The VA hospital inquiry that has become a national political firestorm started with a series of complaints from a recently retired doctor, worried about delays in care that may have led to deaths at the Phoenix Veterans Affairs hospital.
Since the VA started investigating, similar allegations have surfaced in other states including Florida, and now the issue has the attention of President Barack Obama. On Wednesday, he said is angered by allegations of misconduct and vowed "to fix whatever is wrong."
To put the election-year talk surrounding the debate in context, look at some key facts about the issue:
Who is making the accusations?
Dr. Samuel Foote, a former clinic director for the VA in Phoenix, started sending letters to the VA Office of Inspector General in December, complaining about systematic problems with delays in care.
Foote, who retired after spending nearly 25 years with the VA, later took his claims to the media, then to Republican Rep. Jeff Miller, chairman of the House Veterans' Affairs Committee, who announced the allegations at an April hearing.
Foote says up to 40 veterans may have died while awaiting treatment at the Phoenix hospital and that staff, at the instruction of administrators, kept a secret list of patients waiting for appointments to hide delays in care. He believes administrators kept the off-the-books list to impress their bosses and get bonuses.
Since Foote's revelations, two more former Phoenix VA employees have made the same claims.
What is the VA's response?
The VA Inspector General's office said late Tuesday that 26 facilities are now being investigated across the country - a significant expansion of the probe from last week. And the White House has taken a much more active role in responding to the VA allegations in the past week. Obama met with VA Secretary Eric Shinseki at the White House on Wednesday and expressed his support for the retired four-star Army general.
Phoenix administrators vehemently deny the allegations. The VA has so far found no evidence to substantiate the claims after an internal probe.
The Phoenix hospital's director, Sharon Helman, scoffed at the notion that she would direct staff to create a secret list and watch patients die in order to pad her pockets. Helman has been placed on leave while the Inspector General's Office investigates. She has been provided with police protection after receiving numerous death threats.
Some also question the motives of Foote and the others making accusations. One employee, who first raised the concerns publicly a few weeks ago, was fired last year and has a pending wrongful termination lawsuit against the hospital. Before he retired, Foote was reprimanded repeatedly for taking off nearly every Friday, according to internal emails he provided the AP.
What's next?
Obama has assigned his deputy chief of staff, Rob Nabors, to oversee reforms at the agency. Nabors is visiting Phoenix this week to meet with VA staff, and members of Congress are issuing several pieces of legislation to overhaul the agency.
Shinseki, a retired Army four-star general, is facing calls for his resignation from some lawmakers. Obama spoke warmly of Shinseki Wednesday, saying the secretary had poured his heart and soul into his job, but said there would be accountability if the allegations of misconduct are proven to be true.
What is the overall state of the VA?
The VA operates the largest integrated health care system in the country, with more than 300,000 fulltime employees and nearly 9 million veterans enrolled for care. Obama said Wednesday that 85 million appointments for veterans are scheduled each year.
The Phoenix claims are the latest to come to light as VA hospitals and clinics around the country struggle to handle the enormous volume. VA facilities in Florida, South Carolina, Pennsylvania, Georgia, Texas, New Mexico and Illinois, among other states, have been linked to delays in patient care or poor oversight.
An internal probe of a Colorado clinic found that staff had been instructed to falsify records to cover up delayed care at a Fort Collins facility. A nurse at a VA center in Cheyenne, Wyoming, was put on leave this month for allegedly telling employees to falsify appointment records.
The VA has acknowledged that 23 patients have died because of problems related to care since 1999, according to an ongoing nationwide internal VA review, which showed that delays often occur when a doctor refers a patient to another physician, such as a specialist. During the same time period of the deaths, more than 250 million of these consults were requested.
The 23 deaths do not include a deadly Legionnaires' disease outbreak in the VA Pittsburgh Healthcare System, or three patient deaths blamed on mismanagement at the Atlanta VA hospital.
The White House said the VA has made tremendous progress in reducing case backlogs, but that they need to be completely eliminated.
