When Sharon Helman – former director of the Spokane VA hospital – arrived at the Phoenix VA hospital in 2012, her priority was clear: Reduce wait times and eliminate the scheduling manipulation that obscured them.

Helman’s boss at the time told the Arizona Republic: “My first instruction to her was, ‘We’ve got to deal with the wait-time issue.’ ”

A 2011 audit had uncovered wait-time falsifications throughout the Southwest system of VA hospitals, which had prompted a VA undersecretary to urge top administrators not to “game” the system.

But a new federal audit suggests that Helman’s time in Phoenix merely reinforced the gaming of the system – and might have expanded it. By this spring, 3,500 veterans sat on an “unofficial wait list” that was more than twice as large as the official one.

Helman, meanwhile, had been reporting great progress, relaying impressive statistics, and earning raises and bonuses. This resulted in “a misleading portrayal of veterans’ access to patient care,” the Aug. 26 audit concluded. “Despite her claimed improvements in access measures during fiscal year (FY) 2013, we found her accomplishments … were inaccurate or unsupported.”

A former VA employee in Spokane has made similar allegations about Helman’s time at the hospital here, from 2009 to 2010, saying he was encouraged to manipulate the scheduling system to hide long wait times.

Linda Reynolds, the current director of Spokane’s Mann-Grandstaff VA Medical Center, said she did not know of allegations from before her time here. She emphasized that a wide range of changes have taken place in recent months to improve both the access to care and the way that is measured.

Recent audits of wait times and patient access have shown great improvement here – Spokane’s “electronic wait list” has plummeted from above 1,500 to around 100 in the past few months. Reynolds attributed this to a variety of factors: an initiative to get more care for veterans from private providers, the addition of extra hours and staffing, and more training surrounding the scheduling system.

These audits also reinforce the importance of accurate, honest accounting. At one point, after all, Helman’s numbers looked pretty good, too. Should we be confident about the current numbers? Reynolds said yes.

“We’re dedicated to doing it right,” she said. “We know, down to the person, what is going on. … Our whole goal is to provide quality care and timely care.”

The audit by the VA’s Office of Inspector General was the final report on some of the most damning allegations that first broke in Phoenix earlier this year. The report addressed one of the claims that many critics have repeated as fact – that 40 veterans died while awaiting care. Auditors concluded that, while there were serious deficiencies in care, “we are unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans.”

But the audit tells a story about Helman’s leadership that reflects some of the larger problems within the VA: an overbooked system combined with high expectations, an intense pressure to improve access, and a system of bonuses and rewards for administrators to fix the problems – even if it meant merely “fixing” them.

Helman was a fast-rising and seemingly well-regarded administrator in the system. She left Spokane in January 2010, went to the Hines VA hospital system in Chicago, and then arrived in Phoenix in February 2012. Though this year’s wait-time scandal has come as a surprise to some, it was already old news in the Southwest region of VA hospitals. An audit of those VA hospitals had uncovered widespread record manipulation. The Phoenix hospital had been singled out for failing to put veterans on the official electronic waiting list – essentially hiding the problem.

The Phoenix hospital system was facing long backlogs for care, and Helman made it clear she wanted this to change. She set a “Wildly Important Goal” of reducing wait times for primary care. A WIG is a business leadership seminar cliché, and Helman embraced it: Posters went up around the hospital touting the goals, and it was emphasized repeatedly, the audit says.

However, instead of producing better results for veterans, the effort produced cooked books, auditors concluded. When Helman gave her self-assessment in 2013, she wrote, “I drove tremendous improvement in primary care access in FY 13. At the beginning of the FY, I identified a severe facility weakness in access. I realigned priorities and resources and developed a Wildly Important Goal (WIG) to engage staff and increase access. My leadership to achieve WIG of improving access was realized in the dramatic improvement in multiple measures.”

Helman cited several measures to support this. She was given a raise and an $8,500 bonus. But auditors checked Helman’s claims and found them wrong or baseless. For example, Helman claimed her initiatives had led to 86 percent of all primary care patients being seen within seven days of their desired appointment date; auditors concluded the correct figure was 59 percent. She claimed that half of all new patients could see a doctor within 14 days; auditors put the correct figure at 16 percent. They could find no support for other statistical claims.

Helman was placed on leave when the scandal broke, and her raise and bonus connected with those claims was rescinded. The audit recommends unspecified administrative action against top officials at the hospital; it’s hard to envision her not losing her job.

Much of the language in the audit is cautious and circumspect. But there is a glaring moment of bluntness, in an email written by a doctor in March. The doctor had been asked by another hospital how the Phoenix VA had made such impressive progress on slashing its wait times.

“Not sure how to answer this,” the doctor wrote. “Can I just say smoke and mirrors?”