Thursday, April 18, 2013
By M. Scott Carter, Journal Record Capitol bureau reporter
OKLAHOMA CITY – An audit of the Oklahoma Department of Veterans Affairs and its seven long-term care centers shows problems with inconsistent training and pervasive substandard wages and raises questions about the way investigations and inspections are performed at the centers, state Auditor and Inspector Gary Jones said Wednesday.
However, ODVA administrators and the nine-member War Veterans Commission have taken some steps to improve the agency, he said.
Done at the request of Republican Gov. Mary Fallin, the performance audit reviewed the operation of the ODVA and its veterans centers. Fallin requested the audit after a yearlong investigation by The Journal Record and OETA showed cases of abuse, rape, neglect and deaths at several of the centers.
In the audit, released Wednesday morning, Jones called on the Legislature to place the veterans centers back under state inspection. He said in some instances, veterans living at the state centers were not guaranteed basic provisions.
“Despite the fact that these residents have served our country during times of war, not every center guarantees resident veterans some of the most basic provisions, such as a clean set of sheets on the weekend or an appropriate response to a complaint of alleged abuse,” Jones wrote in a letter to Fallin that accompanied the report. “These deficiencies in essential services hardly seem a suitable way to repay those who have sacrificed to protect the rest of us and will likely spend the remainder of their lives in such conditions.”
The chairman of the Senate’s Veterans and Military Affairs Committee said the audit underscored work done by lawmakers during the 2012 legislative interim.
“The audit reflects a number of things we found last year,” said Sen. Frank Simpson, R-Ardmore. “It supports the work we’ve been doing.”
Simpson, who said he was still reviewing the document, said he was pleased that the audit called for placing the veterans centers back under state inspection. He said the legislation to change the ODVA inspections, Senate Bill 629, would probably go to a legislative conference committee this week.
In a statement issued Wednesday, Fallin praised the audit. Clearly, the governor said, the report illustrates that improvements are necessary.
“The audit reveals an unacceptable lack of oversight and accountability at the ODVA, particularly at the state’s seven veterans centers,” Fallin said. “These shortcomings are particularly disturbing in light of multiple accusations of abuse and neglect aimed at agency staff, some of which may have resulted in the death of Oklahoma veterans.”
Because of the agency’s problems, Fallin said she would ask lawmakers to work with her to restore accountability and oversight to the ODVA.
“Good legislation has already been filed this session by Sen. Frank Simpson, who has been a tireless advocate for improving services to veterans,” she said. “Senate Bill 629 would require veterans centers to be inspected by the Department of Health, ensuring that veterans living in long-term care facilities are safe and receiving high-quality care and services. A second bill, SB 235, would centralize the management of veterans centers, addressing the inconsistencies in quality highlighted in the ODVA audit. I am strongly encouraging lawmakers to send those bills to my desk to be signed into law.”
In addition to problems with agency oversight, in the audit Jones identified the ODVA’s nursing care as the agency’s highest-risk program and criticized the way the ODVA and its care centers conducted investigations about patient abuse and neglect.
“The fact that internal teams of employees are conducting investigations leads to several concerns,” Jones wrote. “First, internal employees may not be independent. Not only are the investigators likely to know the individuals being investigated but the administrator, who sometimes participates as a team members and receives the investigation results before they are reported to the central office, may be in a position to have the report results changed.”
Jones said abuse reports could be changed from substantiated to unsubstantiated and, in at least one instance, administrators opted to override recommendations from outside parties. The audit also questioned the training received by employees who participate in internal investigations.
“Most internal employees have not received training in investigative techniques and may have other responsibilities at the center,” Jones wrote, “leaving little time to conduct a complete and thorough investigation.”
Jones said the audit includes more than 20 recommendations for improving the system, including stricter enforcement of rules and policies.
“If the commission does not take responsibility for detailed review of inspection results and enforcement of corrective action plans, it must enable another independent reviewing body such as the Oklahoma State Department of Health with enforcement power to ensure the problems found during inspections are actually corrected,” Jones wrote.
Failure to implement the appropriate corrective actions, the auditor wrote, could result in lower-quality care for residents and even a loss of life.
Jones said his investigation showed that current members of the WVC appear to have taken some action toward improving the quality of care for veterans, including the recent appointment of a full-time deputy director to oversee daily operations.
“Our report offers multiple recommendations detailing how the commission may overcome its institutional challenges to implement consistency and accountability,” Jones wrote. “These recommendations are intended as a starting point to reform current practices and shift the agency’s current culture of apathy and disengagement. It won’t happen overnight, but it is possible for ODVA to change its current environment and achieve its mission of providing excellent health services to our veterans today and in the years to come. When it comes to the care of our veterans, doing anything less is not justifiable.”