Non-Clinical Topics

DC VAMC Resolves Some of ‘Dysfunction’ Cited By VA Inspector General

by Sandra Basu

September 9, 2018
At the end of July, volunteers helped more than100 veterans and transitioning servicemembers members learn about VA benefits and community resources at he DCVAMC’s Welcome Home Benefits Fair. (DCVAMC photo from Twitter)

WASHINGTON—The DC VAMC has addressed or resolved six of 25 recommendations made by the VA Office of Inspector General (OIG) and is working to resolve the remaining ones, the facility announced last month.

“There have been substantial improvements over the past few months in practice management, logistics and prosthetics in particular, and leaders have a strong plan ahead for even more progress in the coming weeks,” VA Secretary Robert Wilkie said last month.

Wilkie visited the medical center shortly after taking office, meeting with facility and regional leaders and receiving updates on recent progress.

The VA reported that improvements and changes at the facility are in six broad areas:

  • ensuring instruments for surgical procedures are available and sterile;
  • having an electronic inventory to identify needed equipment rapidly and in a timely fashion;
  • implementing financial controls for purchasing supplies;
  • ensuring timely access to veteran appointments;
  • bringing skilled leaders to the medical center; and
  • building and maintaining systems to monitor current and future progress.

VA also announced that the facility would soon have a new permanent director and said that, in the interim, DC VAMC Chief of Staff Charles Faselis, MD, would serve as acting director of the facility.

The announcement followed an IG report on the DC VAMC earlier this year that identified issues at the facility. At the time, then—VA Secretary David Shulkin, MD, said he did not believe were isolated to that one facility.

Among the serious issues identified was the facility’s “inability to consistently provide supplies, equipment and instruments to patient care areas when needed” and “Ineffective sterile processing contributing to delays or postponements of procedures due to unavailable usable instruments.”

The report also said the medical center had “more than 10,000 open and pending prosthetic and sensory aid consults as of March 31, 2017, causing some patients to wait months for needed items.”

Among other findings in the report was that there was a “lack of consistently clean storage areas for medical supplies and equipment.”

It also pointed to “excessive vacancies in leadership positions and other pervasive staffing issues across multiple departments.”

Widespread Dysfunction

The report called the “dysfunctions” at the medical center “prevalent and deeply intertwined.”

“They could not be attributed to any single individual but rather were the result of inadequate actions and accountability across many services and positions. The OIG encountered a culture of complacency among VA and VHA leaders at multiple levels who failed to address previously identified serious issues with a sense of urgency or purpose,” the report explained.

The report noted that “despite these significant issues, the OIG did not find evidence of patient deaths or other adverse clinical outcomes resulting from these deficiencies.”

The IG report also pointed to a lack of control over purchase cards and explained that “in an effort to protect patients, some medical center personnel increasingly relied on government purchase cards to obtain necessary supplies and equipment.”

This “resulted in instances of employee misuse of purchase cards and generally increased the risk of fraud, waste, and abuse in the procurement of medical supplies,” it said.

In general, the financial management of supply purchasing throughout VA has been a concern for lawmakers. In May, the House passed a bill that would require the VA secretary to revoke the purchase card from any employee who is found to have knowingly misused their card or approval authority.

The House also passed a bill this year—also under consideration in the Senate—known as the Veterans Affairs Medical-Surgical Purchasing Stabilization Act.

The bill would, among other things, ensure that each VA employee who conducts formulary analyses or makes decisions about including items on the formulary has relevant medical expertise. The bill authors explained that lawmakers are concerned that there isn’t enough input from clinicians on formulary decisions and so the formulary is not meeting the needs of medical centers.

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