Alleged Unapproved Acquisition of a Robotic Surgical System for the W.G. (Bill) Hefner Veterans Affairs Medical Center, Salisbury, North Carolina

The VA Office of Inspector General (OIG) conducted this review in response to a November 2017 anonymous complaint that the W.G. Hefner VA Medical Center located in Salisbury, North Carolina, purchased a robotic surgical system for about $2.3 million without adequate planning and approval. The complainant alleged that the purchase was made using “leftover” funds without approval, and that the purchase was unnecessary because the building was unsuitable to house robotic surgical systems and the medical center already had an unused system purchased in 2012. The Veterans Health Administration’s (VHA) use of robotic surgery—a computer-assisted, minimally invasive surgery technique—has increased as more VHA medical facilities obtain robotic surgical systems and apply the technique to different procedure types. The OIG substantiated that staff were permitted to order the new robotic surgical equipment during year-end spending without proper review and approval. This occurred due to an ineffective capital investment review process and weak internal controls over the ordering process at the Veterans Integrated Service Network 6. Purchasing robotic surgical systems without the required planning, review, and approval increases the risk that programs will acquire expensive equipment without alignment of VA’s resources, such as site preparation and recurring maintenance on systems purchased. The OIG did not substantiate the second allegation. In response to OIG report recommendations, the Deputy Under Secretary for Health for operations and management and the Veterans Integrated Service Network 6 network director agreed to clarify approval requirements and ensure the capital investment board meets annually to review requests in a timely manner.