Federal Reports

We investigated an allegation that Douglas Domenech, Assistant Secretary for Insular and International Affairs, U.S. Department of the Interior (DOI), violated his Federal ethics pledge under Executive Order No. 13770 by meeting with an official from his former employer, the Texas Public Policy Foundation (TPPF), during the required 2-year recusal period following Domenech’s resignation from the TPPF.Although we did not find that Domenech violated his ethics pledge as alleged, we found that he did violate Federal ethics regulations that prohibit Federal employees for 1 year from participating with their former employers in particular matters involving specific parties. Domenech, who began working for the DOI in January 2017 as a special Government employee (SGE), arranged and held two meetings with a TPPF attorney in April 2017 about issues in litigation between DOI bureaus and the TPPF. Domenech had a duty to consider whether his involvement in these meetings would cause a reasonable person to question his impartiality, and his failure to make that determination violated the regulation.Domenech did not violate his ethics pledge, however, because he was an SGE when the meetings took place and thus was not required to sign the pledge at the time. He signed the pledge in September 2017, after he became a permanent DOI employee.

According to the Centers for Disease Control and Prevention (CDC), opioids were involved in more than 47,000 deaths in 2017, and opioid overdose deaths were 6 times higher in 2017 than in 1999. CDC has awarded funding to States to address the nonmedical use of prescription drugs and to address opioid overdoses. We are conducting a series of audits of States that have received CDC funding to enhance their prescription drug monitoring programs (PDMPs). We selected California for audit because it experienced a significant increase in the rate of drug overdose deaths during 2016 and 2017.

This Comprehensive Healthcare Inspection Program provides a focused evaluation of the quality of care delivered at the VA Butler Health Care Center, covering leadership, organizational risks, and key processes associated with promoting quality care. Focused areas were Quality, Safety, and Value; Medical Staff Privileging; Environment of Care; Medication Management: Controlled Substances Inspections; Mental Health: Military Sexual Trauma Follow-Up and Staff Training; Geriatric Care: Antidepressant Use among the Elderly; Women’s Health: Abnormal Cervical Pathology Results Notification and Follow-Up; and High-Risk Processes: Emergency Department and Urgent Care Center Operations. During the OIG’s review, two of four executive leaders were serving in an acting capacity. With the exception of the chief of staff’s scores, selected survey scores related to employee satisfaction and trust were generally higher than VHA averages. Patient experience survey scores indicated that patients appeared generally satisfied with leadership and the care provided. Leaders appeared to support efforts to improve and maintain patient safety, quality care, and other positive outcomes. Review of accreditation findings, sentinel events, and disclosures did not identify any substantial organizational risk factors. Leaders were knowledgeable about selected Strategic Analytics for Improvement and Learning and community living center metrics and should continue to act to sustain and improve performance of measures contributing to the Strategic Analytics for Improvement and Learning “5-star” and community living center “2-star” quality ratings. The OIG issued five recommendations for improvement in the following areas: (1) Medical Staff Privileging • Professional practice evaluation process (2) Military Sexual Trauma Follow-up and Staff Training • Military Sexual Trauma mandatory training (3) Antidepressant Use among the Elderly • Patient/caregiver education and evaluation of understanding • Medication reconciliation (4) Abnormal Cervical Pathology Results Notification and Follow-up • Women Veterans Health Committee membership composition

The VA Office of Inspector General (OIG) conducted this review to determine if the Veterans Health Administration (VHA) completed radiology and nuclear medicine exam requests and follow-up care in a timely manner. The audit team also reviewed two related hotline allegations and determined if VHA managed canceled requests appropriately nationwide. The audit team estimated that 17 percent of routine exams and 25 percent of urgent exams were not completed within the required time frames. Reasons included staff and equipment shortages, issues with staff allocation, and insufficient monitoring of the scheduling process. Additionally, facility staff did not consistently follow radiology and nuclear medicine policy for canceled outpatient requests. Inappropriate cancellations can lead to delayed or incomplete exams and increase patient wait times. The audit team found that most follow-up care was completed appropriately. Facility staff either attempted to complete the recommended follow-up care with veterans or confirmed that they received it. The OIG made several recommendations to the under secretary for health to address management issues on the facility and regional levels. Among the recommendations were ensuring that facility staff evaluate the workload for scheduling exam requests and monitor requests that have been pending for more than seven days, implementing a mechanism to routinely audit canceled exam requests and take corrective action as needed, developing and implementing a plan for improving radiology and nuclear medicine oversight regionally, and creating a method for sharing new guidance with radiology and nuclear medicine leaders. The audit team also substantiated allegations of inappropriate exam cancellations at the James A. Haley and Iowa City VA medical centers. The issues were addressed in the general recommendations.

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Audit of recurring accounting entries for the NLRB's backpay financial records.