"It wasn't a secret at all."

The V.A.'s practice of zeroing out appointments and substituting new dates was standard practice, David A. Fahrenthold writes:

One great test of any bureaucracy is whether it can effectively deliver bad news to the top of its chain of command.

In recent years, the VA health system started to fail that test.

In some cases, local officials’ bonuses depended on the numbers looking good. So, at some point years ago, they began asking clerks to change the numbers — with practices like “zeroing it out.” Cheating was made easier by the VA’s ancient computer systems, designed decades ago.

“They would say, ‘Change the “desired date” to the date of the appointment,’ ” said one employee knowledgeable about scheduling practices at a VA medical center. The employee, who spoke on the condition of anonymity for fear of retaliation, decided to go along with those requests. Fighting the order to lie wasn’t worth it.

This week, federal auditors provided stark evidence of the problem that VA’s leaders had missed. The auditors had studied 226 veterans who got appointments at the VA medical center in Phoenix. The official data showed they waited an average of 24 days for an appointment. In reality, the average wait was 115 days.

Now, VA’s leaders have been faced with a startling failure. The bureaucracy below them wasn’t telling them the truth about wait times. The numbers system they set up to go around the bureaucracy wasn’t, either.

The only answer, now, has been to send people out to VA clinics to talk to schedulers, face to face. Before the auditors went out, they were warned they might hear evidence that clerks had been cheating the system.

“If this occurs, remain calm,” the VA counseled auditors in a memo. It suggested follow-up questions. “Have you brought this to anyone’s attention? If needed, follow up with: What has been the response?”

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