A Veterans Administration researcher used actors and pressured veterans into participating in a “secret shopper”-style project, and now the House Veteran Affairs Committee is investigating how the agency spent $900,000 for the faked study.
The head of the study, Dr. Saul Weiner, professor of medicine, pediatrics and medical education at the University of Illinois at Chicago, admitted actors were hired to portray veterans, according to a letter from the committee chairman, Rep. Mike Coffman, R-Colo.
“The actors wore hidden microphones to capture the physician-patient interaction; feigned symptoms that took real appointment slots from veterans and tied up facility resources, such as lab tests, while health-care professionals sought answers to the actor’s fake maladies,” Coffman said.
The letter was directed to Carolyn Clancy, the interim under secretary for health at the U.S. Department of Veterans Affairs.
Wiener was approved a grant of at least $900,000 for a study “to improve staff and provide attention to veterans’ individual circumstances and needs … when assisting them or planning their care,” according to the June 3 letter from Coffman.
The study, described as akin to a “secret shopper” program where people anonymously rate a business’ service, was supposed to measure the effectiveness of the interaction between VA doctors and their patients during appointments. The goal was to make doctors’ visits more patient-centered. Actors posing as patients presented themselves with made-up maladies and secretly recorded their interaction with the doctors for analysis.
In the letter, Coffman addressed many unusual and troubling aspects of the study.
For one thing, he reported, VA physicians “were forewarned that ‘patients’ would be ‘wired’ in order to capture the physician-patient dialogue.”
And when veterans voiced concerns “about the misuse of resources,” Weiner “purportedly began enlisting actual veterans from facility waiting rooms.”
“According to complaints filed with the local union, some veterans did not want to participate, but in at least one instance, a veteran was badgered at least four times to do so.”
Coffman said veterans “noted concerns that, if they did not participate, they would be ‘flagged’ as uncooperative and might be retaliated against by the facility.”
“In these instances, those veterans who did participate alerted the physician by handwritten note that they were being recorded during the physician-patient interaction. Apparently, none of the veterans used in this study signed a consent form to participate.”
The study was conducted in several hospitals in the Great Lakes Veterans Integrated Services Network, including the Hines VA Hospital, which has been engulfed in scandal, with one of the worst wait times in the country.
“Firstly, the improper use of VA resources for actors’ fake maladies is beyond comprehension given VA’s wait time scandal and spending scandal,” the letter stated.
It also noted that since doctors were made aware of the hidden microphone, all results from the study would be tainted.
“Finally, one thing that is not measurable, and is apparently not even a consideration in the impact of this study, is the damage done to the patient/physician trust relationship,” the letter said.
Prior to the investigation, the research was lauded by the VA and the University of Illinois at Chicago.
An email to Weiner requesting comment did not generate a response. Nor did multiple telephone calls and additional emails to others with information about the investigation.
“Since 2006, a team of our investigators led by Dr. Saul J. Weiner, have been developing and testing methods for assessing physician performance at planning care that takes into account patients’ individual circumstances and needs or contexts,” according to a 2012 memo sent by then VISN 12 Director Dr. Jeffrey Murawsky to the Research and Development Department at the Hines VA.
On April 15, 2013, UIC put out a press release highlighting Weiner’s research, titled “Patients Go Undercover to Record Encounters with Doctors.”
“What our study really tells us is that the information that patients divulge during appointments about their life situations is critical to address and take into account if we’re looking for optimal health care outcomes,” Weiner was quoted saying at the time.
In 2010, Weiner’s research was published in Annals of Internal Medicine.
Marc Brandt, a spokesman for VISN 12, said, “An investigation is ongoing into Dr. Weiner’s study.”
Emails to Meagan Lutz, press person for the main office of the VA, and Tim Mantegna, press person for HVAC, also were not returned.
Officials were tipped off to the unusual nature of the study when doctors complained to a hospital union, according to a source at the Hines VA.
By Michael Volpe