Pert James Vietnam by James Pert 2
James Pert, during his service in Vietnam. Courtesy Sandy Pert

James Pert had been through his share of life-threatening battles. A rough-hewn Marine, he had fought in Vietnam from 1968-1970, where, in addition to enemy fire, he was exposed to the toxic defoliant Agent Orange.

By his early sixties, he was partially disabled and suffering from skin cancer, diabetes and post-traumatic stress disorder (PTSD). Still, he was a happy man, proud of the sacrifices he made serving his country and looking forward to spending his retirement years with his wife, Sandy Pert.

Instead, he lost his life due to a bureaucratic shuffle, according to his widow.

Pert is among a growing number of veterans who died while waiting for a doctor’s appointment, including as many as 40 whose names were kept on a secret list by Phoenix Veterans Administration officials.

“This should have never happened,” Pert’s widow, Sandy, told International Business Times, about her husband's death from cancer after having his treatments repeatedly delayed. “If we’d found it sooner, I really believe it could have been treated. We were married for 33 years. My heart is broken. I just can’t understand. How could they treat him so badly when he served his country so honorably?”

According to Dr. Sam Foote, a physician at the Phoenix VA for 24 years who retired in December 2013, VA managers in Phoenix participated in an elaborate scheme designed to hide the fact that 1,400 to 1,600 sick veterans were forced to wait months to see a doctor.

Internal e-mails obtained by CNN showed that top management at the VA hospital in Arizona knew about the practice and even defended it.

In an interview with IBTimes, Foote said the VA in Phoenix essentially kept two sets of books. Veterans who came in for treatment were first placed on a secret, handwritten paper list. These veterans were not placed on the official, computerized list until an appointment actually became available. The computerized list was then used to show that treatments had been done in a timely manner.

The VA’s public affairs office declined to answer questions about any specific veteran cases in Phoenix. On April 25, the office issued a statement saying the agency had invited its independent Office of the Inspector General to do a comprehensive review at the Phoenix VA Health Care System as quickly as possible, and it had sent a team of clinical experts to review appointment scheduling procedures and any delays.

Sandy Pert, 64, said she and her husband had been excited about the future when they moved from Lincoln, Neb., to the Phoenix area in August 2012. Instead of a comfortable retirement, James suffered a recurrence of his cancer and became terminally ill while waiting to be seen by doctors at the Phoenix VA.

He had been seeing a VA doctor in Lincoln every three months to ensure that his cancer was still in remission, but he was told in Phoenix that there was a waiting list six to nine months long just to see a VA doctor, she said.

According to Sandy Pert, VA officials said they would put his name on a list, but they never did.

In January 2013, James began having trouble breathing, so Sandy took him to a nearby non-VA hospital where he was admitted for pneumonia and given antibiotics.

“The doctors there said James needed a PET scan right away because of his cancer history,” a claims specialist for an insurance company said. When he finally did get an appointment with the VA to get the scan, the doctor said he did not need it and only did blood work, she said. “He said there were other ways to detect the cancer. And he never even called us with the blood test results. James finally called a month later and was told his blood work was normal.”

But he was still having trouble breathing, so in April, Sandy said, VA doctors did a bronchial scope procedure, and it came back with news that the cancer had returned. Phoenix VA doctors finally did a PET scan on May 10, 2013, and he was diagnosed with stage IV skin cancer. By that point it had spread to his lymph nodes, spleen, chest and brain.

“The VA doctor said it was too late to do anything,” Sandy said. “They said James had six months to live. We ended up only having five weeks.”

James died on June 15, 2013, at age 64.

The tragedy is compounded by the fact that James Pert is not unique. He is among a long list of U.S. veterans who died waiting to be seen by a doctor, according to allegations by Dr. Sam Foote, who spent 24 years as a physician at the facility before retiring in late 2013.

Foote, who said that as many as 40 patients died while awaiting treatment in Phoenix, has lodged a number of complaints with the VA’s independent inspector general, which is now investigating, as are both houses of Congress. A Senate hearing is planned to take place after the inspector general's office completes its investigation.

Foote said the secret list was ordered by the hospital’s director, Sharon Helman, with the cooperation of other top-level management staff in Phoenix, to make it look like patient wait times had been reduced. He said the hospital adopted the scheme to evade the VA's creation-date software, which is how the department tracks actual waiting times.

Why was this list devised, and who’s to blame? Foote believes it can be traced back to Helman’s desire for a bonus and to further her career. Hellman, who has publicly denied any knowledge of any secret lists, received a $9,345 bonus in 2013, in addition to her annual base salary of $169,900.

Overall, leadership at the hospital was paid more than $700,000 in taxpayer money, according to numerous reports citing publicly available salary data.

“I think it’s pretty clear who’s to blame for this,” Foote said. “Helman flat-out lied to two U.S. senators recently, saying she never heard of a secret list. She didn’t mention the memo I have from July 13 where she is brought up on ethics charges for reducing waiting times down to 10-14 days when she moved them over to new appointments. She falsified data which clearly resulted in her getting a bonus, and most likely, as a result, many of these veterans died.”

When allegations surfaced earlier this month that wait times for Arizona VA patients were being falsified, Helman said she knew nothing about it. But the Arizona Republic reported last week that an e-mail exchange nine months ago among Phoenix VA employees shows that she was aware of the issue and concluded that the concerns warranted an internal ethics review.

The Republic noted that Damian Reese, a VA program analyst, had written: "I think it's unfair to call any of this a success when veterans are waiting six weeks on an electronic waiting list before they're called to schedule their first PCP (primary-care provider) appointment. Sure, when their appointment was created, [it] can be 14 days out, but we're making them wait 6-20 weeks to create that appointment. That is unethical and a disservice to our veterans."

In the e-mail string obtained by the Republic, Helman wrote to Nancy Claflin, associate director of patient care services, "I think this should also go as an admin ethics consult."

Foote told IBTimes that the delays worsened after the Phoenix VA began its Patient Aligned Care Team initiative, which was supposed to improve veterans care and reduce costs.

Foote said the initiative “put us 7,000 patients in the hole. It was a system that promised Ferrari-like performance, but it was imposed on a Phoenix VA that was just trying to provide basic Chevy transportation. The real story here is that VA is defending Hellman and what is going on in Phoenix because the PACT system has been a failure. It’s too expensive, but they are stuck with it. That is what you’re seeing.”

Sally Eliano, whose husband’s late father is also on the list of 40 veterans provided by Foote to the VA’s inspector general, still gets emotional when she talks about Thomas Breen, a Navy veteran she lovingly called “Pop.” Breen, 71, whom Eliano describes as “deeply patriotic and proud of his military service,” died five months ago while waiting for an appointment with a doctor at the Phoenix VA at age 71.

“If we had taken Pop to an animal hospital, he would’ve had better care than what he got at the VA,” said Eliano, who rushed Breen to the VA emergency room in Phoenix last September after blood was discovered in his urine. Breen was seen by an ER doctor, Eliano said, but no tests were run to determine if his bladder cancer had returned, though she told them about it.

Thomas Breen
Thomas Breen, 71, with his dog. Courtesy Sally Eliano

Instead, doctors checked his foot, hands and heart. “Pop had severe arthritis, but that’s not why he was there,” she said. “I came to the ER with a gallon of blood to show them.”

When Breen was released, the doctor gave a letter to Eliano indicating that he was in need of an urgent doctor’s appointment to be scheduled within a week. The doctor said someone from the VA would call within a week or so to schedule the appointment for Breen with a primary-care doctor for an urgently needed follow-up.

“They never called,” Eliano said. So she started calling the VA, day after day, trying to get an appointment. In mid-November, Breen’s condition worsened and Eliano took him to a non-VA emergency room. He was then moved to another non-VA hospital in Scottsdale that ran tests. He died soon after at a hospice facility, of bladder cancer.

A few days later, Eliano finally got the call from the VA asking to schedule Breen’s appointment.

“I told them ‘You’re a little late. He is dead,’” Eliano said. “Pop was so proud of his service. He loved his country and even made me buy an American flag to put outside the house. But they treat animals better than they treated him at VA. I feel betrayed.”

Brian Mancini, who is still alive, had a similar experience. As an army medic who served for 13 years, including combat tours, he lost his eye and part of his face in a bomb blast that nearly killed him in Iraq. Mancini spent almost four years at Walter Reed Army Hospital getting his life and health back. But when he got out, his treatment at the Phoenix VA made things worse, not better.

“It was betrayal, in a word,” Mancini said. “I’ve met my obligations to my country. But they have not met their obligation to me. When I heard about the secret list, I felt both angry and vindicated. I know now that this stuff wasn’t just happening to me.”

Mancini said he was not surprised by recent revelations about the secret list of veterans dying while waiting to be seen by doctors. He said he had to wait nearly a year to be seen by a doctor, and that he is lucky to be alive.

“Every time I called them, I could not get in touch with anyone. No one ever returns your phone calls,” he said. “I was seriously wounded and crying on my floor every night, suffering, and I could not get anyone to take an interest in what I was going through. And when they talked to me, they would always use paper to track things. I would ask them, ‘Is your system right? Why aren’t you on a computer’?’ It was ridiculous.”

Mancini concluded, “The Phoenix VA doesn’t look at you as a person. They have a total lack of understanding of your personal needs.”

President Obama meanwhile ordered VA Secretary Eric Shinseki to look into the charges. Answering a question about the controversy while in the Philippines, Obama said, “I believe that if somebody has served our nation, then they have to get the benefits and services that they have earned, and my budgets have consistently reflected that. That’s why we’ve resourced the Veterans Affairs office more in terms of increases than any other department or agency in my government. That doesn’t mean, though, that some folks may still not be getting the help that they need. We’re going to find out if, in fact, that’s the case.”

Rep. Jeff Miller (R-Fla.) recently introduced a bill that will make it easier for the Veterans Affairs secretary to fire or demote senior career executives at the department, which he claims isn’t doing enough to fire managers who aren’t doing a good job. He cited more than 30 recent preventable deaths at VA medical centers across the country whose executives still earned bonuses.