Reports renew scrutiny of VA oversight, quality of care

New reports from the Veterans Affairs (VA) Office of Inspector General (OIG) as well as the U.S. Government Accountability Office (GAO) signal that the embattled VA still has not fully rebounded from a scandal that rocked it to its core.

First, a slew of new investigative reports from the OIG raise questions about why the agency waited to publicly disclose allegations of wrongdoing at the country's beleaguered VA hospitals, according to USA Today.

The agency does not release its reports when inspection officials decide that VA officials could address the problems identified, when pending litigation is involved or when the complaints are unsubstantiated, a spokeswoman for Richard Griffin, the interim VA inspector general, told the newspaper. Yet of the 140 recently released reports, which the OIG had held onto since 2006, 59 of them contained substantiated claims, USA Today reports.

The VA's troubles--including its myriad information technology challenges--also landed it on the GAO's "High Risk List" composed of faltering government programs and functions, according to a report released Wednesday. "Of particular concern is the outdated, inefficient nature of certain systems, along with a lack of system interoperability--the ability to exchange information--which presents risks to the timeliness, quality and safety of VA healthcare," the report states.

Interoperability issues between the VA and the Department of Defense have occurred for more than a decade, the report notes, but recently the Captain James A. Lovell Federal Health Care Center (FHCC) in North Chicago, the first planned fully integrated federal healthcare center for use by both VA and Department of Defense (DOD) beneficiaries, highlighted how little has been done to address the problem. In June 2012, GAO found that FHCC had to employ five full-time pharmacists and one technician solely to manually check patients' VA and DOD records to identify allergy information and potential drug interactions, according to the report.

The GAO has also criticized the VA for not doing enough to address cybersecurity issues, FierceHealthIT has reported, though an April report found that the number of veterans affected by data breaches fell 65 percent in March.

The other major concerns the GAO highlighted include: ambiguous policies and inconsistent processes, which may pose risks to access, quality and safety of care; inadequate training for VA staff; unclear resource needs and allocation priorities; and inadequate oversight and accountability.

The OIG reports, meanwhile, paint a disturbing picture of some of the instances of veteran mistreatment and mismanagement that have plagued the VA. One report noted an incident in Lebanon, Pennsylvania, in which a veteran's face caught fire during surgery. To increase transparency about such events, Sen. Ron Johnson (R-Wis.), has co-sponsored legislation that would require the OIG to make future inspection reports available to the federal government and the public. "The only way you have any hope of fixing a bureaucracy is for public disclosure," he told USA Today.

This is not the first time that government agencies have come under fire for failing to address the allegations of veteran mistreatment that snowballed into a national scandal. While the OIG has accused the Veterans Health Administration of misleading the public about the scope of dangerous delays in care at VA facilities, Griffin himself became the subject of scrutiny when emails surfaced that called into question the objectivity of one of his OIG investigations, FierceHealthcare has reported.

To learn more:
- read the USA Today article
- here's the OIG reports
- read the GAO report (.pdf)

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