Pittsburgh VA Discovers Emergency Pandemic Supplies Expired

By Walter F. Roche Jr.

Veterans Affairs officials in Pittsburgh have completed a review of hundreds of medical supplies stockpiled for emergencies after learning that some of them had gone well beyond their expiration dates.

The inventory of more than 200 pallets of items, stored in Building 49 at the VA’s H.J. Heinz campus in O’Hara, was completed to determine which items can still be used, said Beth Miga, spokeswoman at the VA Pittsburgh Healthcare System.

“We determined that a hands-on review of our pandemic response supplies was necessary to ensure our inventory records were as accurate as possible,” Miga wrote in an email.

The review was completed this week but Miga would not disclose its results. She said federal law did not permit her to disclose what specific supplies have expired. She would only say that items in seven of 22 categories expired and triggered the review.

Experts say it is difficult to guarantee the efficacy of medical supplies that exceed a manufacturer’s expiration date.

“A reliable stockpile of supplies for combating an infectious disease outbreak or pandemic is essential,” said Dr. Amesh Adalja, an infectious disease physician at the UPMC Center for Health Security. “When certain supplies age exceeds their manufacturer’s expiration date it is difficult to guarantee their efficacy and healthcare workers should have the highest level of confidence in their equipment when treating patients with contagious infectious diseases.”

Those supplies include medications, vaccines, certain medical equipment as well as personal protective equipment for healthcare workers such as masks and respirators, he said.

“The proper handling of these substances is important for patients and public health,” said U.S. Sen. Robert Casey when told about the outdated items. “It’s incumbent upon the VA to replace these items quickly so they’re there in case of emergency and provide the public and local health officials all appropriate information.”

According to Miga, some of the items do not have manufacturer’s expiration dates, “but we are still examining these supplies to determine their status and order replacements if necessary.”<br/>She said the inventory would provide an opportunity “to study our warehouse procedures and ensure that soon-to-expire stocks are shifted for use within the VA system.”<br/>The rules referred to by Miga describe the supplies as being “reserved specifically for the treatment of casualties from a mass casualty event.”<br/>It states that the director of the VA medical facility is responsible for activating when “a local regional or national emergency warrants its use.”

The caches, according to the directive, “are specifically intended to treat veterans, staff and others that may present to the local VA medical facility.”

Michael Stelacio, department commander of the Pennsylvania American Legion, called it unfortunate that supplies expired when they could have been transferred to other VA facilities for immediate use before expiration. “It’s obvious there’s some ineptness,” Stelacio said. “This is another one of these things that has to be corrected.”

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VA Pittsburgh Mail Room Functions Probed

By Walter F. Roche Jr.

Notices to some 14,000 area veterans of upcoming medical appointments have been delayed by two factors sparking an ongoing internal investigation of mail room practices .
Beth Miga, a spokeswoman for the Pittsburgh regional office of Veterans Affairs acknowledged Wednesday that an investigation was underway.
According to Miga some delays of up to three weeks were caused by a computer crash, while other shorter delays stemmed from the switching of contractors for mailing services.
As a result of the contract switch, she said, some 10,000 notices had to be mailed from VA facilities in Butler.
 "Due to a change in our mail metering services in June 2015, VA Pittsburgh used mail meter services at VA Butler Healthcare. This issue was not due to a lack of funding, but was an alternate way to send mail and continue to communicate with veterans about their VA care while we brought our new system online," Miga wrote in an email.
She said the mailings were "roughly one to two days" behind our usual schedule and "did not negatively impact the care we provide to veterans."
She said a new contractor, Pitney Bowes, was selected through a competitive process to replace Neopost USA which had the old expiring contract.
As for the computer crash, Miga said that while notices normally arrive several weeks before a scheduled appointment, the delayed notices arrived only a week ahead of the scheduled date.
"We did not have to cancel or reschedule any appointments due to recent mailing delays," she said in an email.
"The delay was due to an unexpected crash in the computer hardware that we use to generate these letters,"she added.
The scheduling of medical appointments and delays in treatment have been major issues in an ongoing review of VA care across the country.
Sparked by congressional inquiries and investigations by the VA's Inspector General charges have also surfaced that in some VA facilities, though not in Pittsburgh, records have been changed to hide lengthy delays in veterans getting needed services.
Former VA Secretary Eric Shinseki resigned earlier this year in the midst of revelations about delayed health care for veterans.

No Bid VA Pittsburgh Contracts Questioned

By Walter F. Roche Jr.



Veterans Administration officials in Pittsburgh failed to properly monitor three multimillion dollar no-bid contracts with a local physicians group and paid multiple invoices for anesthesiology and cardiac surgery services that could not be accounted for.
In a 26-page report issued Friday, the VA Inspector General said that the questionable payments were made under three contracts with the University of Pittsburgh Physicians with a combined value of $11.1 million. The contracts were in 2010 and 2011.
"Our review found that VAPHS was certifying invoices for payment without any substantive review or verification that the hours billed to the VA were actually rendered to the VA," the report states.
The auditors attributed the lapses to the lack of monitoring. In fact the official assigned to monitor work under the contract wasn't even at the same location.
Barbara Forsha, acting regional director of the Pittsburgh VA said in a response to questions said that her office took immediate action "to correct these shortcomings in our system. We are working to complete the recommendations the VA OIG set in the report as quickly as we can."
Wendy Zellner, spokeswoman for UPP said in an email response to questions,"We have a long an effective partnership with the VA and are committed to following all government rules and regulations. We are studying this report to see if any changes in our practices are necessary."

Calling discovery of the monitor's absence "particularly troubling," the auditors said they learned that the monitor's review consisted of simply matching up the hours billed with accompanying time sheets.
"The contracting officer was stationed at another facility and did not and could not conduct any real time monitoring of physician time sheet entries," the IG concluded.
The IG's own review of the time sheets, which included analysis of actual corresponding surgical records found that there were hours billed in anesthesiology and cardiac surgery that could not be accounted for.
In anesthesiology, for instance, a review of 20 days with billings totaling $80,659, found two entries for a total of seven hours that could not be accounted for.
Also cited by the auditors was the practice of physicians signing in up to 12 hours before records showed they actually began performing surgery.
One surgeon signed in at 6 a.m., but the surgery did not begin until 8:10 p.m.
"This practice went undetected for the entire two-year contract," the report states.
In another case, the VA was billed at a full time rate for a physician who was working only part time. Overpayments totaled $44,082, according to the report..
The report also questioned overhead payments to UPP totaling $847,733 which the IG found were not supported or documented to be in compliance with VA directives.
The auditors concluded that the questionable billing as recorded in the time sheets "should have been a red flag."

VISN 4 to Get Another Interim Director

By Walter F. Roche Jr.

Another interim director is about to take over command of the Veterans Administration region covering not only Pittsburgh and Pennsylvania but also parts of two other states.
David Cowgill, a VA spokesman confirmed today that William H. Mills, currently the director of VA operations in Altoona, will take over as VISN 4 director on Aug. 11.

A VA spokesman in Washington said an order to assign Mills to the directors post for a period not to exceed 120 days was "pending approval."
Mills, who was promoted multiple times by former VISN 4 Director Michael Moreland, will replace Carla Siveck who has been serving as an interim director since Dec. 14, 2014.
Moreland resigned under fire on Oct. 4, 2013 in the midst of an outbreak of Legionnaires Disease that took six lives in area VA facilities.
Like Siveck and Moreland, Mills does not have a medical degree. He has a masters in education.
Moreland, who was labeled the poster child for the lack of accountability among VA managers by U.S. Rep. Jeff Miller, a Florida Republican, was replaced by Terry Gerigk Wolf, who was later fired for her role in the Legionnaire outbreak.
Before his appointment to the Altoona post, Mills was the assistant VA director in Lebanon. He has served other jobs within VISN 4 including Memphis and Pittsburgh, also at VA facilities in West Virginia, Kentucky, North Carolina  and Connecticut.
Mills' current salary is $154,390. Sivek's salary in 2014 was $136,611 plus she was paid a $3,000 bonus, federal payroll records show.
Moreland, those same records show, was earning $170,000 a year when he stepped down. He also collected two bonuses totaling nearly $100,000. Those extra payments prompted outrage from members of congress who called for the VA to take back the bonuses.
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