Federal Reports

The Inflation Reduction Act (IRA), enacted in August 2022 as Public Law 117-169, appropriated $3 billion to the U.S. Postal Service to assist with its delivery fleet modernization. The Act provides the Postal Service $1.29 billion in funding for the procurement of zero-emission delivery vehicles (electric vehicles) and $1.71 billion in funding for the purchase, design, and installation of the necessary charging infrastructure at Postal Service facilities.

The Clean Air Act requires delegated agencies to work with the EPA to reduce air pollution from stationary sources. From at least 2006, the EPA did not ensure that two large, delegated agencies, the Texas Commission on Environmental Quality, or the TCEQ, and California's South Coast Air Quality Management District, identified a subset of synthetic-minor sources of air pollution, or SM-80s. The permit limitations on SM-80s need to be clear and enforceable because, if the limitations are not adhered to, the source may operate at major source levels and should be subject to more stringent requirements. The EPA's Office of Enforcement and Compliance Assurance's lack of in-depth evaluations of Regions 6 and 9, lack of SM-80 requirements, and reliance on unenforceable guidance contributed to deficiencies we identified in the regional offices' oversight.

The VA Office of Inspector General (OIG) reviewed an allegation that a patient experienced a delay in receiving basic life support (BLS) during a medical emergency on the grounds of the Carl T. Hayden VA Medical Center (facility) in Phoenix, Arizona, and later died at a community hospital.The OIG determined the patient experienced a delay in receiving BLS. The OIG learned of deficiencies related to the initiation of emergency medical care, including (1) conflicting facility policies that were inconsistent with Veterans Health Administration (VHA) requirements, (2) lack of layperson cardiopulmonary resuscitation (CPR) training, and (3) lack of an automatic external defibrillator (AED).Quality of care concerns were also identified, which included a discrepancy between the documented plan for a wearable cardioverter defibrillator (WCD) and the absence of an order for the device, and a failure to assess vital signs at an appointment preceding the medical emergency. The OIG was unable to determine whether a change in care would have resulted in a different outcome for the patient.Facility leaders’ lack of response upon awareness of the event did not align with high reliability organization (HRO) principles and I CARE values. The OIG identified the patient safety manager did not facilitate a thorough investigation of the related patient safety report, which resulted in an inaccurate harm assessment. Additionally, the patient safety manager and Facility Director failed to ensure a timely review of the report and investigation.The OIG made 10 recommendations to the Facility Director related to congruence of facility policies and their alignment with VHA Directives, layperson CPR training, placement of AEDs at the facility, outpatient clinic compliance with vital signs completion, complaint review processes, communicating in alignment with HRO and I CARE values, training on patient safety reporting, and investigation and closure of patient safety reports.

The VA Office of Inspector General (OIG) conducted a healthcare inspection to review surgical service and quality management concerns at the Hampton VA Medical Center (facility) in Virginia.The OIG found facility leaders conducted three focused clinical care reviews (FCCRs) in response to concerns about the assistant chief of surgery’s surgical care. However, facility leaders failed to report the results of two FCCRs and delayed reporting the results of one FCCR to the Medical Executive Committee, and did not use multiple reviewers for interrater reliability in any of the FCCRs to ensure the reviews were “fair and objective.” Facility leaders took several privileging actions against the assistant chief of surgery. However, the OIG found multiple deficiencies with notification letters and processes, including failure to adhere to VHA policy, send extension letters, include required language within the letters, and use clear terminology. Leaders also failed to report the assistant chief of surgery to the state licensing board after identifying six cases of substandard care.Surgical staff did not complete required patient safety reports. Morbidity and mortality conferences were held in a manner that compromised the formal peer review process and resulted in negative staff experiences. The chief of surgery did not recognize the need for three substandard cases to be considered for peer review. The VISN Chief Medical Officer and the facility chief of quality, safety, and value failed to prevent a management review from including two cases that were being peer reviewed concurrently. The OIG determined that facility leaders generally did not communicate and document required institutional disclosure elements.Eleven recommendations were made to the facility director regarding FCCRs, privileging actions, state licensing board reporting, professional practice evaluations, patient safety reporting, morbidity and mortality conferences, peer review, and institutional disclosures. One recommendation was made to the VISN Director.

On December 19, 2023, the Office of Special Counsel referred a whistleblower disclosure in which a Social Security Administration (SSA) employee alleged that, “SSA Claims Examiners are not informing claimants about the potential detriment of electing to apply for spousal benefits prior to full retirement age.” The Agency referred that allegation to the Office of the Inspector General for review.