A watchdog agency checked in on the Department of Veterans Affairs' response to COVID-19, including screening processes and pandemic readiness, and they found some areas lacking.
Within two days of the World Health Organization declaring the coronavirus spread a pandemic, the Veterans Health Administration, which cares for about 9 million veterans, began screening processes to protect against infection.
VA also began preparing for its fourth mission -- to serve as a last line of defense for Americans, not just veterans, during health crises.
About a week after VA began screening for the virus, Office of the Inspector General (OIG) investigators launched an inquiry to evaluate how VA was performing, including unannounced visits to hospitals, clinics and nursing homes -- while working to ensure those visits wouldn't put veterans or staff at risk.
Investigators found some facilities were not properly screening or limiting visitors and VA hospital, clinic and nursing home leaders were concerned about supplies, testing and staff. Investigators did note, though, that much of the VA staff they observed were working hard to care for veterans in the crisis.
Screening
Almost all of the 237 medical facilities investigators visited were collecting COVID-19 specimens for testing, but none of those facilities could process them on site. Some referred those who needed testing to county or state health departments.
Leaders of those hospitals, clinics and nursing homes told investigators they were sending their samples to the Palo Alto, Calif. VA for testing.
"One facility estimated that (testing) time could be reduced from several days down to four hours by processing at an onsite laboratory," the report said.
Supplies
Hospital, clinic and nursing home leaders told investigators their inventory of medication used to help manage virus symptoms or treat critically ill patients to support their heart function or to sedate intubated patients "may be insufficient," the report said.
Some facility leaders told investigators they were concerned about how much personal protective gear they had for staff and how many test kits they had available.
Leaders of two VAs, one in Durham, N.C. and another in Detroit, reported shortages of mechanical ventilators, the report said.
Staff
Almost half of the medical facility leaders investigators spoke to said they had seen an increase in staff not showing up for work, but were able to provide coverage or overtime pay to "minimize impact," the report said.
Some VAs reported low staffing for police and environmental management services, areas VAs have struggled to keep fully staffed in the past.
Sharing resources
Nearly half of medical facility leaders told investigators they planned to share intensive care beds, personal protective equipment and supplies with VA's network of private community providers.
Most of those leaders said they would send veterans to another VA or private, community, university or Defense Department hospitals if they were unable to meet their needs related to the virus.
"COVID-19 is not a challenge unique to VA medical centers. Communities across the country are faced with preparing for a surge of patients who will need critical care due to illness and complications. There may be a need for VA medical centers to refer patients to other VA facilities or community providers or be asked to provide care to community patients," the report said.
"The OIG recognizes that conditions at VHA facilities and veterans’ needs related to the COVID-19 pandemic may change rapidly. The OIG will continue monitoring VHA in its efforts to provide safe quality healthcare to veterans while also protecting the health of VA employees and preparing for a national crisis response during this pandemic," Assistant Inspector General for Healthcare Inspectors Dr. John Daigh said.
When asked about the report, VA Press Secretary Christina Mandreucci did not address specific concerns such as supplies, testing, screening and staff, but instead criticized the OIG.
"Now is the time for all VA employees to pull together to address the COVID-19 national emergency and keep veterans and their families safe," she said. "That’s why VA has requested that the inspector general put all of its assigned medical personnel to work by assisting VA medical centers in caring for patients as part of the department’s COVID-19 response. To date, the IG has yet to respond to this important and urgent request."
Mandreucci also said VA is concerned that in conducting its review of the facilities as part of its oversight duties, OIG investigators "did not abide by CDC guidelines regarding social distancing" and may have "put our patients and staff at risk."
OIG said in its report that investigators took precautions to prevent potential spread of infection.
"The unannounced visits to facilities were planned to minimize exposure and potential transmission of the novel coronavirus for both VA and OIG personnel as well as patients and visitors. Every effort was made to ensure that the visits were not disruptive to facility activities or distracting from COVID-19 responses," the report said.
"The IG’s report states that it encountered VA health care leaders, providers, and support staff who are united in the mission to provide high-quality care to the veterans we serve," Mandreucci said. "While there is always room for improvement, the VA remains committed to supporting veterans as America deals with the COVID-19 outbreak. VA healthcare workers have performed amazingly well during these challenging times and will continue to do so."
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