A federal watchdog found the Atlanta VA medical center had failed to answer calls and schedule appointments for veterans in a timely fashion, according to a newly released report.

The VA Office of Inspector General examined 135,600 calls made from July to September of 2023, an inquiry the watchdog said was prompted by a hotline complaint made earlier that same year. In the complaint, a whistleblower alleged the Atlanta VA was slow to answer calls, which included calls from veterans in mental health distress, according to the report.

In spring of 2023, The Atlanta Journal-Constitution first reported allegations that thousands of mental health calls to the Atlanta VA had gone unanswered over the prior year due to a lack of staff. Several months after the AJC’s reporting, the Atlanta VA acknowledged the mental health call crisis, and reported improved answer times for those veterans.

The OIG’s examination sheds new light on the innerworkings of the Atlanta call center around that time. In July 2023, the whistleblower reported the call center had answered more than 95% of mental health calls because it had diverted staff from veterans calling for other needs, like primary care.

The OIG said the lack of staff contributed to longer wait times in other areas, such as primary care and surgery appointments. In all, the OIG found the call center wasn’t answering about 30% of its calls from July to September 2023. Many callers waited over five minutes to have their calls answered, and the wait time averaged about seven minutes.

“Analysis of the call center data also substantiated the complainant’s follow-up allegation concerning the shift of resources to the mental health review,” the report says. “The OIG team found that, during the review period, the mental health queue exceeded VHA’s performance standards, while the primary care and surgery queues fell well below the standards.”

The OIG team said the facility followed through on the approved July 2023 staff request, hiring 80 staff by the end of February 2024. Since the review, the Atlanta VA moved many of its calls to a regional center.

In a statement, Kai Mentzer, executive director for Atlanta VA Health Care System, said the regional southeast office and Atlanta VA are already working to implement the report’s recommendations, and have made significant changes, like introducing a callback system for any abandoned calls.