Administrators at the Department of Veterans Affairs' hospital in Phoenix used an off-the-books paper system to hide a backlog of thousands of sick veterans who needed health care, and at least 40 vets died while waiting for the facility to take them.

Details of the scheme were unearthed by a CNN investigation, which shared emails of VA officials who praised the hospital's system for its "efficiency" (and others who had reservations about the procedure). CNN also interviewed an ex-VA doctor and the family of a dead Navy vet who languished on the list while awaiting treatment for stage 4 bladder cancer:

The secret list was part of an elaborate scheme designed by Veterans Affairs managers in Phoenix who were trying to hide that 1,400 to 1,600 sick veterans were forced to wait months to see a doctor, according to a recently retired top VA doctor and several high-level sources.

VA rules generally require that vets be taken into care within two to four weeks of their first contact with the department. But Dr. Sam Foote, a 24-year veteran of Phoenix's VA system, says there was an easy way to get around that requirement and stick vets with longer wait times:

There's an "official" list that's shared with officials in Washington and shows the VA has been providing timely appointments, which Foote calls a sham list. And then there's the real list that's hidden from outsiders, where wait times can last more than a year.

"The scheme was deliberately put in place to avoid the VA's own internal rules," said Foote in Phoenix. "They developed the secret waiting list," said Foote, a respected local physician.

Other VA workers confirmed the system's existence to CNN. "[T]hey would report to Washington, 'Oh yeah. We're makin' our appointments within — within 10 days, within the 14-day frame,' when in reality it had been six, nine, in some cases 21 months," one employee said.

That process proved fatal to Thomas Breen, 71, a former sailor who went to the Phoenix VA emergency room last fall with blood in his urine and came out with an "urgent" referral to see a urologist at the facility. Two months later, he was dead of bladder cancer, never having gotten his appointment to se the specialist. The VA called with an appointment time a week after he died.

Could an earlier appointment have saved him? Probably not—but palliative care could have ensured that Breen and others like him need not suffer in debilitating pain through their final months.

Internal emails grabbed by CNN showed the hospital staff openly discussing their shadow system of in-processing. One dissenter took issue with the kudos other administrators had been handing each other over their good standing with Washington:

"I have to say, I think it's unfair to call any of this a success when Veterans are waiting 6 weeks on an electronic waiting list before they're called to schedule their first PCP (primary care physician) appointment," the e-mail states. "Sure, when their appointment is created, it can be 14 days out, but we're making them wait 6-20 weeks to create that appointment."

The e-mail adds pointedly: "That is unethical and a disservice to our Veterans."