US lawmakers have launched an investigation into the Department of Veterans Affairs after multiple whistleblowers have come forward to say that veteran’s hospitals systematically manipulate waiting lists, resulting in the deaths of dozens of patients.

The growing scandal erupted early this week, when a Veterans Affairs (VA) employee alleged that at least 40 patients died waiting for an appointment at a VA hospital in Phoenix, Arizona.

VA hospitals are notorious for their long delays and sometimes inferior care due to understaffing and budgetary issues, among other problems. Several whistleblowers told reporters that, in an effort to salvage their own reputation, VA administrators mandated that thousands of patients’ names be moved to an unofficial waiting list. If those veterans died, the whistleblowers claimed, the names would simply be removed from the list quietly.

Senator John McCain, the Arizona Republican who is perhaps the most famous veteran in the US, said the situation was “unacceptable” during a town hall conference Friday in which he met with family members of those veterans who allegedly died waiting for care.

“Now we are hearing about similar situations in major VA facilities throughout the country,” McCain told NBC News. “I think this is going to get a lot bigger before it’s over.”

While officials at the Phoenix VA hospital have maintained public silence, McCain said they “denied everything” when questioned in private. The senator warned that, along with the dozens of deaths in Phoenix, the problem is likely more widespread.

“How many got sicker and sicker, and more and more serious problems with illness, or that needed medical care that they didn’t receive?” he continued. “We have no idea how many that is.”

Investigations are underway in Texas, Wyoming, and a number of other states throughout the country. David Newman, a registered nurse at the VA Medical Center in Cheyenne, Wymong was placed on administrative leave Friday after CBS published an email Newman wrote giving instructions to his staff. The memo explains how to list patients within the required 14-day appointment window no matter when the window was first requested, and regardless of how long the sick veteran waited.

“Yes, this is gaming the system a bit…” because “when we exceed the 14 day measure, the front office gets very upset, which doesn’t help us,” the email said.

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