Two Pa Veterans Homes Cited for Violations

By Walter F. Roche Jr.

Two of the six Pennsylvania run nursing homes for veterans have been found out of compliance with the minimum standards required for participation in the federally financed Medicare and Medicaid programs.
In detailed inspection reports recently posted on the state Health Department's web site, the violations were found at the 339-bed Hollidaysburg Veterans Center in Blair County and the 238 bed Southeast Veterans Center in Chester County.
Joan Nissley, spokeswoman for the state Department of Military and Veterans Affairs, which runs the homes, said that corrective action plans to address the deficiencies have been implemented and accepted by the state Health Department.
"We remain committed to providing quality long-term care for Pennsylvania's veterans and their spouses in a safe, secure and caring environment," Nissley stated, adding that she could not comment on specific personal patient care.
The report on the Chester County facility cites multiple cases of patients falling and sustaining injuries because staffers did not assist them as ordered in their medical records.
The facility "failed to ensure that adequate monitoring, supervision and implementation of interventions were provided to prevent falls and injuries," the report states.
A female resident was found to have suffered a hip fracture when staffers responded to her calls for help on March 18 of this year.
"Resident was ambulating unassisted and with no supervision," the report states.
Another patient's fall resulted in multiple areas of bleeding on the brain.
"The licensed staff failed to follow the resident's plan of care," the report states.
Yet another patient suffered a head laceration from a fall in January. That same patient suffered from falls on May 30, Aug. 17 and Aug. 24, the report states.
Another patient diagnosed with hypertension and dementia had five falls between April and October of this year.
"The facility failed to provide resident B7 with appropriate supervision during ambulation to prevent falls," the inspectors reported.
Other deficiencies reported at the Chester county facility included failing to properly store medications and discard expired medications.
In several cases the inspectors found that staffers failed to inform the patients' physicians when tests were missed or adverse test results had been recorded.
There were medication errors including the case of a patient who had ear drops mistakenly placed in the eye.
The report on the Hollidaysburg home included details of patients being transported on wheelchairs without leg rests, thus placing them at risk for injuries.
One patient was observed with his legs bouncing up and down while being taken out of the dining area.
The report states that the facility had failed to perform an assessment to determine "if it was safe" to transport the patients in wheelchairs without leg rests.
In an October case, the inspectors found that staffers failed to thoroughly investigate the cause of bruising on a patient's arm.
Another patient who required oxygen was observed with an empty tank.
In February a patient was discovered with two pairs of scissors impaled on his abdomen. The inspectors noted that a day before that discovery a strong odor had been detected in the patient's room but it was not reported or investigated.
"When areas of concern are identified, we take immediate action to address and rectify them, with a continued focus on the safety and care of residents," Nissley said, noting that all six homes are fully licensed.
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VA Whistleblower Suit Revived

By Walter F. Roche Jr.

A federal appeals court has reversed a lower court ruling and given new life to a whistle-blower suit alleging that a company with long time ties to former Veterans Affairs Secretary Anthony J. Principi defrauded the agency under a contract to provide medical exams.
The ruling by a three judge panel of the 9th Circuit Court of Appeals reverses a U.S. District Court ruling dismissing the claims filed by David Vatan, a former employee of the contractor QTC Medical Services.
The lower court had dismissed Vatan's claims contending he failed to provide the court with a detailed copy of QTC Medical's contract with the Veterans Administration.
Formerly a subsidiary of Lockheed Martin, QTC was once headed by Principi. The former VA Secretary subsequently registered as a lobbyist for QTC-Lockheed. QTC was eventually sold to Leidos, Inc
The appeals court ruled that the False Claims Act does not require that Vatan file an exact copy of the VA contract.
"Where, as here, the relevant information is within the defendant's exclusive possession and control such pleading is sufficient," the court said referring to the details in the Vatan complaint.
It added that if the standards set by the district court were to be applied to all False Claims Act suits, it would "vitiate the False Claims Act by excluding many whistle-blowers, who, as here, allege insider knowledge of wrongdoing that few others would be positioned to reveal."
The appeals court also concluded that speculation by the district court on possible elements of the contract was irrelevant.
"The specific contractual language and any contemplated error rate in the contract are immaterial to whether this claim is adequately pleaded," the ruling states.
Vatan "alleges that QTC essentially lied to the government as to whether files were reviewed," it continues.
The court concluded that Vatan's allegations "are specific enough to give defendants notice of the particular misconduct. He therefore successfully alleges that QTC misrepresented what goods or services it provided to the federal government."
Vatan's original suit charged that QTC required its employees to process so many claims for Agent Orange injuries in such a short time, it was impossible for them to complete a thorough examination.
Lawyers for QTC denied the allegations.

VA Probe Confirms Long Wait List, Manipulation

By Walter F. Roche Jr.

An internal  investigation has confirmed that the Veterans Administration facility in Pittsburgh had 700 veterans waiting for appointments in 2014 and that staffers routinely manipulated data to hide the actual number of veterans facing unacceptable delays.
In a 22 page report on its probe of the allegations, the VA's Inspector General said it confirmed media reports that more than 700 veterans were on a New Enrollee Appointment Request (NEAR) list in May of 2014.
The "Administrative Summary" of the probe was made public late last week.
In addition after interviewing some 40 current and former employees and reviewing emails and other records, the IG found widespread evidence that staffers were manipulating data to hide the fact that veterans were not getting appointments within acceptable 30 day time periods.
In fact some staffers reported being told to make it appear that a veteran had no wait at all.
"Medical Support Assistant (MSA)  #1 confirmed he had been directed to schedule appointments in a manner that did not accurately reflect accurate wait times," the report states.
A former senior leader told investigators "it was her understanding that MSAs were being directed to manipulate appointment entries so that it appeared that performance standards were met when in reality standards were not being met."
According to the report some current and former staffers interviewed said they were not aware of any wait time manipulation. In some of those cases, however, investigators found emails and other evidence showing the same staffers did alter data despite the denials.
According to the report, a supervisor said "she became aware of a way to reset the 30-day time frame for scheduling appointments so that they did not exceed the 30 day requirement.
Another staffer said "she shortened wait times on her appointment only because those above her wanted her to do it.
Yet another staffer reported that she shortened wait time about 20 times from December of 2013 to March of 2014.
The cause of the lengthy delays, according to the report, were multiple and ranged from a shortage of medical professional to a logjam when a single staffer was assigned to set appointments for all veterans on the NEAR list.
The IG also looked into but did not confirm allegations that some staffers were given bonuses as a reward for manipulating data. The data showed one service chief received more than $45,000 in extra pay.

TB Case at VA Pittsburgh, PA

By Walter F. Roche Jr.

An unidentified veteran who has been a patient at Veterans Affairs facilities in the Pittsburgh area has been diagnosed with tuberculosis and is undergoing treatment.
VA Pittsburgh officials disclosed Wednesday that the patient was diagnosed Monday and is responding well to treatment. He has been a patient at the VA outpatient facility in Beaver County and the University Drive facility in Pittsburgh.
According to an announcement from the VA, no additional cases have been found but the agency is now notifying persons who may have come into contact with the ailing veteran and offering free testing. That process is expected to take several days, according to VA officials.
"While it is unlikely anyone potentially exposed will become ill, out of an abundance of caution we urge notified patients and employees to be tested, " VA Medical Director Karin McGraw said in a statement.
Tuberculosis is transmitted through the air and symptoms include coughing up blod, chest pain, fever, chills and night sweats.

Two PA Veterans Homes Cited in Sexual Assaults

By Walter F. Roche Jr.

Two state run veterans homes have been cited by the Pennsylvania Health Department for incidents in which female residents were sexually assaulted by male patients.
The incidents, one at the Hollidaysburg Veterans Home and the second at the Gino J. Merli Veterans Center in Scranton, triggered citations for violations of state law and regulations.
The two facilities, which have been the subject of several other critical inspection reports, are part of the state Department of Military and Veterans Affairs, which operates six such facilities statewide.
A third home, the Southwestern Veterans Home in Pittsburgh, was cited recently for an incident in which a veteran was seriously injured while being transported in a wheelchair. The home's license was put on a provisional basis as a result of the inspection.
Joan Nissley, a department spokeswoman, said the incidents at the Scranton and Hollidaysburg facilities "sparked a wide-ranging, multidisciplinary review that is still ongoing."
Asked if any employees were disciplined following the  incidents, Nissley said that while she could not comment on any specific personnel matter "we can state that appropriate disciplinary actions have been taken where applicable."
Nissley said there are 28 female patients at the Scranton home and 46 at Hollidaysburg. Overall 13 percent of all state veterans home residents are female.
At the Hollidaysburg Veterans Home a male resident, who had previously assaulted a female patient, entered that same female patient's room on Aug. 21 and pulled down her pants and touched her genitals then began masturbating.
A staffer saw the male patient leaving the female's room with his pants unzipped and his genitals exposed.
According to the report the female patient was bruised and had slight bleeding. She was sent to a hospital for an examination.
The female resident, the report continues, "was scared and very upset." She said she didn't ring the call button because she was scared
The Health Department report noted that following the incident officials at the home did not interview other female residents to ask whether they had ever been sexually assaulted.
The same male resident had assaulted the same female patient in April, the report states. He squeezed her breast two times on April 22 when she was seated in her wheelchair in a hallway.
Following that incident, staffers were advised to keep the male resident away from the female, the report states, but "there was no documented evidence that following the April 22 incident, the staff monitored Resident 1 (the male) when he was around female residents."
The 15-page report also faults the Blair County home for failing "to provide sufficient detail about a resident incident to the Department of Health regarding an incident which seriously compromised a resident's safety."
In a plan of correction, Hollidaysburg officials said the male patient had been moved to an all male unit and was to undergo a psychiatric evaluation. The victim was provided supportive counseling and a psychiatric evaluation.
The plan also includes training of staff on dealing with sexual behaviors. Other residents were evaluated for any inappropriate sexual behaviors, according to the plan.
Officials at the Scranton veterans home were cited for failing to monitor a patient who had a history of inappropriate sexual behavior. The patient was supposed to have 1 to 1 monitoring during waking hours but early in the morning of July 23 the staffer assigned to watch the male patient left to attend to another patient.
The employee, the report states, did not ask another staff member to observe the male resident even though he had been observed in the hallway near the female patient's room.
"The facility failed to ensure that Resident 28 (the female) was kept safe from Resident 1's unwanted sexual behavior," the report states.
According to the report the staffer who left to attend another patient "was immediately removed from the nursing unit.
In addition the facility was cited for failing to report the incident to the state Department of Aging, as required by law.
Notification was provided however, to local police and the Area Agency on Aging.
In its plan of correction, the facility formally notified the area agency of the incident and said it would audit all abuse allegations
At the Southwestern Veterans Center in Pittsburgh a patient was injured when he fell headfirst on the floor causing a forehead gash requiring 18 stitches.
The aide had failed to apply leg rests to the wheelchair as ordered and when the wheelchair hit a threshold the patient pitched forward striking the floor.
In its corrective action plan the facility reported it re-evaluated the injured patient and the need for leg rests. The plan also includes evaluating all other wheel chair bound patients for the need for leg rests.
Nissley said the agency's "number one priority is ensuring that our veterans and their spouses receive long term care in a safe and secure and caring environment."
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QTC Loses 4 Contracts After Bid Protest

By Walter F. Roche Jr.



A company with ties to a former U.S. Veterans Affairs Secretary has lost four contracts with the veterans agency as a result of successful protest with the U.S. General Accountability Office.
In awards announced this week QTC Management a subsidiary of Lockheed Martin was stripped of awards it had previously been granted to provide disability exams for veterans in four regions of the country.
QTC, a company with ties to former VA Secretary Anthony Principi, will still have contracts in two VA regions.
With the new awards Logistics Health of LaCrosse, Wisc., also a Lockheed Martin subsidiary, gets contracts in four of seven regions.
The new awards follow a GAO review which found that the "VA made several prejudicial errors in evaluating the proposals for these contracts."
 QTC, a California based firm, was once headed by Principi. More recently the former secretary was signed on as a lobbyist for Lockheed.
He has stated that he was not involved in the recent bidding effort.
In addition to Logistics Health , contracts to conduct medical exams were awarded to Medical Support Los Angeles, Veterans Evaluation Services in Texas and VetFed Services of Virginia.
The contracts, if extensions are exercised could have a total value of $6.8 billion.
In its 23-page decision on the original awards in late March, the GAO said it agreed with the protesting firms that the VA's evaluation of prices was "unreasonable
"The agency (VA) essentially changed the evaluation criteria they used to measure price reasonableness," the decision states.
The GAO found that bidders had not been provided with the needed information to shape their bids.

GAO Details VA Bidding Issues

By Walter F. Roche Jr.

The U.S. Government Accountability Office says the Veterans Administration used unreasonable standards in evaluating the price of medical exams submitted for a contract worth up to $6.8 billion over five years.
In a 23-page decision finally issued today, the audit agency also found that the VA gave one firm more credit than it should have in evaluating its anticipated performance in performing medical exams on veterans seeking disability benefits.
That company, VetFed Services, partnered with another winning bidder, QTC Medical, for most regions of the country, but was going it alone in the district in question.
"We conclude that its assignment of a good rating to VetFed for its past performance in District 2 (Kentucky, Tennessee, Alabama, Georgia, South Carolina and Florida)was unreasonable," the GAO decision states.
As the decision noted VetFed has partnered in the past with QTC by utilizing its staff and computer capabilities.
A shortened version of the decision had been issued earlier in the week, but the final document was delayed while the GAO redacted so-called proprietary information. VA officials have indicated that while they do not plan to rebid the pact, they will address the issues raised by the GAO.
The GAO had recommended in its decision that the VA reopen negotiations with the offerors and solicit and evaluate revised proposals and then make new source selection decisions.
Two bidders, including Veterans Evaluation Services, filed protests of the contract awards after they were announced in the Spring. The awards are for one year with options for four annual renewals.
As for the price evaluation, the GAO found that the VA shifted the way it compared bids without telling the bidders about the changes.
"We agree with the protesters that the agency's evaluation of total prices was unreasonable," GAO General Counsel Susan A. Poling wrote in the decision.
She found that bidders were not provided with the required information to shape their bids.
"The agency (VA) essentially changed the evaluation criteria they used to measure price reasonableness," the decision states.
While sustaining some of the protests, the GAO found several other claims without merit, including the impending sale of QTC to a third party.
QTC, based in Diamond Bar, Calif. was once headed by former VA Secretary Anthony Principi, who now is a registered lobbyist for QTC's parent company, Lockheed Martin. The GAO said that the possible sale of QTC was not relevant.
Principi has stated he was not involved in the bidding effort.
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