Acting VA Secretary Sloan Gibson last week pledged to hold his agency accountable for the systemic problems that veterans have encountered in getting timely health care. "We're going to have change in this organization," Mr. Gibson said.

Based on an internal audit of VA hospitals released Monday, it's evident that Mr. Gibson has a lot of work to do. The inspector general of the Department of Veterans Affairs found that more than 57,000 patients nationwide have been waiting at least 90 days for their first appointment. Additionally, 64,000 who have enrolled in the VA network during the last decade have never been seen.

Those findings, cited in a Washington Post report on Monday, followed an earlier probe that found appointment delays averaging 115 days in the Phoenix VA hospital and clinics. And 1,700 veterans on an unofficial wait list had no assurance of being seen in a timely manner - if ever. The lack of treatment in Phoenix has been blamed for the deaths of at least 40 veterans.

Gen. Eric Shinseki resigned as VA secretary on May 30 because of the scandal.

More changes are clearly due, and Mr. Gibson has promised to hold the VA bureaucracy responsible.

Of particular local interest in Monday's IG report was the finding of extended waits for appointments at Charleston's Ralph H. Johnson VA Medical Center. The average waiting period for new patients was listed at 45 days.

That contrasts sharply with comments by the center's interim director, Scott Isaacks, quoted in our news report on Monday. Mr. Isaacks said the local medical center meets the 14-day standard for new appointments. The discrepancy was being reviewed by local officials late Monday. "We are trying to understand the difference in the data," Mr. Isaacks told our reporter.

The inspector general's review of 731 hospitals and clinics found evidence of problems across the range of the agency.

The audit was undertaken by IG employees from May 12 to June 3. At least one division of the VA recognizes the necessity of timely action.

The IG found that the 14-day standard for new appointments "was simply not attainable," citing a lack of openings for patients, inept scheduling personnel and inflexible software used to set up appointments.

That standard, however, puts pressure on schedulers "to utilize inappropriate practices in order to make the waiting time appear more favorable," the audit found. Those include making delayed appointments off the books.

Those findings comport with the earlier probe of the Phoenix VA facilities that uncovered a series of elaborate practices to make its performance look better than it should have - far better.

The system that produced such unrealistic expectations and improper - in some instances, life-threatening - responses by VA personnel "must be confronted head-on," the IG wrote. Straightforward solutions are required "in order to regain the trust of the veterans the VA serves."

Moreover, the widespread shortcomings in agency standards and practices demand a close review of every single VA medical center and clinic throughout the nation.

Don't expect this bureaucratic disease to cure itself.