"At the V.A. San Diego HCS—Imperial Valley VA Clinic, patients and visitors were permitted to freely enter the waiting room."

A snap audit by agents for the Veterans Affairs inspector general has called out San Diego region Veterans Health Administration staffers for failing to properly screen visitors for the coronavirus and asserted that local V.A. facilities are short on supplies and equipment.

"Visits to selected facilities were completed from March 19 through March 24, 2020," according to a March 26 report regarding the system's COVID-19 readiness.

"Inspectors drove to [Veterans Health Administration] medical facilities that were close to their homes and observed or underwent the screening process or both."

"Upon arrival to a facility, [Office of Inspector General] staff did not immediately make their identity known to VHA staff.

"After observing VHA personnel screen individuals who were seeking entrance or being screened themselves or both, OIG staff sought entrance to community living centers ...to determine if they would be denied entrance as a visitor."

"The unannounced visits to facilities were planned to minimize exposure and potential transmission of the novel coronavirus for both V.A. and OIG personnel as well as patients and visitors," the document adds.

"A total of 237 facilities (58 medical centers, 125 community-based outpatient clinics, and 54 community living centers) were visited," according to the report. The bulk of the V.A. facilities received adequate grades, with the San Diego region one of a few outliers.

"Four facilities were observed as having no screening procedures in place. At three locations, [Office of Inspector General] staff presented themselves as visitors and were politely greeted but not asked any COVID-19 screening questions."

"At the fourth facility, the V.A. San Diego HCS—Imperial Valley VA Clinic, patients and visitors were permitted to freely enter the waiting room. The [Office of Inspector General] team entered, stood in the waiting room for 10 minutes, and were not greeted or screened by VHA staff." The Chula Vista VA mental health clinic was also among the four that failed the screening. Veterans clinics in Lakeside and Auburn Gresham, Virginia were faulted for similar failures.

Compounding San Diego's bad marks, officials here reported no plans to share either beds or personal protective equipment supplies with community providers, according to the document.

"Facility leaders were asked about plans to share intensive care unit beds or personal protective equipment with community hospitals, whether there was a written agreement for transfer of COVID-19 patients to non-VA community hospitals when a higher level of care was needed, sharing of V.A. staff with non-VA facilities, and referral patterns."

Fewer than half of the V.A. facilities reviewed nationally had reported such plans, the report notes. "As of March 19, 2020, 23 of the 54 (43 percent) facility leaders reported plans to share ICU beds, personal protective equipment supplies, or both, with community providers. "

Auditors cited the San Diego region for having inadequate supplies of hand sanitizers, N95 respirators, disposable level 4 gowns, surgical masks, and disinfecting/sanitizing wipes, per the report.

"The OIG recognizes that conditions at VHA facilities and veterans' needs related to the COVID-19 pandemic may change rapidly." concluded John Daught, M.D., the agency's assistant inspector general for Health Care Inspections.

"It is hoped that the findings in this report will assist VHA leaders in gaining a better assessment of screening, access, and emergency preparedness at its facilities. This may also be a useful reference for facilities that were not visited to gauge their status."

A March 26 memo from the Veterans Health Administration fired back, contending that the inspector general's audit itself may have jeopardized patient and staff safety.

"We are...deeply concerned that these investigators (many of them clinicians) did not abide by CDC guidelines regarding social distancing, and their movement from one V.A. hospital and Community Clinic to the next could very possibly make them COVID-19 vectors and put our patients and staff at risk."

Responded auditors: "The "'investigators' were nearly all clinicians who volunteered to drive to facilities to conduct the inspection. To leverage that opportunity, OIG leaders determined that asking some questions about readiness and medication, supply, and equipment needs would be of immediate use to both V.A. and other stakeholders.

"All OIG staff screened for conditions before traveling to facilities and did observe CDC guidelines on site. Any inference to the contrary is inaccurate."