New Reports From the VAOIG

Combined Assessment Program Review of the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas 02/04/09. The purpose of the review was to evaluate selected operations, focusing on patient care administration and quality management (QM). During the review, we provided fraud and integrity awareness training to 627 system employees. The review covered eight operational activities. The system complied with selected standards in the following four activities: (1) coordination of care, (2) emergency/urgent care operations, (3) staffing, and (4) survey of healthcare experiences of patients. We identified transforming care at the bedside as an organizational strength. We made recommendations for improvement in the following four activities: (1) environment of care, (2) pharmacy operations and controlled substances inspections, (3) QM, and (4) medication management.

Combined Assessment Program Review of the VA Central Iowa Health Care System Des Moines, Iowa 02/03/09. The purpose of the review was to evaluate selected operations, focusing on patient care administration and quality management (QM). During the review, we provided fraud and integrity awareness training to 88 employees. The review covered eight operational activities. The system complied with selected standards in the following two activities (1) staffing and (2) survey of healthcare experiences of patients. We identified the telepharmacy program and QM program redesign as organizational strengths. We made recommendations for improvement in the QM program, environment of care, coordination of care, pharmacy operations, medication management, and emergency/urgent care operations.

Review of Allegations of Mismanagement, Central Alabama Veterans Health Care System 02/03/09. In response to correspondence from the Chairman, Senate Committee on Veterans Affairs and the Chairman, House Committee on Veterans Affairs,the Office of Inspector General referred eight allegations of mismanagement at the Central Alabama Health Care System to the Director, Veterans Integrated Systems Network 7 (VISN) for a response. The VISN did not substantiate three of the allegation and the conclusions were supported by the documentation provided. The VISN partially substantiated three of the allegations and took corrective action, which included issuing a bills of collection to Emergency Room nurses who were paid at the wrong rate and to a physician who was inappropriately paid a retention bonus. The remaining two allegations involved contracts awarded to purchase the services of two retired VA employees. Although the VISN did not substantiate the allegations, based on our review of the documentation, we concluded that both contracting actions violated Federal acquisition regulations. There was no justification for awarding these procurements without competition. The Statement of Work to procure the services of the Financial Manager was inadequate and the purchase order issued to procure the services for the Credentialing and Privileging office did not include a Statement of Work. The purchase order for the services of a Financial Manager was issued against a Federal Supply Schedule contract that was not authorized to sell the services requested. In addition, the services were personal services and the duties and responsibilities included inherently governmental functions. VA does not have authority to issue contracts for personal services and it is improper to contract for inherently governmental functions. The VISN Director concurred with our findings and recommendations and implemented a plan to take corrective action.

Healthcare Inspection Mammography, Cardiology, and Colonoscopy Management Jack C. Montgomery VA Medical Center Muskogee, Oklahoma 02/03/09. This review was done at the request of Senator James Inhofe to determine the validity of allegations regarding delays in mammography services, cardiology consult responses, and scheduling colonoscopy procedures at the Jack C. Montgomery VA Medical Center. We determined that in 2007 patients did not consistently receive mammograms in a timely manner, cardiology consultation requests were not always scheduled within the required timeframe, and waiting times for scheduling colonoscopies was generally excessive. We substantiated that a subject colonoscopy patient did not receive a screening colonoscopy as requested and that a diagnostic colonoscopy was not scheduled within 60 days. We could not substantiate or refute whether primary care providers were notified regarding the status of requests from the three services. Prior to our visit, management had already implemented initiatives to correct the issues regarding delays. However, management needed to discuss the subject patient colonoscopy concern with Regional Counsel to determine whether this case met disclosure requirements. Management and the Regional Counsel have since determined that the case did not require disclosure; we consider this case closed.