Report finds testing, equipment and staffing shortfalls at VA facilities around the country.
As the Veterans Affairs Department experiences exponential growth in the number of novel coronavirus cases it is treating in its vast network, an auditor is warning that many of its facilities are at risk of severe shortfalls in equipment, supplies and staffing.
VA on Friday confirmed at least 571 patients in its network have contracted COVID-19, nearly tripling its total on Monday, March 23. The department’s inspector general reported Friday that many of VA's facilities are not adequately screening individuals before they enter and are running low on testing kits, equipment, supplies, doctors and nurses. The potential for medical personnel shortfalls comes as Rep. Mark Takano, D-Calif., who chairs the House Veterans Affairs Committee, reported on Friday that 185 VA employees have tested positive for the virus.
The IG found that more than 60% of the 58 medical centers are experiencing inadequate supplies and equipment. In addition to masks, gloves and sanitizer, various facilities reported insufficient testing kits, swabs, goggles, face protections and wipes. Two centers, in Detroit and Durham, North Carolina, are facing shortages of ventilators, a key piece of equipment for COVID-19 patients struggling to breathe. VA management told the IG that it had enough equipment for an influx of coronavirus cases, but it was monitoring the situation daily.
“Facility leaders expressed concerns related to supplies needed to test patients for COVID-19,” the IG said. “They also acknowledged low inventory of personal protective equipment for staff.”
Christina Mandreucci, a VA spokeswoman, called for "all VA employees to pull together" to address the national emergency.
"While there is always room for improvement, the VA remains committed to supporting veterans as America deals with the COVID-19 outbreak," she said. "VA health care workers have performed amazingly well during these challenging times and will continue to do so."
One facility reported not having enough physicians to withstand an influx of patients, while nine anticipated a shortfall of intensive care unit nurses. Facility leaders attributed the shortages to school closures, redeployments to conduct entrance screenings and general absenteeism. Half of the medical centers reported an uptick in absenteeism, citing child care needs and older employees staying home.
Employees calling out could increase since the IG’s review. Richard Stone, the acting head of the Veterans Health Administration, issued guidance this week obtained by Government Executive authorizing VA employees who cannot telework to take paid “weather and safety leave” if they need to be home with children whose schools or daycares are closed. The leave can be approved in 15-day increments and also applies to employees subject to shelter in place orders or who have "known contact and direct exposure" to COVID-19.
The department has long struggled with vacancies and currently has 49,000 unfilled positions, most of which stem from VHA openings. It highlighted its recent approval from the Office of Personnel Management to rehire former employees among its efforts to boost staff.
“VA is actively recruiting permanent and temporary employees across the nation in both clinical and non-clinical positions,” the department said.
VA has faced criticism for being slow to enact telework on a widespread basis. It has since expanded it for most of its Veterans Benefits Administration workers and some additional non-health care staff, though employees still report being denied the ability to work remotely due to potential strains on the department's networks. Unions representing VA employees have complained the department has refused to bargain over aspects of its coronavirus response, including the use of telework and the distribution of personal protective equipment.
In its report, the IG found about 70% of medical centers had instituted proper entrance screening procedures, including questioning individuals on any respiratory symptoms they are experiencing, travel history and exposure to others who contracted the virus. At 28% of the centers, however, inspectors making unannounced visits were not asked one to three of the questions. At one center, the inspectors were asked no questions at all.
The IG also went to more than 100 outpatient community VA facilities, and 97% had proper screening in place. VA had set up screenings in cars, tents and lobbies. VA instituted a no visitor policy at its nursing homes—known as community living centers—on March 10, but nine of the 54 VA homes the IG visited had no means to stop visitors from entering.
VA management suggested it was still rolling out a policy it had just instituted four days earlier to restrict access to its facilities. It also criticized the IG for allowing its inspectors to travel to various facilities, saying they risked further spreading the virus. The IG countered the inspectors strictly administered self-screenings and followed CDC protocols. In fact, the IG said, it only conducted the inspections at the behest of VHA. The review utilized “unobtrusive but effective oversight,” the IG said. Mandreucci, the VA spokeswoman, said the IG should ensure any medical personnel assigned to its office return to treating patients.
The IG identified only one facility—VA’s Palo Alto medical center—that could administer COVID-19 tests in-house. Most other facilities sent their tests to private labs or county and state health departments, though one facility simply referred patients seeking tests elsewhere. Five facilities planned to administer tests and provide results internally, but were still waiting for chemical reagents. Officials said that would reduce the time for results from several days to four hours.
About half of VA medical centers said they were planning to share unused ICU beds and equipment with private sector hospitals in their communities. The department sparked some confusion this week when it announced it would suspend referrals to the private sector under its community care program Congress expanded in 2018, later clarifying it would consider patients’ needs on a case-by-case basis. The pause was intended to prevent veterans from exposure to the virus and overwhelming hospitals that are already stressed. VA will receive $2 billion for the program under a stimulus bill Congress approved on Friday, part of the $20 billion it will see to boost health care services at its facilities.
Takano, the House VA committee chairman, said on Friday the funding will help alleviate a situation that is bound to get worse.
“Because of the lack of widespread testing due to supply chain challenges like low levels of reagents, shortages of swabs and testing kits, a dwindling supply of masks to protect health care workers, understaffed VA hospitals without providers to administer the tests, and a two-to-seven day lag for veterans to receive results, we know that the magnitude of this public health emergency and the number of veterans sickened by this deadly virus are underreported,” Takano said. “It will only become more severe in the weeks to come.”
The IG noted in its report that VA employees were dealing with a difficult situation and handling it with professionalism.
“Throughout this inspection process, the OIG encountered dedicated VHA leaders, frontline care providers, and support staff united in their mission to provide high-quality care to the veterans they serve,” the IG said.
This story was updated with additional comment from VA.