide effective oversight.” (See
Three more Phoenix VA officials fired in aftermath of wait-time, retaliation probes, by Dennis Wagner, azcentral.com, June 8, 2016.)
The VA scandal clearly hasn’t reached a conclusion yet and neither has Foote. He’s spoken with
Fox News (March 13, 2015) and
CBS Evening News (Dec. 25, 2015), and he’ll continue to fight for U.S. veterans. “One of the reasons I was so successful at Phoenix was because I had a long record of problem-solving,” says Foote. It’s a good thing, too, because Foote won’t back down.
Emily Primeaux, CFE, is associate editor of Fraud Magazine. Her email address is: eprimeaux@ACFE.com.