Preliminary GAO report shows many deficiencies in health care for women veterans including lack of privacy.

by Larry Scott, VA Watchdog dot Org

The following GAO report will come as no surprise to women veterans.

VA Health Care: Preliminary Findings on VA's Provision of Health Care Services to Women Veterans  GAO-09-884T, July 14, 2009  Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 33 pages)   Accessible Text

We look forward to the complete report.

We have the preliminary report highlights followed by an AP news story.

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VA HEALTH CARE

Preliminary Findings on VA’s Provision of Health Care Services to Women Veterans

Why GAO Did This Study

Historically, the vast majority of VA patients have been men, but that is changing. VA provided health care to over 281,000 women veterans in 2008—an increase of about 12 percent since 2006—and the number of women veterans in the United States is projected to increase by 17 percent between 2008 and 2033. Women veterans seeking care at VA medical facilities need access to a full range of health care services, including basic gender-specific services—such as cervical cancer screening—and specialized gender-specific services—such as treatment of reproductive cancers.

This testimony, based on ongoing work, discusses GAO’s preliminary findings on (1) the on-site availability of health care services for women veterans at VA facilities, (2) the extent to which VA facilities are following VA policies that apply to the delivery of health care services for women veterans, and (3) key challenges that VA facilities are experiencing in providing health care services for women veterans. GAO reviewed applicable VA policies, interviewed officials, and visited 19 medical facilities—9 VA medical centers (VAMC) and 10 community-based outpatient clinics (CBOC)—and 8 Vet Centers. These facilities were chosen based in part on the number of women using services and whether facilities offered specific programs for women. The results from these site visits cannot be generalized to all VA facilities. GAO shared this statement with VA officials, and they generally agreed with the information presented.

What GAO Found

The VA facilities GAO visited provided basic gender-specific and outpatient mental health services to women veterans on site, and some facilities also provided specialized gender-specific or mental health services specifically designed for women on site. Basic gender-specific services, including pelvic examinations, were available on site at all nine VAMCs and 8 of the 10 CBOCs GAO visited. Almost all of the medical facilities GAO visited offered women veterans access to one or more female providers for their gender-specific care. The availability of specialized gender-specific services for women, including treatments after abnormal cervical cancer screenings and breast cancer, varied by service and facility. All VA medical facilities refer female patients to non-VA providers for obstetric care. Some of the VAMCs GAO visited offered a broad array of other specialized gender-specific services on site, but all contracted or fee-based at least some services. Among CBOCs, the two largest facilities GAO visited offered an array of specialized gender-specific care on site; the other eight referred women to other VA or non-VA facilities for most of these services. Outpatient mental health services for women were widely available at the VAMCs and most Vet Centers GAO visited, but were more limited at some CBOCs. While the two larger CBOCs offered group counseling for women and services specifically for women who have experienced sexual trauma in the military, the smaller CBOCs tended to rely on VAMC staff, often through videoconferencing, to provide mental health services.

The extent to which the VA medical facilities GAO visited were following VA policies that apply to the delivery of health care services for women veterans varied, but none of the facilities had fully implemented these policies. None of the VAMCs and CBOCs GAO visited were fully compliant with VA policy requirements related to privacy for women veterans in all clinical settings where those requirements applied. For example, many of the medical facilities GAO visited did not have adequate visual and auditory privacy in their check-in areas. Further, the facilities GAO visited were in various stages of implementing VA’s new initiative to provide comprehensive primary care for women veterans, but officials at some VAMCs and CBOCs reported that they were unclear about the specific steps they would need to take to meet the goals of the new policy.

Officials at facilities that GAO visited identified a number of challenges they face in providing health care services to the increasing numbers of women veterans seeking VA health care. One challenge was that space constraints have raised issues affecting the provision of health care services. For example, the number, size, or configuration of exam rooms or bathrooms sometimes made it difficult for facilities to comply with VA requirements related to privacy for women veterans. Officials also reported challenges hiring providers with specific training and experience in women’s health care and in mental health care, such as treatment for women veterans with post-traumatic stress disorder or who had experienced military sexual trauma.

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Auditors: Privacy lacking at some VA hospitals

By KIMBERLY HEFLING

WASHINGTON (AP) — Veterans Affairs Department hospitals and clinics aren't always making sure female veterans have privacy when they bathe and receive exams, government auditors said Tuesday.

As thousands of women return from Iraq and Afghanistan and enter the VA's health system, the Government Accountability Office reported that no VA hospital or outpatient clinic under review is complying fully with federal privacy requirements.

GAO investigators found that many VA facilities had gynecological tables that faced the door — including one door that opened to a waiting room. It also found instances where women had to walk through a waiting area to use the restroom, instead of it being next to an exam room as required by VA policy.

At four hospitals investigators visited, women were not guaranteed access to a private bathing facility. In two of those cases, there wasn't a lock on the door.

Female veterans told the Senate Veterans' Affairs committee that VA workers need to be better educated about combat situations that women face in the two ongoing wars. Beyond privacy concerns, there are other issues as well, they said, such as a lack of child care at VA hospitals and difficulty in finding diaper-changing tables.

"Many VA facilities are not prepared to accommodate the presence of children," said Kayla Williams, an Iraq veteran and author. "Several friends have described having to change babies' diapers on the floors of VA hospitals."

A majority of the women who have turned up at VA facilities are between the ages of 20 and 29, and on average are much younger than the average male veteran, the GAO survey found. Nearly 20 percent have been diagnosed with post-traumatic stress disorder, and many experienced sexual trauma while serving. Yet, a smaller percentage of eligible women than men use VA care.

Randall Williamson, director of health care issues at GAO, said while top VA officials are committed to improvements in women's care, hospitals and clinics weren't always taking simple steps to make women more comfortable — such as moving the direction of exam tables.

"Part of it comes down to commitment at the local level," Williamson said. The GAO is the investigative arm of Congress.

Patricia Hayes, chief consultant of the veterans strategic health care group at the VA, said the VA recognizes the care given to women isn't as good as what's offered to men, but it's made changes and will continue to do so.

She said space constraints and the layout of buildings pose challenges, but the VA is putting together long-term plans for construction improvements. Changes under way "will build the system that will provide care equal to the health care needs of all America's veterans, regardless of gender," Hayes said.

In 2008, the VA provided health care to more than 281,000 women veterans, a 12 percent increase from 2006. Over the next two decades, the number of women veterans is expected to increase by 17 percent.

Congress is considering legislation by Sen. Patty Murray, D-Wash., that would mandate a review of barriers keeping women veterans from getting care from the VA and require the VA to start a pilot program to provide child care to women seeking mental health care.

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TOPICS: veterans, veterans' benefits, VA, Department of Veterans' Affairs, DoD, GAO, women veterans health care