Phoenix VA Lab Results Backlog: 2,224 Send-Out Test Results Unfinalized 100+ Days, OSC Letter 2026
By VA Headlines staff · Published Oct 30, 2026 · Source document dated October 22, 2026
For about two and a half years, the send-out lab at the Carl T. Hayden VA Medical Center in Phoenix did not finalize hundreds of test results in VA's electronic records on time, according to a whistleblower case the U.S. Office of Special Counsel (OSC) sent to the President on October 22, 2026.
How the case started
A whistleblower brought the concerns to OSC. OSC referred the allegations to VA Secretary Douglas A. Collins on August 25, 2025. The VA Office of the Medical Inspector investigated, and Secretary Collins reviewed and signed the agency report. OSC determined the report's findings "appear reasonable."
What investigators found
The Phoenix send-out lab ships specimens to commercial or other VA labs for specialized testing: 56,784 tests in fiscal year 2023, 63,366 in 2024 and 62,803 in 2025. Staff must verify and finalize returned results as complete in VistA.
As of July 2025, the lab had a backlog of approximately 2,224 send-out test results over 100 days old that had not been finalized: 1,848 pharmacogenomics panel tests, 260 special send-out tests and 116 germline genetic tests. Investigators found that leadership did not provide sufficient oversight because they were unaware of the backlog until July 2025, and that a staffing shortage contributed.
Investigators noted that a test appearing on the incomplete list "does not necessarily mean the result was unavailable to the ordering provider."
What was not substantiated
The investigation did not substantiate that the delays contributed to the deaths of two patients, and did not substantiate the allegation about a missing procedure for reporting communicable diseases. The whistleblower disagreed with the findings on the unsubstantiated allegations and criticized VA leadership for not giving the lab adequate staff.
Fixes VA reported
In July 2025, leaders approved overtime and hired temporary contract staff. VA reported retraining lab staff, revising the lab's quality assurance plan and adding staff. According to the report, the backlog was reduced to seven special send-out results over 100 days old, plus 32 results less than 48 days old. The medical center intends to begin in-house testing of high-volume tests by December 2026.
Why it matters
Lab results that sit unverified can slow follow-up care. This case came to light because a whistleblower used OSC's disclosure process.
Related: VA painful scar rating errors. How we report: Methodology & Corrections.
Letter to the President, OSC File No. DI-25-001991 (Carl T. Hayden VA Medical Center, Phoenix)
OSC File DI-25-001991 · October 22, 2026
Read the official document (PDF)
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