Public Service and the Keepers of Accountability

By Jason Bowns

Bathed in a paradox of criticism and hope, the Inspector General (IG) concept dominates current news headlines. The IG is on America’s mind.

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IG reports may satisfy or verify. Then they become targets of ire at other times when critics claim that the IG has not gone far enough – that it has even failed in its duty.

That duty’s wellspring is the IG Act of 1978, as amended. This enabling legislation created separate Offices of Inspector General (OIGs) within federal departments and agencies, with a shared purpose being “to create independent and objective units” while requiring that IG heads “…shall be appointed by the president, by and with the advice and consent of the Senate, without regard to political affiliation and solely on the basis of integrity and demonstrated ability…”

OIG duties include “to conduct and supervise audits and investigations relating to the programs and operations,” as well as “to provide leadership and coordination and recommend policies…to promote economy, efficiency and effectiveness…[and] to prevent and detect fraud and abuse.” There’s also a reporting requirement to keep the establishment head and Congress “fully and currently informed about problems and deficiencies…”

By design, OIGs cannot act upon recommendations, which ensures greater independence and objectivity. The power to act is vested with Congress and executive branch leadership.

Frequently, these recommendations remain words on a page. The Veterans Health Administration (VHA) scandal attests to that. Despite recent public outcry, the U.S. Department of Veterans Affairs (VA) OIG consistently reported severe appointment scheduling deficiencies for years.

In its July 8, 2005, report – published nearly a decade ago – the OIG found that schedulers did not follow established procedures; medical facilities did not have effective electronic waiting list procedures; and there was no effective training program for schedulers. Recommendations included that the VHA “ensure medical facilities prohibit the use of informal waiting lists.”

Two years later, the VA OIG conducted yet another audit. Its 2007 report concluded, “Schedulers were still not following established procedures for making and recording medical appointments,” adding that “the accuracy of VHA’s reported waiting times could not be relied on and the electronic waiting lists at those medical facilities were not complete.” Five of eight recommendations to address scheduling irregularities were still not fully implemented.

The VA OIG published a report May 18, 2008, focusing on VHA health care facilities in New York and New Jersey. There, the OIG determined that wait times were still inaccurate and misstated, scheduling procedures were not followed, schedulers still maintained informal waiting lists, and lower wait times were linked to VHA management bonuses.

Five of eight recommendations from the 2005 report remained unimplemented and all four recommendations for corrective action relayed by the 2007 report remained unimplemented. The VA undersecretary’s reply was that “holding VISN 3 accountable was counterproductive” because it examined “policy solutions that VHA is already addressing.”

In a 2012 report, the VA OIG found that scheduling data measures were inaccurate and unreliable, performance numbers were overstated, noncompliance with mandatory 14-day scheduling time frames was rampant and schedulers did not consistently follow procedures.

Thus, the VA OIG reported serious and systemic appointment wait time deficiencies for years, sharing its recommendations with the VA secretary and Congress, which hold the power to act.

That fact alone may evoke the words of 19th century British philosopher and parliament member Jon Stuart Mill, “A person may cause evil to others not only by his actions but by his inaction, and in either case he is justly accountable to them for the injury.”

Recent news headlines have accused the VA OIG of “softening” its latest fact-finding report into VHA appointment scheduling deficiencies. During hearings in both the House and Senate earlier this month, committee members questioned the VA OIG’s independence, in part because its latest report did not conclusively state that long wait times caused veterans’ deaths.

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In reply, acting VA IG Richard Griffin noted, “The OIG has no authority or responsibility to make determinations as to whether acts or omissions by VA constitute medical negligence under laws of any state…” The IG Act empowers VA OIG to review “programs and operations,” as it did by reporting systemic wait time issues for years. By defending the factual findings and resisting political pressure to exceed its statutory authority, VA OIG exhibits independence.

VA OIG findings also concluded that many schedulers failed to follow published policies. This reinforces how policies on paper, like society’s laws, lack meaning unless individuals choose to heed them. Even when no one else is watching, we’re accountable to ourselves, to our ideals, our principles and our values. Within is where the anti-corruption fight begins – and how it wins.

On July 15, 1944, a wise teenager named Anne Frank wrote that, “Parents can only give good advice or put them on the right path, but the final forming of a person’s character lies in their own hands.”

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