Some 100,000 veterans across the country are facing long periods to see doctors, according to an internal Department of Veterans Affairs audit released Monday.
The VA says it already has contacted 50,000 veterans trying to get them quicker medical care.
The systematic manipulation of appointments records across the massive veterans health care system to show high performance when there wasn't any led former secretary Eric Shinseki to resign late last month.
It remains unclear how many veterans were harmed by delays in care, although at least hundreds of thousands within a year's time were forced to wait longer to see a doctor than the ambitious timetable of 14 days established by the agency.
The audit found that facilities in Memphis, Johnson City and Nashville were unable to schedule appointments within 30 days for about 7,000 veterans, or 3 percent of the total. New patients at the Middle Tennessee Healthcare System had to wait 71 days for specialist care, ranking sixth-longest among all facilities. The Mountain Home facility near Johnson City ranked ninth, with a wait of 67 days.
In Tennessee, four VA facilities in Nashville, Memphis, Chattanooga, and McMinnville have been flagged for further review following the audit.
Sloan Gibson, the interim secretary of the Department of Veterans Affairs, said last week that 18 Arizona veterans had died while awaiting doctor appointments at the hospital in Phoenix. But he said it is unclear whether their deaths were the result of those delays.
Investigators have found that VA schedulers across the country were instructed how to change appointment dates, keep unofficial lists of patients whose care was delayed or set up appointments at the convenience of an overburdened system rather than the veteran.
The VA audit released Monday revealed that there was at least some level of manipulated scheduling at three of every four agency medical facilities -- whether a hospital or a clinic -- across the country. Unofficial lists of veterans whose care was delayed were kept at 70% of medical facilities, the audit found.
A key problem that surfaced at the VA hospital in Phoenix, where the scandal first erupted when a retire doctor raised red flags, were allegations of "secret lists" of hundreds of veterans who could not be seen by a doctor because none were available.
The audit found instances in which appointments records were altered at 90 VA out-patient clinics. At 24 sites, staffers said "they felt threatened or coerced to enter" false appointment dates by superiors.
In a statement released Monday, the VA said "where appropriate, (it) will initiate the process of removing senior leaders."
"VA's first goal is to get veterans off wait lists and into clinics," the agency said. Officials said they intend to do this by temporarily expanding services at certain clinics, sending more veterans to private clinics at VA expense and employing mobile medical units.
An initial audit report that Shinseki provided President Obama along with an offer to resign on May 30 — an offer the president accepted the same day — described a health system with a "systemic lack of integrity."
Concerned that hospital officials were orchestrating the cover-up of delays to make their performance reviews look better — reports upon which salary increases and bonuses are based — Shinseki in one of his final actions removed wait-time standards from the personnel review process.
The early version of the VA audit concluded that the 14-day goal was too ambitious and unattainable given the insufficient number of doctors available to treat a population of aging veterans along with thousands from the Iraq and Afghanistan wars who have a complex set of injuries, wounds and behavioral health problems.
A VA system of 150 hospitals and 820 outpatient clinics treats about 6 million veterans each year and has 9 million enrolled as patients. While the nation's total population of veterans is declining — as the massive World War II and Korean War generations pass away — an aging population coupled with the influx of new veterans from the most recent wars has led to steady increases in outpatient appointments to nearly 85 million a year.