Backlog of Veterans' Disability Claims Increases 179% Under Obama

[Tahuyaman]

Fixing the VA is a promise Trump need to ensure he fulfills. This is a biggie.

[waltky]

VA Hospitals Could Be Left Vulnerable to Violence...

VA Hospitals Could Be Left Vulnerable to Violence: Watchdog Report
12 Jan 2018 | WASHINGTON -- The Department of Veterans Affairs isn't following certain security standards at its hospitals and clinics that are required of all federal buildings, potentially putting patients and visitors at risk, the Government Accountability Office concluded in a report released Thursday.

The watchdog agency's report detailed shortcomings in VA security, most notably that it does not require facilities to alter security measures based on fluctuating threat levels. "This could leave staff, patients, and visitors, as well as property, vulnerable to unmitigated risks," wrote Lori Rectanus, a director with the GAO. The report was sent to congressional committees, VA Secretary David Shulkin and Homeland Security Secretary Kirstjen Nielsen. The VA agreed with the findings and responded that it was re-examining and updating its security policies. Rectanus wrote in a letter to Rep. Phil Roe, R-Tenn., chairman of the House Committee on Veterans' Affairs, that the hundreds of VA hospital and clinics nationwide recently had been "the target of violence, threats and other security-related incidents -- including bomb threats and violent attacks involving weapons."

She referenced one fatal shooting in 2015, when a psychologist was killed at a VA clinic in El Paso, Texas. "Ensuring physical security for these medical centers can be complicated because VA has to balance safety and security with providing an open and welcoming healthcare environment," Rectanus said. The VA requires security cameras, silent distress alarms, perimeter fencing and a police force at all of its hospitals, the report states. But security levels differ at each facility, and there's little oversight. The agency leaves security decisions to local officials, and it doesn't have system-wide performance measures. That means the VA doesn't have the ability to determine what security measures are effective, the GAO found. "VA cannot ensure that local physical security decisions are based on actual risk, are appropriate to protect the facility and are effective or whether the variations or the security impact of them are important," the report states.

The type of oversight VA lacks is required of all government agencies by the Interagency Security Committee. The committee is a government body created by former President Bill Clinton in 1995, following the bombing of the Alfred P. Murrah Federal Building in Oklahoma City. Before then, minimum security standards did not exist for non-military federal buildings.

During the GAO review, inspectors traveled to nine VA hospitals from September 2016 to this month. They visited facilities in Bedford, Massachusetts; Houston; Los Angeles; Bay Pines, Florida; Sheridan, Wyoming; Washington, D.C.; Puget Sound, Washington; Orlando, Florida, and Louisville, Kentucky. The staff levels of the police forces varied at each hospital and all of them had vacancies in their forces because of recruiting difficulties. The VA agreed to comply with the GAO's recommendations that it change its risk-management policies and better oversee security at all of its hospitals. Gina Farrisee, VA deputy chief of staff, said in a letter that the agency would complete the recommendations by next January.

https://www.military.com/daily-news/...og-report.html

[waltky]

Here's lookin' at ya...

VA Criticized over Eye Care for Vets in Rural Areas
1 Feb 2018 | WASHINGTON -- A Department of Veterans Affairs program aimed at increasing access to eye exams for rural and homeless veterans utilizes a technique that some optometrists consider subpar care.

Through the program, veterans receive eye screenings using technology called auto-refraction to check for vision problems and disease. The results are used as the basis for eyeglass or contact lens prescriptions. During a typical eye exam, auto-refraction is a starting point for an eyeglass prescription, not the primary source, said Matt Willette, director of congressional relations with the 40,000-member American Optometric Association. The association has raised concerns with the VA that the method could lead to missed diagnoses and imprecise eyeglass prescriptions. It is a claim the VA disputes. "This is an experimental protocol," Willette said. "No one has tested to see if it's close to an eye exam, or if it misses a lot of stuff. That really worried us, veterans being experimented on." The program, called Titled Technology-Based Eye Care Services, or TECS, started in 2015 in clinics surrounding the VA medical center in Atlanta. The following year, the state of Georgia enacted a law requiring prescriptions for eyeglasses to be issued after an in-person, comprehensive exam and not limited to information from an auto-refractor. Because the VA is a federal agency, the law does not apply.

The American Optometric Association has issued complaints about TECS since about mid-2016, Willette said. The organization has recently increased its protest after learning the VA might expand the program to more sites nationwide. In response to criticisms that TECS offers substandard care, VA spokesman Curtis Cashour said those claims were "not at all accurate." There's a quality-assurance system in place, he said, that "tracks outcomes and ensures high-quality care." The screenings are conducted by licensed and certified ophthalmologists, he said. Last January, leaders of TECS published early findings that the program saved time for veterans and physicians and led to cost savings for the VA when compared to face-to-face exams at VA hospitals. The VA is also touting it as a method to improve veterans' access to care.

Air Force Lt. Col. David Miller, an optometrist assigned to the 442nd Medical Squadron assists in setting up a phoropter which will be used to give eye exams

Of the 2,690 veterans who received a checkup in the program's first 13 months, 33 percent secured a same-day appointment, and 98 percent got an appointment within 30 days of requesting one, according to the published findings. "The goal of the program is to reduce health care disparities in veterans by providing better access to eye care for rural and homeless veterans," Cashour said. "These populations are medically underserved, and VA is working to modernize and improve the way we deliver eye care to our veterans to prevent blindness." But Willette argued veterans failing to get an appointment at a VA facility could turn to the Choice program for a comprehensive eye exam, rather than settling for an inferior checkup. The Choice program, created in 2014 to reduce wait times, allows VA patients to receive private-sector medical care. Willette also contends the VA isn't doing enough to warn veterans that the TECS screenings aren't comprehensive exams. "VA is essentially trying to pass it off as an eye exam, but it's not," he said. Cashour said brochures and other educational materials about the TECS program emphasize the screenings don't replace in-person exams.

Sen. Johnny Isakson, R-Ga., wrote a letter to the VA in February 2017 with concerns TECS was providing a lesser level of care for veterans and "providing them with a false sense of security" that they were receiving treatment on par with a complete eye exam. Isakson's office said Wednesday that his staff members received a briefing about TECS weeks after the letter was sent. "It was very helpful, and we were satisfied with the information we received," said Amanda Maddox, Isakson's spokeswoman. Another senator, Republican John Boozman of Arkansas, questioned VA Secretary David Shulkin about the program in June. Boozman, a trained optometrist, has expressed concerns about the TECS screenings being based on experimental technology that hasn't been tested for accuracy and provides only limited results. "That truly is third-world," Boozman told Shulkin at a congressional hearing. "There is no example of this going on in private practice in America."

Shulkin, new to the job at the time of the hearing, said he would look into the program. AMVETS, a national veterans service organization, also has spoken out about TECS. Joe Chenelly, its executive director, described it as "misguided." "They appear to be reducing the quality of service for veterans," he said. As of now, the program is based at several VA medical centers in addition to the one in Atlanta and about 8,000 veterans have been screened through TECS, Cashour said. "We don't know where to go from here," Willette said. "I certainly don't want to bash the VA, they've got a difficult job, but this is one of the things they need to deal with."

https://www.military.com/daily-news/...ral-areas.html

[waltky]

Many Veterans Still Excluded from Critical VA Services...

Many Veterans Still Excluded from Critical VA Services
30 Mar 2018 Delphine Metcalf-Foster is the national commander of the Disabled American Veterans (DAV) and a disabled U.S. Army veteran of the Gulf War. She served as caregiver to her husband, also a disabled Army veteran.

Our nation's veterans put their lives on the line to defend and protect the American people, and we owe it to them and their families to ensure they receive the care and support they earned. Unfortunately, many ill and injured veterans of World War II, the Vietnam War, Korean War and Gulf Wars -- as well as their caregivers -- are being excluded from a range of critical Department of Veterans Affairs support services. Since 2010, veterans injured after Sept. 11, 2001, have been eligible for benefits and support through the VA's Program of Comprehensive Assistance for Family Caregivers -- to include respite care, access to health insurance, a modest stipend and home health training. But veterans of past generations are ineligible for the program, all because of an arbitrary date. The Disabled American Veterans had pushed hard and advocated for inclusion of a provision expanding eligibility of this program to veterans of all eras in the omnibus spending package released in late March. Unfortunately, the provision did not make it into the final bill that Congress enacted.

I personally know the sacrifice caregivers make. When my husband Jimmy -- who was also an Army veteran -- developed Alzheimer's and dementia, I was suddenly thrust into the role of caregiver. I did my best to give him the support he needed, but I also had to work full-time because we had limited resources. As much as I wanted to keep my soldier home, his condition worsened. I grew older, and soon his care was too much for me to handle. I was forced to move Jimmy to a nursing facility, where he lived out the remainder of his days. If Jimmy had served after 9/11, we may have been eligible for comprehensive VA caregiver assistance. He could have spent the rest of his life where he belonged -- at home, with me. Sadly, my story is not unique. Veteran caregivers often live a life of immense, though humble, self-sacrifice. Many must halt their careers, forgo educational pursuits and set aside personal goals to provide the care needed to a loved one seriously injured in the line of duty.

World War II veterans arrive at the World War II Memorial in Washington, D.C., for a ceremony honoring their service in the Pacific theater

Caregivers rarely put their own needs first and, in many cases, they themselves experience a decline in physical and emotional health as they tirelessly see to the needs of their veteran. A 2017 DAV study confirms these troubling statistics. Almost 80 percent of caregivers who received no federal support said they had suffered negative impacts on their health, career, financial security and family relationships. It's true that our post-9/11 veterans need and deserve access to the VA's caregiver support program, and it has done so much to ease the strains and stresses that come with caregiving. But tens of thousands of veterans of previous wars and their caregivers have been going it alone -- with little to no outside help or support -- for decades. As the veterans age, their illnesses and injuries often worsen. Meanwhile, their caregivers grow older and their ability to care for their loved one may diminish too. We firmly believe that no matter when a service-connected injury occurred, veterans have earned the right to equal care and benefits. A single date on the calendar should not determine how much support a seriously disabled veteran receives.

For too many of our nation's veterans, the restrictive post-9/11 eligibility criteria for the VA's caregiver program has meant a life of insult added to serious injury. They and their caregivers have incurred unnecessary emotional and financial hardships on top of life-altering disabilities, and that is simply unjust. This was a historic opportunity to incorporate a much-needed, long-awaited reform policy that would have dramatically improved the quality of life of our nation's veterans and their caregivers. But we cannot let our foot off the gas as we drive toward this important goal. We must do better by our veterans, and we call on Congress and the Trump administration to do what is right and what is fair by supporting expansion of caregiver benefits and support services to all generations of severely injured veterans.

https://www.military.com/daily-news/...-services.html

[waltky]

New VA Secretary Pledges Cleanup Of Scandal-Plagued VA DC Hospital...

New VA Secretary Pledges Cleanup Of Scandal-Plagued DC Hospital
7 Aug 2018 - In his second week on the job, new VA Secretary Robert Wilkie pledged a cleanup of the scandal-plagued Washington, D.C., Department of Veterans Affairs Medical Center where inspectors found doctors using rusty surgical tools and identified a sense of "complacency" in the facility's leadership.

Wilkie went to VAMC Monday, where he was told that plans were in place for "assuring reliable availability and sterilization of instruments for surgical procedures," the VA said in a release. Wilkie also was told that an electronic inventory was being set up to make sure that the hospital, serving about 90,000 veterans in the D.C. area, overcomes chronic equipment shortages. Previous reports from the VA's Office of Inspector General charged that VAMC staffers at times had to make emergency runs to neighboring hospitals to ask for supplies. The hospital had to borrow bone material for knee replacement surgeries and also ran out of tubes needed for kidney dialysis, forcing staff to go to a private-sector hospital to procure them, the IG's report last year said.


VAMC officials also told Wilkie that they were doing better at making timely appointments, particularly for prosthetics. "We had a good visit today, and I appreciated hearing from facility and regional leadership on the important work that has been done to address the Inspector General's concerns, as well as plans for resolving all its remaining recommendations," Wilkie said in a statement. "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." Wilkie approved yet another shuffle of VAMC's leadership to implement the changes. The current acting director, Adam M. Robinson Jr., will return to his previous position as director of the VA Maryland Health Care System.

Washington, D.C., Department of Veterans Affairs Medical Center.

A new permanent director for VAMC has been identified, and the name will be announced "in the near future," the VA said. In the interim, VAMC Chief of Staff Charles Faselis will serve as acting director of the facility. Damning reports from VA Inspector General Michael Missal on conditions at VAMC were a factor in the downfall of Wilkie's predecessor as VA Secretary, Dr. David Shulkin, who was fired in a Tweet by President Donald Trump in March. In April 2017, Missal took the unusual step of issuing an emergency report on conditions at VAMC before his inspection was complete to avoid putting patients at risk. In his scathing report, IG Missal said that storage areas for medical supplies at the VAMC were filthy, management was clueless on what was in the storage areas, medical supply rejects may have been used on patients and more than $150 million in supplies and equipment had never been inventoried.


Shulkin relieved VAMC Director Brian Hawkins and replaced him with Lawrence Connell, one of his top policy advisors and a retired Army colonel. In early March, just before Shulkin was fired, Missal issued another report warning that for years VAMC had "suffered a series of systemic and programmatic failures to consistently deliver timely and quality patient care." The report charged that there were staff shortages in several departments and that about $92 million in supplies and equipment were purchased over a two-year period without "proper controls to ensure the purchases were necessary and cost-effective." In April, Connell was out as temporary director following a dispute over "technical aspects" of his appointment, the VA said. In his latest report on VAMC, Missal made 25 recommendations for improving care. The VA said Monday that VAMC had implemented six of the 25 recommendations and was working to resolve the remaining 19.


https://www.military.com/daily-news/...-hospital.html

[Peter1469]

That is a shame- it is a nice facility.

New VA Secretary Pledges Cleanup Of Scandal-Plagued VA DC Hospital...

New VA Secretary Pledges Cleanup Of Scandal-Plagued DC Hospital
7 Aug 2018 - In his second week on the job, new VA Secretary Robert Wilkie pledged a cleanup of the scandal-plagued Washington, D.C., Department of Veterans Affairs Medical Center where inspectors found doctors using rusty surgical tools and identified a sense of "complacency" in the facility's leadership.

[waltky]

'Rust and Blood' Found on VA Medical Center Surgical Instruments...

VA to Add Medical Staff After 'Rust and Blood' Found on Surgical Instruments
5 Sep 2018 - At the Manchester, New Hampshire, VA Medical Center last year, surgeries were canceled when debris that appeared to be "rust and blood" was found on instruments doctors were about to use.

At the Washington, D.C., VA Medical Center last year, the staff ran out of sterilized instruments, and even bone marrow, and had to borrow them from neighboring hospitals. At the Cincinnati VA Medical Center in 2016, inspectors found that the system was failing to provide doctors with equipment that was "free of bioburden [bacteria], debris, or both." At the West Los Angeles VA Medical Center, 83 surgeries were cancelled in 2016 because of fly infestations in operating rooms. Rep. Phil Roe, R-Tennessee, a medical doctor and chairman of the House Veterans Affairs Committee, said he found it amazing that the Veterans Health Administration within the VA was struggling to fulfill the "most basic function" of its hospitals: "to make sure you have sterile equipment." "It's astonishing to me," Roe said at a hearing Wednesday before the Subcommittee On Oversight and Investigations.


Roe, who served two years in the Army Medical Corps, said he had performed or assisted in thousands of surgeries. "I never even thought about it, was the equipment going to be sterile that I'm using today?" he said. In response, Dr. Teresa Boyd, the VA's assistant under secretary for Health for Clinical Operations, acknowledged the problem but pointed to mitigating data on the surgical site infection rate. Of the more than 424,000 surgeries scheduled at the VA in the past year, only 0.8 percent had to be cancelled because of concerns with equipment sterility, Boyd said. At the Washington, D.C., VA Medical Center, the rate was 1.09 percent. That compared with surgical site infections rates of 1.41 percent nationally, and 1.9 percent in industry, she said.

The Manchester, N.H., Veteran Affairs Medical Center.

However, Dr. John Daigh, Jr., assistant inspector general for Healthcare Inspections at the VA's Office of Inspector General, said there was still cause for concern regarding the VA's protocol for sterile equipment and ensuring the same standards across all its facilities. The sterile equipment issue at the VA has been a recurring problem dating back to at least 2009 and has been documented in numerous reports from the Government Accountability Office, the VA's Office of Inspector General, the VHA's Office of Medical Inspector, and verified whistleblower complaints. In 2009, more than 10,000 veterans at VA facilities in Florida, Georgia and Tennessee were put at risk for hepatitis because of concerns over the sterility of instruments used for colonoscopies.


Hospital officials at the time reported that tubing for endoscopes used repeatedly in the procedures had been rinsed but not disinfected. At the hearing, Rep. Jack Bergman, R-Michigan, the subcommittee's chairman and a retired Marine lieutenant general, charged that failures in VA leadership allowed "safety protocols to go unnoticed and uncorrected." He said the VHA's central office was unaware that medical centers were failing to submit timely Sterile Procedure Services reports, "suggesting that blame goes all the way to the top." Boyd said the issue was being addressed at all levels of the VA. She also concurred with the findings of recent GAO reports, and said that a shortage of SPS staff was a contributing factor.



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[Tahuyaman]

The situation is probably worse at many private or civilian hospitals. They have the ability to cover up these types of incidents. VA and military hospitals can't.

[waltky]

Drug-Running, Lax Opioid Testing Found in VA's Residential Treatment Programs...

Drug-Running, Lax Opioid Testing Found in VA's Residential Treatment Programs
13 Sep 2018 - Poor oversight and failures in testing procedures led to two non-fatal fentanyl overdoses last year at a VA residential treatment program in upstate New York in which patients acquired the potent synthetic drug from another veteran at the facility, the VA's Office of Inspector General reported Wednesday.

In a similar report in July, the IG found that lax oversight and poor communication among staff were factors in the overdose death of a patient at another unidentified VA residential drug treatment program in 2015. That patient was found dead in a locked bathroom. An autopsy attributed the cause of death to a heroin overdose. In the case at the Bath, N.Y., VA Medical Center's treatment program, Matthew Helmer, 34, of Hyde Park, N.Y., a resident in drug treatment, was charged in October 2017 with felony counts of drug possession by federal prosecutors, who alleged that he was a "runner" for other veterans in the program, the local Star-Gazette newspaper reported. In court documents, a VA investigator said Helmer told him that "he knew that [patients] overdosed and were currently in the hospital," but was unaware of how they acquired the synthetic opioid fentanyl, the newspaper reported. Drug paraphernalia was found in Helmer's room and he acknowledged that heroin was his own drug of choice, the newspaper said. The IG's report focused on the 170-bed Domiciliary Residential Rehabilitation Treatment Program (DRRTP) in Bath, a town in New York's "southern tier" near the Pennsylvania border.


The DRRTP is part of the Bath VA Medical Center, the VA's oldest health care facility. The Bath facility was set up in 1865 as the National Home for Disabled Volunteer Soldiers returning from the Civil War. It currently serves about 13,000 veterans in the region. The IG's report noted that "the Veterans Health Administration does not require treatment programs to routinely test for illicit drugs, such as fentanyl, that are trending in the community." Following the two non-fatal fentanyl overdoses, the Bath center changed its urine drug screening (UDS) methods to include testing for the presence of fentanyl, but the tests went to "a non-VA laboratory with a turnaround time that compromised the timeliness of clinical intervention and overdose prevention," the IG report found. The result was that "the OIG determined that the facility's fiscal year 2017 positive UDS tracking data was inaccurate." The report also cited Bath center staff as saying that urine screening results were not properly recorded.

This undated photo provided by the Cuyahoga County Medical Examiner’s Office shows fentanyl pills.

The residential treatment program then went to a system in which "color-coded stickers" were placed on the doors to the rooms of residents with a history of opioid use who were believed to be at high risk for suicide, the IG's report said. The sticker system was discussed at meetings, but "key staff reported being unaware of its use for residents at high risk for suicide," said the 37-page report by Dr. John D Daigh Jr., assistant Inspector General for Healthcare Inspections. The report also found that staff at the residential treatment program "did not have sufficient personal protective equipment or training to safely conduct contraband searches of residents' rooms and belongings." It cited several case studies at the Bath treatment program indicating that drugs including fentanyl were available for those who wanted them. In the case of a veteran identified as "Resident B," who had recently completed an in-patient program for opioid detoxification, a routine urine test taken 15 days after he became a Bath resident was positive for opioids. On the 19th day, a search of Resident B's room "produced a baggie of unknown pills, a small orange cap with unidentified powder in it, a knife with a blade longer than three inches, straight razor blades, a needle, and a packaging wrapper for suboxone," the report said.


Another urine test was positive for the presence of fentanyl. "On Day 20, Resident B declined discharge planning and was discharged irregularly," the case study said. In response to the IG's report, Dr. Joan McInerney, director of the VA's New York/New Jersey Health Care Network, concurred with the findings and pledged action to correct deficiencies. "The Veterans Integrated Service Network will conduct an evaluation of the Bath VA Medical Center processes for fentanyl test results, turnaround times and notification of results. Appropriate action will be taken based on the process evaluation result," McInerney said in a statement. In the case of the veteran's overdose death in 2015, the IG's report in July found that staff at the unidentified residential treatment program failed to take a number of steps that might have resulted in an intervention. The patient had refused, or claimed the inability to provide, a urine sample, the report said. In that circumstance, "staff were required to review the appropriateness of residential care to determine whether the patient should continue in the program and, if so, under what conditions. For this patient, no documented action was taken," the report said.


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