Federal Reports

The Federal Emergency Management Agency (FEMA) did not ensure the timely rebuilding of Puerto Rico’s electrical grid in the aftermath of Hurricane Maria.  FEMA officials missed opportunities to provide more assistance to Puerto Rico to manage its Hurricane Maria Public Assistance grant funds in accordance with Federal regulations and FEMA guidelines.  Specifically, FEMA did not provide enough technical assistance and guidance to the Puerto Rico Electric Power Authority (PREPA) to generate detailed statements of work and comprehensive work plans.   Despite FEMA granting multi-year extensions to avoid work stoppages, as of February 2025, FEMA reported that: • 92 percent (183 of 198) of approved and obligated       construction projects were incomplete; and • $3.7 billion of available permanent work funding had not      been obligated for construction of projects.  In June 2024, FEMA received a revised work plan focused on three categories of work: generation, transmission and distribution, and water assets.  The plan lacked detailed costs, schedules, and performance goals — all of which are important to monitoring progress. Over seven years after Hurricane Maria, FEMA does not know when Puerto Rico’s electrical grid will be completely rebuilt.  The grid remains unstable, inadequate, and vulnerable to interruptions, as evidenced by another complete loss of power on December 31, 2024.  

The OIG conducted a national review to evaluate the alignment of information related to mental health, substance use disorder (SUD), and suicide risk treatment needs within the Veterans Health Administration’s (VHA’s) Homeless Operations Management and Evaluation System (HOMES) data collection system and electronic health record (EHR). The OIG also assessed homeless program staff’s adherence to suicide risk screening procedures and care coordination.

Homeless program staff did not document the HOMES Assessment in 42 percent of patient EHRs, which limited access to important clinical information among clinicians outside of VA homeless programs.

The OIG found that 85 percent of patient EHRs included a suicide risk screening at the time of the HOMES Assessment or in the 30 days prior, as required. However, VHA has not implemented processes to ensure that staff complete the required suicide risk procedures, including risk mitigation, in response to HOMES-identified risk of self-harm. 

Homeless program staff did not document care coordination as outlined in VA homeless program policy. The OIG found that 35 percent of patients with HOMES-identified treatment needs, who were interested in participating in treatment, had EHR documentation of care coordination related to those treatment needs. VHA homeless program strategic goals include coordinating care to address veterans’ mental health and SUD needs; however, VHA has not delineated responsibility for ensuring care coordination, resulting in a lack of oversight and risk of patients not receiving needed mental health and SUD treatment.

The OIG made four recommendations to the Under Secretary for Health related to consistent EHR documentation of HOMES clinical information, suicide risk screening at intake, suicide risk screening in response to danger of self-harm identified in the HOMES Assessment, and documentation of mental health and SUD care coordination.  

The audit objectives were to determine whether program funds were managed in accordance with the ARC and Federal grant requirements.

Why We Did This Report

The Inspector General Act of 1978, as amended, requires each inspector general to prepare semiannual reports for Congress. As part of that reporting, the inspector general must identify all recommendations from the prior reporting period for which corrective actions have not been completed by the agency, as well as any management decisions with respect to audit, inspection, or evaluation reports issued during that prior reporting period.

Summary of Findings

For this compendium, we compiled recommendations that we had reported as resolved in the semiannual report to Congress that we issued on May 30, 2025. These 80 recommendations were originally issued to the EPA over a span of more than 15 years, from fiscal year 2008 through fiscal year 2024. As of May 31, 2025, 78 of those recommendations remained open, representing $43.3 million in potential cost savings. Of these 78 recommendations, 43 recommendations, with $33.3 million in potential cost savings, remained open after three years or will be older than three years by their expected completion dates. Additionally, 15 recommendations that were issued in reports between July 2022 and May 31, 2025, remain unresolved. We also identified 13 recommendations, 12 resolved and one unresolved, with potential monetary benefits of nearly $865.8 million, that we deem as high priority.

The OIG conducted this review after receiving a hotline allegation that the 2024 emergency department expansion and renovation at the Audie L. Murphy Memorial Veterans’ Hospital in San Antonio, Texas, did not meet standards. Some exam rooms were said to put patients at risk because the rooms were not equipped for urgent care.

The OIG confirmed the allegation. Fast-track exam rooms, used to quickly assess and treat patients with minor injuries or illnesses, did not have permanent medical air, oxygen, and vacuum outlets, nor did all the rooms have acceptable exam lights. In addition, in one room the contractor failed to install the required plumbing for permanent medical air, oxygen, and vacuum lines. The deficiencies occurred in part because the VHA directive guiding minor construction projects did not incorporate the legal requirement that the director of the Office of Construction and Facilities Management (CFM) manage and oversee the project. Other factors included the contractor’s use of the wrong template to design fast-track rooms and the project engineer’s approval of the room that lacked required plumbing.

When fast-track rooms and procedural and general exam rooms lack the necessary equipment for emergency care, patient care may be delayed while healthcare professionals locate portable equipment. VA officials agreed with the OIG’s four recommendations to ensure processes and guidance are in place for the CFM to provide appropriate oversight and management over minor construction projects, revise the VHA directive on minor construction projects to incorporate legal requirements, review emergency department exam and fast-track rooms for compliance with standards, and review a CFM assessment of emergency department for compliance with design and equipment requirements.