Veterans Health Care
VA's Medical Support Role in Emergency Preparedness Gao ID: GAO-05-387R March 23, 2005Since the terrorist attacks on September 11, 2001, the Department of Veterans Affairs (VA) has increased its efforts to plan for and respond to national emergencies, including acts of terrorism and natural disasters. Additionally, in August 2004, the Federal Bureau of Investigation and the Department of Homeland Security announced that military and VA medical facilities were potential terrorist targets. In light of military casualties from conflicts in Afghanistan and Iraq and continued threats of terrorist incidents, Congress asked us to review VA's medical support role in emergency preparedness. Specifically, we agreed to provide information on the following questions: (1) What is VA's role in providing medical support within the U.S. to military personnel in wartime and during national emergencies? (2) What actions has VA taken to improve its internal emergency preparedness to ensure that it is ready to maintain continuity of operations and provision of medical services to veterans? (3) What is VA's role in participating in emergency medical response measures with other federal, state, and local agencies?
GAO found that Public Law 97-174 authorizes VA to provide inpatient medical care to active duty members of the armed services during or immediately following their involvement in armed conflicts during wartime and national emergencies. According to VA, while the Department of Defense (DOD) has never requested priority care from VA based on this law, VA has routinely reported to the Congress and DOD the number of inpatient beds available for military personnel. We also found that VA has taken numerous actions to improve emergency preparedness, such as developing educational and training materials for its staff, training staff at 134 VA medical centers, and increasing security at its facilities by requiring a minimum of two patrolling VA police officers on duty at all times. Other activities, such as developing a systemwide strategy for protecting its facilities and acquiring decontamination equipment, are still in progress. Finally, VA participates in emergency medical response measures with other federal, state, and local agencies by providing assistance in seven support functions outlined in the Department of Homeland Security's National Response Plan. For example, if requested, the types of support VA would provide include public health and medical services, emergency management, and public safety and security.
GAO-05-387R, Veterans Health Care: VA's Medical Support Role in Emergency Preparedness
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March 23, 2005:
The Honorable Steve Buyer:
Chairman:
The Honorable Lane Evans:
Ranking Democratic Member:
Committee on Veterans' Affairs:
House of Representatives:
The Honorable Christopher H. Smith:
House of Representatives:
Subject: Veterans Health Care: VA's Medical Support Role in Emergency
Preparedness:
Since the terrorist attacks on September 11, 2001, the Department of
Veterans Affairs (VA) has increased its efforts to plan for and respond
to national emergencies, including acts of terrorism and natural
disasters. Additionally, in August 2004, the Federal Bureau of
Investigation and the Department of Homeland Security announced that
military and VA medical facilities were potential terrorist targets. In
light of military casualties from conflicts in Afghanistan and Iraq and
continued threats of terrorist incidents, you asked us to review VA's
medical support role in emergency preparedness.
Specifically, we agreed to provide information on the following
questions: (1) What is VA's role in providing medical support within
the U.S. to military personnel in wartime and during national
emergencies? (2) What actions has VA taken to improve its internal
emergency preparedness to ensure that it is ready to maintain
continuity of operations and provision of medical services to veterans?
(3) What is VA's role in participating in emergency medical response
measures with other federal, state, and local agencies?
To answer these questions, we reviewed the laws that establish VA's
emergency preparedness responsibilities, VA policies and procedures
relating to emergency preparedness, and our past reports on VA's
medical support role in emergency preparedness. In addition, we
observed a VA crisis response team meeting and a continuity of
operations exercise. We also interviewed officials responsible for VA's
emergency preparedness programs. Our work was performed from September
2004 through February 2005 in accordance with generally accepted
government auditing standards.
In summary, Public Law 97-174 authorizes VA to provide inpatient
medical care to active duty members of the armed services during or
immediately following their involvement in armed conflicts during
wartime and national emergencies. According to VA, while the Department
of Defense (DOD) has never requested priority care from VA based on
this law; VA has routinely reported to the Congress and DOD the number
of inpatient beds available for military personnel. We also found that
VA has taken numerous actions to improve emergency preparedness, such
as developing educational and training materials for its staff,
training staff at 134 VA medical centers, and increasing security at
its facilities by requiring a minimum of two patrolling VA police
officers on duty at all times. Other activities, such as developing a
systemwide strategy for protecting its facilities and acquiring
decontamination equipment, are still in progress. Finally, VA
participates in emergency medical response measures with other federal,
state, and local agencies by providing assistance in seven support
functions outlined in the Department of Homeland Security's National
Response Plan. For example, if requested, the types of support VA would
provide include public health and medical services, emergency
management, and public safety and security. Enclosure I contains
briefing slides on our findings.
We provided a draft of this report to VA for comment. In its written
comments, VA concurred with the report's findings. VA also provided
technical comments, which we incorporated were appropriate. (See encl.
II for a copy of VA's comments.)
The information contained in this report was provided to your staff on
December 2, 2004. As discussed with your staff during that briefing, we
agreed to issue a report to you containing the information we provided.
We also are sending copies of this report to the Chairman and Ranking
Minority Member, Senate Committee on Veterans' Affairs, the Secretary
of Veterans Affairs, and other interested parties. We will also make
copies available upon request. In addition, the report will be
available at no charge on GAO's Web site at http://www.gao.gov.
If you or your staffs have any questions about this report, please
contact me at (202) 512-7101 or Michael T. Blair, Jr., Assistant
Director, at (404) 679-1944. Cherie' Starck, Cynthia Forbes, and
Julianna Williams made key contributions to this report.
Signed by:
Cynthia A. Bascetta:
Director, Health Care--Veterans' Health and Benefit Issues:
Enclosures - 2:
Enclosure I:
The Department of Veterans Affairs' Medical Support Role in Emergency
Preparedness:
Briefing Report for the Staff of The Honorable Steve Buyer, Chairman,
and The Honorable Lane Evans, Ranking Minority Member, House Committee
on Veterans' Affairs, and The Honorable Christopher H. Smith, House of
Representatives:
March 25, 2005:
The Department of Veterans Affairs' Medical Support Role in Emergency
Preparedness:
* Introduction:
* Key Questions:
* Background:
* Scope and Methodology:
* Results in Brief:
* Answers to Key Questions:
Introduction:
During national emergencies, the Department of Veterans Affairs' (VA)
primary responsibilities are to ensure that eligible veterans have
continuing access to health care and to safeguard VA employees,
patients, and visitors within its medical centers and properties. VA
also has a role in supporting the military medical system within the
U.S. and in participating in emergency medical response measures with
other federal agencies and with state and local governments.
Key Questions:
1. What is VA's role in providing medical support within the U.S. to
military personnel in wartime and during national emergencies?
2. What actions has VA taken to improve its internal emergency
preparedness to ensure that it is ready to maintain continuity of
operations and provision of medical services to veterans?
3. What is VA's role in participating in emergency medical response
measures with other federal, state, and local agencies?
Background:
VA's expenditures for its medical emergency preparedness activities for
fiscal year 2003 were about $37 million. Estimated total amounts for
fiscal years 2004 and 2005 are approximately $44 million and $50
million, respectively. These expenditures would be less than 1 /10 of 1
percent of VA's annual budget.
Two main entities within VA are responsible for emergency preparedness.
* The Office of Operations and Readiness, under VA's Office for Policy,
Planning, and Preparedness, is responsible for emergency preparedness
activities VA-wide and serves as VA's primary liaison with the
Department of Homeland Security and other federal agencies.
* The Emergency Management Strategic Health Care Group (EMSHG) under
VA's Veterans Heath Administration (VHA) [NOTE 1] is responsible for
providing guidance and support to VA medical facilities for emergency
preparedness activities including coordination and with state and local
entities. EMSHG staff are located in planning VA headquarters and
medical centers throughout the country.
On January 6, 2005, the Department of Homeland Security issued its
National Response Plan. [NOTE 2] The purpose of this plan is to provide
a consistent nationwide framework to standardize management practices
and procedures to ensure that federal, state, and local governments can
work together effectively and efficiently to prepare for, respond to,
and recover from domestic incidents including acts of terrorism, major
natural disasters, or man-made emergencies.
* One component of the National Response Plan is the National Disaster
Medical System (NDMS), which is a joint effort of the federal and
private sectors to provide backup to state and local health care
resources in the event of disasters producing mass casualties.
* As part of the National Response Plan, the nation also maintains
strategically placed stockpiles of drugs and medical supplies (pharmacy
caches) to be used in emergencies. VA rocures and maintains some of
these caches for the Department of Homeland Security and the Department
of Health and Human Services' Centers for Disease Control and
Prevention.
* VA also maintains pharmacy caches for the internal use of its medical
centers.
NOTES:
[1] VHA's primary responsibility is the delivery of health care to
veterans. VHA operates 157 VA medical centers and more than 800
outpatient clinics. In fiscal year 2004, VA provided care to over 4.7
million veterans.
[2] Prior to the National Response Plan, the federal government had a
Federal Response Plan that outlined the roles of federal agencies in a
national emergency. Unlike the National Response Plan, this plan did
not incorporate the roles of state and local governments.
Scope and Methodology:
To do our work, we interviewed VA staff from offices with
responsibility for emergency preparedness, including the:
* Office of Operations and Readiness,
* Office of Security and Law Enforcement,
* Office of Public Health and Environmental Hazards,
* Emergency Management Strategic Health Care Group, and
* Office of Facilities Management.
We also:
* reviewed laws that establish VA's emergency preparedness
responsibilities including Public Law 97-174 (VA and Department of
Deense (DOD) Health Resources Sharing and Emergency Operations Act),
Public Law 93-288, as amended (Robert T. Stafford Disaster Relief and
Emergency Assistance Act), and Public Law 107-188 (Public Health
Security and Bioterrorism Preparedness and Response Act of 2002);
* reviewed VA directives, guidebook, handbooks, and a manual relating
to emergency preparedness activities;
* observed a crisis response team meeting and a continuity of
operations exercise; and:
* reviewed the standard operating procedures for maintaining a VA
pharmacy cache.
Our review was conducted from September 2004 through February 2005 in
accordance with generally accepted government auditing standards.
Results in Brief:
VA's primary role to support the military medical system during wartime
and national emergencies is to provide inpatient medical care in the
U.S. for military personnel. VA routinely reports to DOD the number of
VA beds available for active duty casualties. VA's role is outlined in
a memorandum of understanding (MOU) between the two departments.
VA has taken numerous actions to improve emergency preparedness for its
medical facilities. Actions include the development of an Emergency
Management Program Guidebook, educational and training materials, and a
Continuity of Operations Plan (COOP). VA has also established internal
pharmacy caches, eveloped medical center decontamination programs,
trained staff from 134 VA medical centers on decontamination
procedures, and increased security at its facilities by requiring a
minimum of two patrolling VA police officers on duty at all times.
Other activities, such as developing a systemwide strategy for
protecting its facilities and acquiring decontamination equipment, are
still in progress.
VA participates in emergency medical response measures with other
federal, state, and local agencies by providing the support for seven
functions outlined in the National Response Plan. For example, if
requested and resources are available, the types of support VA could
provide include public health and medical services, emergency
management, and public safety and security.
Question 1: VA's Role in Providing Medical Support within the U.S. to
Military Personnel:
Public Law 97-174 authorizes VA to provide medical services to members
of the armed forces during wartime or national emergencies. This law,
enacted in May 1982, was intended for use in the event DOD has
insufficient resources to take care of military casualties. Under the
law, the Secretary of VA is authorized to give active duty personnel
responding to or involved in a war or national emergency a higher
priority for medical services than all veterans, except those with a
service-connected disability. According to VA officials, DOD has never
requested priority care from VA based on this law.
In December 1982, VA and DOD signed an MOU outlining each agency's
responsibilities pertaining to wartime or national emergencies under
the law. On the basis of the MOU, VA projects the number and types of
beds available for active duty personnel. In accordance with the MOU,
the types of beds reported include critical care, medical/surgical, and
psychiatric.
Every other month, and upon request, VA reports to DOD the number of
beds that could immediately be made available for active duty
casualties within 24 hours. Annually, VA also reports to the Congress
and DOD the number of beds likely to be available in 24 hours, 72
hours, and in 30 days. In developing estimates, VA takes into account
the number of veterans that could be discharged or transferred to other
VA medical centers.
In August 2004, VA reported that, as of January 1, 2004, the following
numbers of beds were available for military personnel [NOTE 3]:
* 2,945 in 24 hours,
* 4,618 in 72 hours, and
* 6,035 in 30 days.
NOTE:
[3] VA's National Bed Control System reports that a total of about
18,500 hospital beds were available in the VA health care system on
September 30, 2004.
Question 2: VA's Actions to Improve Its Internal Emergency
Preparedness:
VA has taken numerous actions to improve its internal emergency
preparedness, including:
* developing an Emergency Management Program Guidebook,
* developing educational and training materials for health care
providers,
* developing a COOP,
* establishing pharmacy caches at 143 VA medical centers,
* developing a VA medical center decontamination program, and:
* improving physical security at VA facilities.
VHA has issued an Emergency Management Program Guidebook for developing
an emergency preparedness program. The guidebook is intended to:
* provide VA medical centers with a uniform approach to develop,
implement, and evaluate an emergency preparedness program;
* provide VA medical centers with "best practice" templates that can be
modified to meet local needs; and:
* help ensure compliance with the Joint Commission on Accreditation of
Healthcare Organizations' (JCAHO) [NOTE 4] emergency management
standards.
VA developed a series of educational and training modules for health
care professionals on the medical response to a potential attack with
weapons of mass destruction. The training materials include information
on:
* the role of clinical leadership at a local VA facility, * chemical
warfare agents,
* biological warfare agents,
* radiological warfare agents,
* blast and explosive weapons, and:
* potential effects of weapons of mass destruction on mental health.
VA developed an agencywide COOP so that it can maintain essential
services to veterans during emergencies. The COOP includes:
* a Readiness Operations Center that operates 24 hours, 7 days a week
to monitor and respond to emergencies;
* a succession plan that identifies personnel that can replace key VA
management if they are unavailable in an emergency; and:
* two alternate command locations that can be used to house and support
key VA management in the event VA operations cannot be managed from
headquarters in Washington, D.C.
In addition, each VA medical center developed a site-specific COOP.
VA established pharmacy caches at 143 VA medical centers.
* In an emergency, these caches would be used for short-term treatment
of veterans, VA staff, and visitors at the VA facility.
* Caches come in two sizes, which provide drugs and supplies to treat
either 1,000 or 2,000 patients for 48 hours.
* The contents of all caches are managed centrally through a database
in Hines, Illinois. However, each VA medical center must follow
standard operatin procedures for cache management. For example, A
medical centers must regularly verify that the cache is stored and
secured in a manner consistent with VA policy and that its contents are
accounted for, current, and available for use. EMSHG staff are also
required to inspect the caches annually.
VA developed and funded a decontamination program that includes
training staff, purchasing equipment, and conducting drills at 134 VA
medical centers. [NOTE 5] VA has recently hired a program manager to
provide oversight of the decontamination program across its medical
centers.
* As of September 2004, staff from all 134 medical centers had
completed decontamination training at either North Little Rock,
Arkansas, or Bay Pines, Florida. Each medical center usually sent four
staff to the training.
* VA Medical centers that have received their equipment are required to
conduct two decontamination drills per year.
As of January 2005,
* 57 VA medical centers had ordered and received decontamination
equipment,
* 48 VA medical centers had ordered and were waiting for
decontamination equipment, and:
* 29 VA medical centers were in the process of submitting an order for
decontamination equipment.
VA created a physical security assessment methodology and between July
2003 and Jul 2004 assessed physical security vulnerability at 118 sites
that VA has determined to be most critical to its missions.
* Facilities critical to VA's missions were identified and ranked based
on criteria such as location and importance to VA's operations.
* Almost all of the sites were VA medical centers; others included VA
regional offices, data centers, and a cemetery.
* VA systemwide strategies for protecting its facilities are currently
being developed in response to the findings from these initial
assessments. Further assessments are planned for additional sites and
new facilities.
VA has also increased security at VA medical centers by requiring a
minimum of two patrolling VA police officers on duty at all times.
NOTES:
[4] JCAHO is an independent not-for-profit organization and the
nation's predominant standards-setting and accrediting body in health
care. Its standards set performance expectations for activities that
affect the safety and quality of patient care.
[5] Not all VA medical centers require their own decontamination
program. For example, some medical centers may receive decontamination
services from DOD or nearby affiliated hospitals.
Question 3: VA's Role in Participating in Emergency Response Measures
with other Federal, State, and Local Agencies:
* 43 VA medical centers are designated as NDIVIS federal coordinating
centers. EIVISHG staff at these centers are responsible for
coordinating and reporting on resources available for NDIVIS efforts,
such as patient reception, transportation, and communication plans.
* VA is participating in emergency medical response measures with other
federal, state, and local agencies as outlined in the National Response
Plan.
* Under the plan, VA has a support role in seven emergency support
functions.
Emergency support functions that VA would provide if requested include:
* Public Works and Engineering provide engineering personnel and
support for repair, construction, and restoration of facilities;
* Emergency Management provide coordination of management efforts,
including financial and human capital resources;
* Mass Care, Housing, and Human Services provide food preparation,
medical supplies and personnel, and facilities suitable for mass
shelter;
* Resource Support provide technical assistance in identifying and
procuring medical supplies and other medical services;
* Public Health and Medical Services provide medical support to state
and local governments and assistance in managing human remains;
* Public Safety and Security provide security planning and traffic and
crowd control; and:
* External Affairs provide emergency public information, as well as
media and community relations.
[End of slide presentation]
[End of section]
Enclosure II:
THE SECRETARY OF VETERANS AFFAIRS:
WASHINGTON:
March 18, 2005:
Ms. Cynthia Bascetta:
Director, Health Care - Veterans' Health and Benefits Issues:
U. S. Government Accountability Office:
441 G Street, NW:
Washington, DC 20548:
Dear Ms. Bascetta:
The Department of Veterans Affairs (VA) has reviewed the Government
Accountability Office's (GAO) draft report, VETERANS HEALTH CARE: VA's
Medical Support Role in Emergency Preparedness, (GAO-05-387R) and
concurs with GAO's findings. Further discussion and comments are
included in the enclosure.
VA appreciates the opportunity to comment on your draft report.
Enclosure:
Sincerely yours,
Signed by:
R. James Nicholson:
[End of section]
(290408):
