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Flashback to 2018

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With the government still in partial shutdown, most of the Office of Inspector General (OIG) have been furloughed. This is unfortunate because the OIG is the main watchdog for the VA concerning urgent patient safety issues; they also conduct scheduled VA assessments, which is another important piece of VA oversight. We’ll hope the President and Congress can find some common ground and end the impasse soon.

Since the OIG has not posted any 2019 reports, let’s look back at January 2018 and examine an investigation into the workings of the Fort Benning, Georgia VA community-based outpatient clinic. We’ll consider a non-clinical issue: safety and security. The OIG investigation was sparked after receiving complaints from worried staff because the VA did not have police at the clinic nor did the VA allow the installation of panic alarms.

The VA clinic at Fort Benning is part of the Central Alabama Veterans Healthcare System and offers primary care and mental health services. It is located on the grounds of the U.S. Army Garrison Fort Benning, which is governed by the Department of Defense, not the VA. We have no doubt that the military police at the Garrison can provide excellent protection if contacted, but the question is whether they should have a presence within the VA clinic.

First, we’re puzzled at why the OIG did not mention the number of patients who visit the clinic — it’s over 10,000. We think this should figure into how security is provided for the staff; it seems reasonable that a clinic of a thousand or two patients will have a smaller security footprint than a clinic with ten thousand patients. In addition, the city of Columbus is not particularly safe. Of all the large cities in Georgia, they rank close to the top for violent crimes such as murder, robbery, and rape.

What the VA did mention was that there not been any major incidents requiring a Fort Garrison police response. At one time this was also true for a high school in Parkland Florida, a theater in Aurora, Colorado, a hotel in Las Vegas, and of course, an Army base in Fort Hood — then a deranged gunman went on a killing spree. It is the twenty-first century.

Despite having a billion dollar budget, the Alabama VA leadership refused to install panic alarms in the clinic; instead, they required the staff to pick up the phone for any emergencies —  “Excuse me Mr. Active Shooter, I’m trying to call the Army Garrison and can’t hear. Please stop firing your assault rifle.”

The reason given had to do with a ‘Workplace Behavioral Risk Assessment,’ that showed the clinic at moderate but not high risk. We’re not given any details about how the assessment was conducted — perhaps a Freedom of Information Act (FOIA) request is in order — nor why a moderate risk isn’t deserving of security. However, our sources reveal that at some VAs, the Director forms a notion about what type of security is required — usually minimal — and then chooses a team to formally reinforce that view. The report produced is often just a paper exercise with no real bearing about the threats VA employees face.

The OIG further notes that zero out of seven staff knew what phone number they should call during an active shooting emergency or even who would respond, the VA or the Army Garrison. Nor were they trained in the VA’s mandatory prevention of disruptive behavior course. The Chief of VA police did say that informational posters were part of staff training, but none were found in the clinic — we wonder if he/she ever visited the clinic.

The Chief of Police also said that they hadn’t received any requests for panic alarms. Per their policy, a this request would come from a service chief. Given the VAs culture of fear and retaliation — see the 2018 report from National Public Radio, an objective media source that generally supports federal institutions and if anything, has a liberal bias — do we really expect a low-paid clinic clerk to complain to a service chief at the medical center?

And speaking of police, it seems no one in the VA knows what they do or how to manage them according to a recent article in USA today. The OIG in yet another investigation, found national and regional security officials were remiss in conducting oversight inspections. This is vital to ensuring that firearms records are current, and security plans and critical incidents are handled appropriately.

One of the problems is that each police department reports to a different facility director at over 150 VA’s instead of a single, central command. So each VA manages them as medical leadership sees fit or simply ignores them. For example at the Seattle VA, the police chief failed to perform supervisory checks or complete security assessments for years — these problems were noted by the OIG in 2012, 2013 and 2014, and again in 2016.

Last, while the Fort Benning military police have been serving the VA clinic for years, somehow the VA director was unable to execute a memorandum of understanding (MOU). This is a simple document that formalizes the security agreement between the Army and the VA.

The OIG noted that this had been partially completed by several interim VA directors but never signed by their counterparts on the Army base. We know that when VA documents are signed, they are attached to a routing slip of various destinations, and then returned to the Director’s office — yet over the span of a year, this MOU was signed three times by VA directors. Surely, the VA support staff could have tracked this and called to follow up. But this lapse doesn’t reflect on them — it reflects on the lack of VA medical center leadership.

The OIG report concludes by saying as of January 2017  — the inspection occurred in June 2016 — the MOU between the VA and the Army still had not yet been finalized. Nor was it listed as a formal recommendation.

Prof. Sam

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