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But even after he arrived at the lab impaired at least twice, VA awarded Levy two performance bonuses on top of his $225,000 salary based on peer reviews that appeared to show that he had a minuscule clinical error rate, according to the indictment.

The truth was just the opposite. An unprecedented 18-month review completed this summer by a team of pathologists from other VA hospitals and affiliated medical schools uncovered a rate of misdiagnoses of nearly 10 percent, more than 10 times the normal frequency .of mistakes by pathologists.

VA officials are calling what unfolded in Specialty Building 21 at the Veterans Health Care System of the Ozarks in Fayetteville an isolated case. But the agency’s sprawling network of 167 hospitals and 1,000 clinics has long struggled to police problem doctors, audits and internal investigations show.

Inspector General Michael Missal’s office in recent years has identified multiple VA physicians who continued to practice even after they were found to have compromised patient care. A report this year by the Government Accountability Office found weak systems for ensuring that problems are quickly addressed when a physician’s quality of care to veterans is compromised. On Wednesday, Missal said his staff is investigating as many as 11 suspicious deaths of veterans at the Louis A. Johnson VA Medical Center in Clarksburg, W.Va.