For months, the Department of Veterans Affairs has been rocked with accusations of delayed appointments and substandard care at some of its 150 medical centers nationwide.
In Albuquerque, New Mexico, the family of a veteran who died while waiting for an ambulance at the hospital cafeteria wants to know if bureaucratic regulations got in the way of compassion and common sense.
CBS News correspondent Wyatt Andrews reports the first call to 911 came from inside the VA cafeteria from a woman upset that the VA's emergency room had just rejected her first plea for help.
"We called our rapid response here at the hospital, but unfortunately they won't respond to him because he's out of the main medical building," the caller said.
A patient later identified as 71-year-old Jim Garcia, a veteran of Vietnam, had collapsed in the cafeteria, but under the VA's rules in Albuquerque the cafeteria, which is about four blocks away, is outside the zone that emergency room staff are allowed to go.
The VA said in a statement it is reviewing "all details of this tragic incident" to learn "whether policy changes are needed to best serve veterans," but it is still not clear if a faster response could have helped Garcia. Several 911 callers said even in the cafeteria, Garcia got expert care immediately.
"We got people doing CPR," a caller said.
"Nurses? Doctors?" a dispatcher asked.
"Nurses," the caller said.
"Nurses? OK," the dispatcher said.
Nurses and paramedics responded but according to one caller none of the doctors.
"There's a table of doctors sitting right next to us, and none of them are doing [expletive]," a caller said.
"OK, I'm sorry about that," a dispatcher said.
According to callers and the VA, the veteran who collapsed was surrounded by physician assistants, paramedics and nurses, all of them trained in emergency care, which may account for why the doctors were simply watching.
The family of the veteran says it is hearing conflicting VA accounts of Garcia's death and is considering a lawsuit.