Federal Reports

We determined significant amounts of overtime were worked by employees at some gas plants. Specifically, we determined 69 percent (221,517 hours) of the 318,903 hours of overtime was performed at 7 of the 17 plants. The overtime worked at these 7 plants was the equivalent of 51 full-time employees. We also determined some employees worked significant amounts of overtime. For example, we found 51 instances during fiscal years 2018 and 2019 where employees worked over 1,000 hours of overtime and 2 of these employees had nearly 2,000 hours of overtime in a single year. Additionally, we determined the Tennessee Valley Authority (TVA) may not be accurately capturing the effects of fatigue because (1) fatigue assessments are no longer required when significant overtime is worked and (2) fatigue data is not trended with health and safety data in TVA’s medical case management system.

The VA Office of Inspector General (OIG) conducted a healthcare inspection to assess allegations related to the prior authorization drug request process. The OIG substantiated that the prior authorization drug request consult template included limited space for prescribers to enter treatment rationale and prescribers did not always know about an option to document unlimited supplemental information. The Pharmacy and Therapeutics Committee included adequate mental health representation; however, the relationship between the committee’s leaders and the mental health representative was problematic and noncollaborative. While the OIG did not determine that the prior authorization drug request or appeals process delayed treatment, a mental health prescriber may have contributed to one patient not receiving medications. Prescribers were unfamiliar with, or erroneously understood, the process for expediting an appeal and mental health prescribers modified their prescribing practices to avoid pharmacy processes. Since 2019, facility leaders were aware of, and did not effectively resolve, unprofessional communications between Mental Health and Pharmacy Services staff, including a mental health prescriber improperly documenting critical comments and disagreeing opinions within patients’ electronic health records. Further, Pharmacy Services staff and leaders sent disrespectful emails about Mental Health Service staff. The OIG substantiated that a pharmacist canceled medication orders without communicating with a patient; however, facility policy requires the requesting prescriber, not the pharmacist, to notify the patient of medication information. The OIG did not substantiate that pharmacists canceled medication orders without communicating with the requesting prescriber or that pharmacist reviewers denied a large number of prior authorization drug requests. The OIG made five recommendations to the Facility Director related to prescriber education, promotion of mental health prescribers’ pursuit of the most effective treatment plan, review of improper electronic health record entries and email, and evaluation of ways to improve workplace relationships.

The VA Office of Inspector General (OIG) investigated allegations that the former executive director of the Idaho Veterans Research and Education Foundation, a VA-affiliated nonprofit, raised her own pay without the board of directors’ approval and misused the nonprofit’s credit card. The OIG also assessed controls over, and oversight of, the nonprofit’s expenditures and payments made by VA to the foundation. The OIG substantiated the allegation that the former executive director received a salary increase without approval. Furthermore, a former assistant who is now the executive director also received a questionable salary increase. The OIG also found that the Boise VA Medical Center made about $50,600 in improper payments to the nonprofit from January 2014 through April 2018 due in part to insufficient oversight. Inadequate board oversight also allowed the executive director to gain full control over the use of nonprofit funds, enabling her to use the nonprofit’s credit card for more than $44,000 in unallowable personal expenses. The former executive director pleaded guilty to one count of federal program theft in US District Court in April 2019. She admitted using the nonprofit’s credit card inappropriately and attempted to conceal that by altering bank statements. She paid about $44,300 in restitution and was later sentenced to five years’ probation. The OIG recommended that the medical center director determine whether administrative action should be taken against the nonprofit’s current executive director and ensure the nonprofit requires two or more responsible officials to oversee salary changes and implements stronger credit card controls. Additional recommendations were for the medical center director to establish procedures for staff to consistently review nonprofit invoices prior to payment to confirm receipt of contracted goods and services, and that periodic reviews are conducted of nonprofit invoices that staff authorized for payment.

We determined significant amounts of overtime were worked by employees at all six of TVA’s coal plants. Specifically, the overtime worked at these plants was the equivalent of 165 full-time employees. In addition, we determined some individual employees worked significant amounts of overtime. For example, we found 37 instances during fiscals years 2018 and 2019 where employees worked over 1,000 hours of overtime and 1 employee who worked over 2,300 hours of overtime in a single year. We also determined TVA may not be accurately capturing the effects of fatigue because (1) fatigue assessments are no longer required when significant overtime is worked and (2) fatigue data is not trended with health and safety data in TVA’s medical case management system. Additionally, employees expressed concerns regarding the adverse impact of understaffing on safe operation of coal plants.

The Office of the Inspector General conducted a review of the Watts Bar Nuclear Plant (WBN) Radiation Protection (RP) organization to identify factors that could impact WBN RP’s organizational effectiveness. Our report identified behaviors that had a positive impact on WBN RP. However, we also identified a behavior that could negatively affect WBN RP. Specifically, we identified a behavioral risk related to accountability that, if left unaddressed, could impact WBN RP’s effectiveness and its continued ability to meet its responsibilities in support of WBN’s mission. We also identified operational positives regarding WBN RP’s working relationship with outside departments and having enough resources to do the work.