Jan Dyer

Patients with cancer are at a high risk of venous thromboembolism (VTE)—in fact, it’s one of the leading causes of death in patients who receive systemic therapy for cancer. But as cancer treatment has evolved, have the incidence and risk of VTE changed too?

Researchers from Veterans Affairs Boston Healthcare System in Massachusetts conducted a study with 434,203 veterans to evaluate the pattern of VTE incidence over 16 years, focusing on the types of cancer, treatment, race and ethnicity, and other factors related to cancer-associated thrombosis (CAT).

In contrast with other large population studies, this study found the overall incidence of CAT remained largely stable over time. At 12 months, the incidence was 4.5%, with yearly trends ranging between 4.2% and 4.7%. “As expected,” the researchers say, the subset of patients receiving systemic therapy had a higher incidence of VTE at 12 months (7.7%) than did the overall cohort. The pattern was “particularly pronounced” in gynecologic, testicular, and kidney cancers, where the incidence of VTE was 2 to 3 times higher in the treated cohort compared with the overall cohort. 

Cancer type and diagnosis were the most statistically and clinically significant associations with CAT, with up to a 6-fold difference between cancer subtypes. The patients at the highest risk of VTE were those with pancreatic cancer and acute lymphoblastic leukemia.

Most studies have focused only on patients with solid tumors, but these researchers observed novel patterns among patients with hematologic neoplasms. Specifically, a higher incidence of VTE among patients with aggressive vs indolent leukemias and lymphomas. This trend, the researchers say, may be associated in part with catheter-related events.

Furthermore, the type of system treatment was associated with the risk of VTE, the researchers say, although to a lesser extent. Chemotherapy- and immunotherapy-based regimens had the highest risk of VTE, relative to no treatment. Targeted and endocrine therapy also carried a higher risk compared with no treatment but to a lesser degree.

The researchers found significant heterogeneity by race and ethnicity across cancer types. Non-Hispanic Black patients had about 20% higher risk of VTE compared with non-Hispanic White patients. Asian and Pacific Islander patients had about 20% lower risk compared with non-Hispanic White patients.

Male sex was also associated with VTE. However, “interestingly,” the researchers note, neighborhood-level socioeconomic factors and patients’ comorbidities were not associated with CAT but were associated with mortality.

Their results suggest that patient- and treatment-specific factors play a critical role in assessing the risk of CAT, and “ongoing efforts to identify these patterns are of utmost importance for risk stratification and prognostic assessment.”

Patients with cancer are at a high risk of venous thromboembolism (VTE)—in fact, it’s one of the leading causes of death in patients who receive systemic therapy for cancer. But as cancer treatment has evolved, have the incidence and risk of VTE changed too?

Researchers from Veterans Affairs Boston Healthcare System in Massachusetts conducted a study with 434,203 veterans to evaluate the pattern of VTE incidence over 16 years, focusing on the types of cancer, treatment, race and ethnicity, and other factors related to cancer-associated thrombosis (CAT).

In contrast with other large population studies, this study found the overall incidence of CAT remained largely stable over time. At 12 months, the incidence was 4.5%, with yearly trends ranging between 4.2% and 4.7%. “As expected,” the researchers say, the subset of patients receiving systemic therapy had a higher incidence of VTE at 12 months (7.7%) than did the overall cohort. The pattern was “particularly pronounced” in gynecologic, testicular, and kidney cancers, where the incidence of VTE was 2 to 3 times higher in the treated cohort compared with the overall cohort. 

Cancer type and diagnosis were the most statistically and clinically significant associations with CAT, with up to a 6-fold difference between cancer subtypes. The patients at the highest risk of VTE were those with pancreatic cancer and acute lymphoblastic leukemia.

Most studies have focused only on patients with solid tumors, but these researchers observed novel patterns among patients with hematologic neoplasms. Specifically, a higher incidence of VTE among patients with aggressive vs indolent leukemias and lymphomas. This trend, the researchers say, may be associated in part with catheter-related events.

Furthermore, the type of system treatment was associated with the risk of VTE, the researchers say, although to a lesser extent. Chemotherapy- and immunotherapy-based regimens had the highest risk of VTE, relative to no treatment. Targeted and endocrine therapy also carried a higher risk compared with no treatment but to a lesser degree.

The researchers found significant heterogeneity by race and ethnicity across cancer types. Non-Hispanic Black patients had about 20% higher risk of VTE compared with non-Hispanic White patients. Asian and Pacific Islander patients had about 20% lower risk compared with non-Hispanic White patients.

Male sex was also associated with VTE. However, “interestingly,” the researchers note, neighborhood-level socioeconomic factors and patients’ comorbidities were not associated with CAT but were associated with mortality.

Their results suggest that patient- and treatment-specific factors play a critical role in assessing the risk of CAT, and “ongoing efforts to identify these patterns are of utmost importance for risk stratification and prognostic assessment.”

Patients with cancer are at a high risk of venous thromboembolism (VTE)—in fact, it’s one of the leading causes of death in patients who receive systemic therapy for cancer. But as cancer treatment has evolved, have the incidence and risk of VTE changed too?

Researchers from Veterans Affairs Boston Healthcare System in Massachusetts conducted a study with 434,203 veterans to evaluate the pattern of VTE incidence over 16 years, focusing on the types of cancer, treatment, race and ethnicity, and other factors related to cancer-associated thrombosis (CAT).

In contrast with other large population studies, this study found the overall incidence of CAT remained largely stable over time. At 12 months, the incidence was 4.5%, with yearly trends ranging between 4.2% and 4.7%. “As expected,” the researchers say, the subset of patients receiving systemic therapy had a higher incidence of VTE at 12 months (7.7%) than did the overall cohort. The pattern was “particularly pronounced” in gynecologic, testicular, and kidney cancers, where the incidence of VTE was 2 to 3 times higher in the treated cohort compared with the overall cohort. 

Cancer type and diagnosis were the most statistically and clinically significant associations with CAT, with up to a 6-fold difference between cancer subtypes. The patients at the highest risk of VTE were those with pancreatic cancer and acute lymphoblastic leukemia.

Most studies have focused only on patients with solid tumors, but these researchers observed novel patterns among patients with hematologic neoplasms. Specifically, a higher incidence of VTE among patients with aggressive vs indolent leukemias and lymphomas. This trend, the researchers say, may be associated in part with catheter-related events.

Furthermore, the type of system treatment was associated with the risk of VTE, the researchers say, although to a lesser extent. Chemotherapy- and immunotherapy-based regimens had the highest risk of VTE, relative to no treatment. Targeted and endocrine therapy also carried a higher risk compared with no treatment but to a lesser degree.

The researchers found significant heterogeneity by race and ethnicity across cancer types. Non-Hispanic Black patients had about 20% higher risk of VTE compared with non-Hispanic White patients. Asian and Pacific Islander patients had about 20% lower risk compared with non-Hispanic White patients.

Male sex was also associated with VTE. However, “interestingly,” the researchers note, neighborhood-level socioeconomic factors and patients’ comorbidities were not associated with CAT but were associated with mortality.

Their results suggest that patient- and treatment-specific factors play a critical role in assessing the risk of CAT, and “ongoing efforts to identify these patterns are of utmost importance for risk stratification and prognostic assessment.”

It has been a troubling mystery—and yet, is an unsolved one: Last January, at least 9 service members who had worked at Malmstrom Air Force Base (AFB) in Montana were reported to have been diagnosed with non-Hodgkin lymphoma. Then more cancer cases were reported, not only at Malmstrom, but at Francis E. Warren AFB in Wyoming, Minot AFB in North Dakota, and Vandenberg AFB in California. The bases operate the silos that house nuclear warheads carried by Minuteman III intercontinental ballistic missiles (ICBMs).

In all, 36 cancer cases were reported among missileers: 10 developed non-Hodgkin lymphoma, 2 Hodgkin lymphoma, and 24 another form of cancer. Eight of the missileers, the majority of whom served at Malmstrom between 1997 and 2007, have died.

So far, though, the US Air Force (USAF) reports that it has found no current risk factors that could explain the unusual number of cases.

In February, Gen. Thomas Bussiere, commander of Air Force Global Strike Command, approved a study to conduct a formal assessment related to specific cancer concerns and examine the possibility of cancer clusters at ICBM bases. The Missile Community Cancer Study, conducted by the Air Force School of Aerospace Medicine, will look at all ICBM wings, all missileers, and those who maintain, guard, and support the bases. The review also incorporates active-duty medical data, the US Department of Veterans Affairs cancer registry data, mortality data, and public cancer registries.

Missileers may be exposed to a variety of chemicals and toxins. The potential hazardous materials exposure at the missile silos extends to all 3 missile bases, USAF says. The equipment in the launch control center and equipment buildings were identical. However, each of the ICBM bases has specific environmental and agricultural factors that will be considered as studies continue, according to the USAF. The land surrounding missile alert facilities, launch control centers, and launch facilities is not owned by the government; the study teams noted that locations could contain additional unknown agricultural hazards. Procedures for testing and cleaning the facilities vary across installations, creating inconsistencies, according to the USAF.

The study teams recently presented their initial findings. “[O]verall,” they said, “there were no factors identified that would be considered immediate concerns for acute cancer risks,” according to a report from the USAF 711^th Human Performance Wing, obtained by the Associated Press.

This isn’t the first time that concerns have been raised about possible cancer clusters at Malmstrom. In 2001, after cases of various cancers from missileers were reported—including cervical, thyroid, Hodgkin lymphoma, and non-Hodgkin lymphoma—the Air Force Institute for Operational Health conducted a site evaluation and sampling for possible chemical and biologic contaminants at their facilities. Results of all tests, the 2005 report said, did not demonstrate any levels above acceptable standards according to state and federal regulations. The survey concluded that launch control centers provide a safe and healthy working environment.

In 2005, following the release of the report, the USAF said “There is not sufficient evidence to consider the possibility of a cancer clustering to justify further investigation.” The research report noted, “[S]ometimes illnesses tend to occur by chance alone and it is not uncommon to see clustering or what has been referred to as ‘perceived clustering’ of conditions, especially when they occur in a close group of people or certain communities as in the military.”

On its website, though, the Air Force Medical Service now says that the findings from 2 decades ago may have changed.

The findings from the new study are not final. The USAF is continuing its investigation, including conducting an epidemiological study of cancers within the missile community. In the meantime, Air Force Global Strike Command Public Affairs says that, in response to the review panel’s recommendations, Gen. Bussiere has directed that facilities be deep cleaned regularly, signage denoting the presence of polychlorinated biphenyls be updated, and burning no longer allowed as a means of destroying classified materials inside the facilities.

Notably, the changes will also include improving communication and coordination between medical personnel and missile community members. Bussiere directed his staff to explore specifically assigning medical professionals to ICBM units, to have a better understanding of the environment and missions. He also ordered further engagement with personnel who work with known occupational hazards to collect more data and information. While awaiting the eventual replacement of the Minuteman III ICBM with the LGM-35A Sentinel, preventive maintenance and environmental upgrades will be prioritized and any upgrade or new piece of equipment will be “scrutinized for hazards.”

The USAF has also established a website to address the missileer community’s concerns.

It has been a troubling mystery—and yet, is an unsolved one: Last January, at least 9 service members who had worked at Malmstrom Air Force Base (AFB) in Montana were reported to have been diagnosed with non-Hodgkin lymphoma. Then more cancer cases were reported, not only at Malmstrom, but at Francis E. Warren AFB in Wyoming, Minot AFB in North Dakota, and Vandenberg AFB in California. The bases operate the silos that house nuclear warheads carried by Minuteman III intercontinental ballistic missiles (ICBMs).

In all, 36 cancer cases were reported among missileers: 10 developed non-Hodgkin lymphoma, 2 Hodgkin lymphoma, and 24 another form of cancer. Eight of the missileers, the majority of whom served at Malmstrom between 1997 and 2007, have died.

So far, though, the US Air Force (USAF) reports that it has found no current risk factors that could explain the unusual number of cases.

In February, Gen. Thomas Bussiere, commander of Air Force Global Strike Command, approved a study to conduct a formal assessment related to specific cancer concerns and examine the possibility of cancer clusters at ICBM bases. The Missile Community Cancer Study, conducted by the Air Force School of Aerospace Medicine, will look at all ICBM wings, all missileers, and those who maintain, guard, and support the bases. The review also incorporates active-duty medical data, the US Department of Veterans Affairs cancer registry data, mortality data, and public cancer registries.

Missileers may be exposed to a variety of chemicals and toxins. The potential hazardous materials exposure at the missile silos extends to all 3 missile bases, USAF says. The equipment in the launch control center and equipment buildings were identical. However, each of the ICBM bases has specific environmental and agricultural factors that will be considered as studies continue, according to the USAF. The land surrounding missile alert facilities, launch control centers, and launch facilities is not owned by the government; the study teams noted that locations could contain additional unknown agricultural hazards. Procedures for testing and cleaning the facilities vary across installations, creating inconsistencies, according to the USAF.

The study teams recently presented their initial findings. “[O]verall,” they said, “there were no factors identified that would be considered immediate concerns for acute cancer risks,” according to a report from the USAF 711^th Human Performance Wing, obtained by the Associated Press.

This isn’t the first time that concerns have been raised about possible cancer clusters at Malmstrom. In 2001, after cases of various cancers from missileers were reported—including cervical, thyroid, Hodgkin lymphoma, and non-Hodgkin lymphoma—the Air Force Institute for Operational Health conducted a site evaluation and sampling for possible chemical and biologic contaminants at their facilities. Results of all tests, the 2005 report said, did not demonstrate any levels above acceptable standards according to state and federal regulations. The survey concluded that launch control centers provide a safe and healthy working environment.

In 2005, following the release of the report, the USAF said “There is not sufficient evidence to consider the possibility of a cancer clustering to justify further investigation.” The research report noted, “[S]ometimes illnesses tend to occur by chance alone and it is not uncommon to see clustering or what has been referred to as ‘perceived clustering’ of conditions, especially when they occur in a close group of people or certain communities as in the military.”

On its website, though, the Air Force Medical Service now says that the findings from 2 decades ago may have changed.

The findings from the new study are not final. The USAF is continuing its investigation, including conducting an epidemiological study of cancers within the missile community. In the meantime, Air Force Global Strike Command Public Affairs says that, in response to the review panel’s recommendations, Gen. Bussiere has directed that facilities be deep cleaned regularly, signage denoting the presence of polychlorinated biphenyls be updated, and burning no longer allowed as a means of destroying classified materials inside the facilities.

Notably, the changes will also include improving communication and coordination between medical personnel and missile community members. Bussiere directed his staff to explore specifically assigning medical professionals to ICBM units, to have a better understanding of the environment and missions. He also ordered further engagement with personnel who work with known occupational hazards to collect more data and information. While awaiting the eventual replacement of the Minuteman III ICBM with the LGM-35A Sentinel, preventive maintenance and environmental upgrades will be prioritized and any upgrade or new piece of equipment will be “scrutinized for hazards.”

The USAF has also established a website to address the missileer community’s concerns.

It has been a troubling mystery—and yet, is an unsolved one: Last January, at least 9 service members who had worked at Malmstrom Air Force Base (AFB) in Montana were reported to have been diagnosed with non-Hodgkin lymphoma. Then more cancer cases were reported, not only at Malmstrom, but at Francis E. Warren AFB in Wyoming, Minot AFB in North Dakota, and Vandenberg AFB in California. The bases operate the silos that house nuclear warheads carried by Minuteman III intercontinental ballistic missiles (ICBMs).

In all, 36 cancer cases were reported among missileers: 10 developed non-Hodgkin lymphoma, 2 Hodgkin lymphoma, and 24 another form of cancer. Eight of the missileers, the majority of whom served at Malmstrom between 1997 and 2007, have died.

So far, though, the US Air Force (USAF) reports that it has found no current risk factors that could explain the unusual number of cases.

In February, Gen. Thomas Bussiere, commander of Air Force Global Strike Command, approved a study to conduct a formal assessment related to specific cancer concerns and examine the possibility of cancer clusters at ICBM bases. The Missile Community Cancer Study, conducted by the Air Force School of Aerospace Medicine, will look at all ICBM wings, all missileers, and those who maintain, guard, and support the bases. The review also incorporates active-duty medical data, the US Department of Veterans Affairs cancer registry data, mortality data, and public cancer registries.

Missileers may be exposed to a variety of chemicals and toxins. The potential hazardous materials exposure at the missile silos extends to all 3 missile bases, USAF says. The equipment in the launch control center and equipment buildings were identical. However, each of the ICBM bases has specific environmental and agricultural factors that will be considered as studies continue, according to the USAF. The land surrounding missile alert facilities, launch control centers, and launch facilities is not owned by the government; the study teams noted that locations could contain additional unknown agricultural hazards. Procedures for testing and cleaning the facilities vary across installations, creating inconsistencies, according to the USAF.

The study teams recently presented their initial findings. “[O]verall,” they said, “there were no factors identified that would be considered immediate concerns for acute cancer risks,” according to a report from the USAF 711^th Human Performance Wing, obtained by the Associated Press.

This isn’t the first time that concerns have been raised about possible cancer clusters at Malmstrom. In 2001, after cases of various cancers from missileers were reported—including cervical, thyroid, Hodgkin lymphoma, and non-Hodgkin lymphoma—the Air Force Institute for Operational Health conducted a site evaluation and sampling for possible chemical and biologic contaminants at their facilities. Results of all tests, the 2005 report said, did not demonstrate any levels above acceptable standards according to state and federal regulations. The survey concluded that launch control centers provide a safe and healthy working environment.

In 2005, following the release of the report, the USAF said “There is not sufficient evidence to consider the possibility of a cancer clustering to justify further investigation.” The research report noted, “[S]ometimes illnesses tend to occur by chance alone and it is not uncommon to see clustering or what has been referred to as ‘perceived clustering’ of conditions, especially when they occur in a close group of people or certain communities as in the military.”

On its website, though, the Air Force Medical Service now says that the findings from 2 decades ago may have changed.

The findings from the new study are not final. The USAF is continuing its investigation, including conducting an epidemiological study of cancers within the missile community. In the meantime, Air Force Global Strike Command Public Affairs says that, in response to the review panel’s recommendations, Gen. Bussiere has directed that facilities be deep cleaned regularly, signage denoting the presence of polychlorinated biphenyls be updated, and burning no longer allowed as a means of destroying classified materials inside the facilities.

Notably, the changes will also include improving communication and coordination between medical personnel and missile community members. Bussiere directed his staff to explore specifically assigning medical professionals to ICBM units, to have a better understanding of the environment and missions. He also ordered further engagement with personnel who work with known occupational hazards to collect more data and information. While awaiting the eventual replacement of the Minuteman III ICBM with the LGM-35A Sentinel, preventive maintenance and environmental upgrades will be prioritized and any upgrade or new piece of equipment will be “scrutinized for hazards.”

The USAF has also established a website to address the missileer community’s concerns.

A primary care physician at the Veterans Affairs Medical Center in Decatur, Georgia, has been indicted on several counts of sexual assault of veteran patients. Rajesh Motibhai Patel is accused of violating his patients’ constitutional right to bodily integrity while acting under color of law and of engaging in unwanted sexual contact.

According to US Attorney Ryan Buchanan, Patel allegedly “violated his oath to do no harm to patients under his care.” He allegedly sexually touched 4 female patients during routine examinations.

Patel’s alleged crimes were “horrific and unacceptable,” US Department of Veterans Affairs (VA) press secretary Terrence Hayes said in a statement. “As soon as VA learned of these allegations, we removed this clinician from patient care and reassigned him to a role that had no patient interaction. Whenever a patient comes to VA, they deserve to know that they will be treated with care, compassion, and respect.”

The case is being investigated by the VA Office of Inspector General. Although Patel is only charged at present, not convicted, investigators believe he may have victimized other patients as well. Anyone with information is asked to call the VA-OIG tipline at (770) 758-6646.

A primary care physician at the Veterans Affairs Medical Center in Decatur, Georgia, has been indicted on several counts of sexual assault of veteran patients. Rajesh Motibhai Patel is accused of violating his patients’ constitutional right to bodily integrity while acting under color of law and of engaging in unwanted sexual contact.

According to US Attorney Ryan Buchanan, Patel allegedly “violated his oath to do no harm to patients under his care.” He allegedly sexually touched 4 female patients during routine examinations.

Patel’s alleged crimes were “horrific and unacceptable,” US Department of Veterans Affairs (VA) press secretary Terrence Hayes said in a statement. “As soon as VA learned of these allegations, we removed this clinician from patient care and reassigned him to a role that had no patient interaction. Whenever a patient comes to VA, they deserve to know that they will be treated with care, compassion, and respect.”

The case is being investigated by the VA Office of Inspector General. Although Patel is only charged at present, not convicted, investigators believe he may have victimized other patients as well. Anyone with information is asked to call the VA-OIG tipline at (770) 758-6646.

A primary care physician at the Veterans Affairs Medical Center in Decatur, Georgia, has been indicted on several counts of sexual assault of veteran patients. Rajesh Motibhai Patel is accused of violating his patients’ constitutional right to bodily integrity while acting under color of law and of engaging in unwanted sexual contact.

According to US Attorney Ryan Buchanan, Patel allegedly “violated his oath to do no harm to patients under his care.” He allegedly sexually touched 4 female patients during routine examinations.

Patel’s alleged crimes were “horrific and unacceptable,” US Department of Veterans Affairs (VA) press secretary Terrence Hayes said in a statement. “As soon as VA learned of these allegations, we removed this clinician from patient care and reassigned him to a role that had no patient interaction. Whenever a patient comes to VA, they deserve to know that they will be treated with care, compassion, and respect.”

The case is being investigated by the VA Office of Inspector General. Although Patel is only charged at present, not convicted, investigators believe he may have victimized other patients as well. Anyone with information is asked to call the VA-OIG tipline at (770) 758-6646.

The painful paused and repaused rollout of the new Cerner electronic health record (EHR) system at the US Department of Veterans Affairs (VA) is now halted as the VA announces a “reset.” The decision applies to all planned deployments. An exception is the Captain James A. Lovell Federal Health Care Center in Chicago, the only fully integrated VA and US Department of Defense (DoD) health care system, which is expected go live in March 2024 as planned. The DoD rollout of its Cerner EHR is further along and expected to be completed in 2024.

The new plan is to redirect resources and “prioritize improvements” at the 5 sites currently using the new EHR: Spokane VA Health Care System, VA Walla Walla Health Care, Roseburg VA Health Care System, VA Southern Oregon Health Care, and VA Central Ohio Health Care System. Additional deployments will not be scheduled, the VA says, until it is confident that the new EHR is highly functioning at the current sites and ready to deliver at future sites, as demonstrated by “clear improvements” in the clinician and veteran experience, sustained high performance and high reliability.

“For the past few years, we’ve tried to fix this plane while flying it—and that hasn’t delivered the results that veterans or our staff deserve,” said Neil Evans, MD, acting program executive director at the Electronic Health Record Modernization Integration Office. “This reset changes that. We are going to take the time necessary to get this right for veterans and VA clinicians alike, and that means focusing our resources solely on improving the EHR at the sites where it is currently in use, and improving its fit for VA more broadly. In doing so, we will enhance the EHR for both current and future users, paving the way for successful future deployments.”  

The various EHR rollouts around the country have been bumpy from the beginning, operating by fits and starts as new problems surfaced and were addressed. To be fair, the whole implementation process only started in 2020 (and deployed at the first VA hospital during the COVID-19 pandemic), but in that time, the VA has had to, in its own words, “revise the timeline” again and again. The Boise VA Medical Center, for instance, was originally scheduled to go live June 25, 2022, then a month later—then 2023.

The VA Office of the Inspector General published 3 reports last year that found significant issues, including improperly routed clinical orders. VA Secretary Denis McDonough announced last July that the VA would delay EHR deployments until January 2023 to ensure that the system’s issues had been resolved. “During VA’s subsequent investigation at our current sites,” he said, “several additional technical and system issues were identified—including challenges with performance, such as latency and slowness, problems with patient scheduling, referrals, medication management, and other types of medical orders.”

In February, Ken Glueck, executive vice president of Oracle, wrote a blog post that was both apologia and explanation. Modernization, he said, “doesn’t come with a magic wand and there’s no easy button.”

After the DoD moved to Cerner for a new EHR system, the VA decided to follow suit. The goal was to create a “seamless, longitudinal record”—and that was the beginning of the largest health IT modernization project in history, Glueck said. And, although he didn’t mention it, the beginning of one of the VA’s biggest headaches. The problem, Glueck wrote, was that the new project involved “standardizing procedures and workflows that may have been different across 130 VistA implementations at largely autonomous VA medical centers.”

In June 2022—a significant month in the whole rollout process—Cerner was acquired by Oracle. By Glueck’s lights, that meant the VA “now has essentially 2 vendors for the price of one—one with extensive clinical expertise and one with extensive engineering expertise.”

Oracle, he said, “is hard at work to stabilize and improve performance; make fixes to functionality and design issues; improve training and build a better user experience.” He noted that significant improvements to the system’s capacity and performance have included reducing the most severe outage incidents by 67%.

In a recent statement, House VA Committee Chairman Mike Bost (R-IL) and Technology Modernization Subcommittee Chairman Matt Rosendale (R-MT) said, “We support Secretary McDonough’s decision in the strongest possible terms. The best way to get out of a hole is to stop digging, and we’re encouraged that VA and Oracle Cerner have finally realized that.”

VA and Oracle Cerner are currently working toward an amended contract that will "increase Oracle Cerner’s accountability to deliver a high-functioning, high-reliability, world-class EHR system,” the VA says. As part of the re-set, the VA also will work with Congress on resource requirements. The VA estimates FY 2023 costs will be reduced by $400 million. 

The painful paused and repaused rollout of the new Cerner electronic health record (EHR) system at the US Department of Veterans Affairs (VA) is now halted as the VA announces a “reset.” The decision applies to all planned deployments. An exception is the Captain James A. Lovell Federal Health Care Center in Chicago, the only fully integrated VA and US Department of Defense (DoD) health care system, which is expected go live in March 2024 as planned. The DoD rollout of its Cerner EHR is further along and expected to be completed in 2024.

The new plan is to redirect resources and “prioritize improvements” at the 5 sites currently using the new EHR: Spokane VA Health Care System, VA Walla Walla Health Care, Roseburg VA Health Care System, VA Southern Oregon Health Care, and VA Central Ohio Health Care System. Additional deployments will not be scheduled, the VA says, until it is confident that the new EHR is highly functioning at the current sites and ready to deliver at future sites, as demonstrated by “clear improvements” in the clinician and veteran experience, sustained high performance and high reliability.

“For the past few years, we’ve tried to fix this plane while flying it—and that hasn’t delivered the results that veterans or our staff deserve,” said Neil Evans, MD, acting program executive director at the Electronic Health Record Modernization Integration Office. “This reset changes that. We are going to take the time necessary to get this right for veterans and VA clinicians alike, and that means focusing our resources solely on improving the EHR at the sites where it is currently in use, and improving its fit for VA more broadly. In doing so, we will enhance the EHR for both current and future users, paving the way for successful future deployments.”  

The various EHR rollouts around the country have been bumpy from the beginning, operating by fits and starts as new problems surfaced and were addressed. To be fair, the whole implementation process only started in 2020 (and deployed at the first VA hospital during the COVID-19 pandemic), but in that time, the VA has had to, in its own words, “revise the timeline” again and again. The Boise VA Medical Center, for instance, was originally scheduled to go live June 25, 2022, then a month later—then 2023.

The VA Office of the Inspector General published 3 reports last year that found significant issues, including improperly routed clinical orders. VA Secretary Denis McDonough announced last July that the VA would delay EHR deployments until January 2023 to ensure that the system’s issues had been resolved. “During VA’s subsequent investigation at our current sites,” he said, “several additional technical and system issues were identified—including challenges with performance, such as latency and slowness, problems with patient scheduling, referrals, medication management, and other types of medical orders.”

In February, Ken Glueck, executive vice president of Oracle, wrote a blog post that was both apologia and explanation. Modernization, he said, “doesn’t come with a magic wand and there’s no easy button.”

After the DoD moved to Cerner for a new EHR system, the VA decided to follow suit. The goal was to create a “seamless, longitudinal record”—and that was the beginning of the largest health IT modernization project in history, Glueck said. And, although he didn’t mention it, the beginning of one of the VA’s biggest headaches. The problem, Glueck wrote, was that the new project involved “standardizing procedures and workflows that may have been different across 130 VistA implementations at largely autonomous VA medical centers.”

In June 2022—a significant month in the whole rollout process—Cerner was acquired by Oracle. By Glueck’s lights, that meant the VA “now has essentially 2 vendors for the price of one—one with extensive clinical expertise and one with extensive engineering expertise.”

Oracle, he said, “is hard at work to stabilize and improve performance; make fixes to functionality and design issues; improve training and build a better user experience.” He noted that significant improvements to the system’s capacity and performance have included reducing the most severe outage incidents by 67%.

In a recent statement, House VA Committee Chairman Mike Bost (R-IL) and Technology Modernization Subcommittee Chairman Matt Rosendale (R-MT) said, “We support Secretary McDonough’s decision in the strongest possible terms. The best way to get out of a hole is to stop digging, and we’re encouraged that VA and Oracle Cerner have finally realized that.”

VA and Oracle Cerner are currently working toward an amended contract that will "increase Oracle Cerner’s accountability to deliver a high-functioning, high-reliability, world-class EHR system,” the VA says. As part of the re-set, the VA also will work with Congress on resource requirements. The VA estimates FY 2023 costs will be reduced by $400 million. 

The painful paused and repaused rollout of the new Cerner electronic health record (EHR) system at the US Department of Veterans Affairs (VA) is now halted as the VA announces a “reset.” The decision applies to all planned deployments. An exception is the Captain James A. Lovell Federal Health Care Center in Chicago, the only fully integrated VA and US Department of Defense (DoD) health care system, which is expected go live in March 2024 as planned. The DoD rollout of its Cerner EHR is further along and expected to be completed in 2024.

The new plan is to redirect resources and “prioritize improvements” at the 5 sites currently using the new EHR: Spokane VA Health Care System, VA Walla Walla Health Care, Roseburg VA Health Care System, VA Southern Oregon Health Care, and VA Central Ohio Health Care System. Additional deployments will not be scheduled, the VA says, until it is confident that the new EHR is highly functioning at the current sites and ready to deliver at future sites, as demonstrated by “clear improvements” in the clinician and veteran experience, sustained high performance and high reliability.

“For the past few years, we’ve tried to fix this plane while flying it—and that hasn’t delivered the results that veterans or our staff deserve,” said Neil Evans, MD, acting program executive director at the Electronic Health Record Modernization Integration Office. “This reset changes that. We are going to take the time necessary to get this right for veterans and VA clinicians alike, and that means focusing our resources solely on improving the EHR at the sites where it is currently in use, and improving its fit for VA more broadly. In doing so, we will enhance the EHR for both current and future users, paving the way for successful future deployments.”  

The various EHR rollouts around the country have been bumpy from the beginning, operating by fits and starts as new problems surfaced and were addressed. To be fair, the whole implementation process only started in 2020 (and deployed at the first VA hospital during the COVID-19 pandemic), but in that time, the VA has had to, in its own words, “revise the timeline” again and again. The Boise VA Medical Center, for instance, was originally scheduled to go live June 25, 2022, then a month later—then 2023.

The VA Office of the Inspector General published 3 reports last year that found significant issues, including improperly routed clinical orders. VA Secretary Denis McDonough announced last July that the VA would delay EHR deployments until January 2023 to ensure that the system’s issues had been resolved. “During VA’s subsequent investigation at our current sites,” he said, “several additional technical and system issues were identified—including challenges with performance, such as latency and slowness, problems with patient scheduling, referrals, medication management, and other types of medical orders.”

In February, Ken Glueck, executive vice president of Oracle, wrote a blog post that was both apologia and explanation. Modernization, he said, “doesn’t come with a magic wand and there’s no easy button.”

After the DoD moved to Cerner for a new EHR system, the VA decided to follow suit. The goal was to create a “seamless, longitudinal record”—and that was the beginning of the largest health IT modernization project in history, Glueck said. And, although he didn’t mention it, the beginning of one of the VA’s biggest headaches. The problem, Glueck wrote, was that the new project involved “standardizing procedures and workflows that may have been different across 130 VistA implementations at largely autonomous VA medical centers.”

In June 2022—a significant month in the whole rollout process—Cerner was acquired by Oracle. By Glueck’s lights, that meant the VA “now has essentially 2 vendors for the price of one—one with extensive clinical expertise and one with extensive engineering expertise.”

Oracle, he said, “is hard at work to stabilize and improve performance; make fixes to functionality and design issues; improve training and build a better user experience.” He noted that significant improvements to the system’s capacity and performance have included reducing the most severe outage incidents by 67%.

In a recent statement, House VA Committee Chairman Mike Bost (R-IL) and Technology Modernization Subcommittee Chairman Matt Rosendale (R-MT) said, “We support Secretary McDonough’s decision in the strongest possible terms. The best way to get out of a hole is to stop digging, and we’re encouraged that VA and Oracle Cerner have finally realized that.”

VA and Oracle Cerner are currently working toward an amended contract that will "increase Oracle Cerner’s accountability to deliver a high-functioning, high-reliability, world-class EHR system,” the VA says. As part of the re-set, the VA also will work with Congress on resource requirements. The VA estimates FY 2023 costs will be reduced by $400 million. 

A former manager at the Philadelphia Veterans Affairs Medical Center (VAMC) has been sentenced to 6 months in federal prison for his part in a bribery scheme.

Ralph Johnson was convicted of accepting $30,000 in kickbacks and bribes for steering contracts to Earron and Carlicha Starks, who ran Ekno Medical Supply and Collondale Medical Supply from 2009 to 2019. Johnson served as chief of environmental services at the medical center. He admitted to receiving cash in binders and packages mailed to his home between 2018 and 2019.

The Starkses pleaded guilty first to paying kickbacks on $7 million worth of contracts to Florida VA facilities, then participated in a sting that implicated Johnson.

The VA Office of Inspector General began investigating Johnson in 2018 after the Starkses, who were indicted for bribing staff at US Department of Veterans Affairs (VA) hospitals in Miami and West Palm Beach, Florida, said they also paid officials in VA facilities on the East Coast.

According to the Philadelphia Inquirer, the judge credited Johnson’s past military service and his “extensive cooperation” with federal authorities investigating fraud within the VA. Johnson apologized to his former employers: “Throughout these 2 and a half years [since the arrest] there’s not a day I don’t think about the wrongness that I did.”

In addition to the prison sentence, Johnson has been ordered to pay back, at $50 a month, the $440,000-plus he cost the Philadelphia VAMC in fraudulent and bloated contracts.

Johnson is at least the third Philadelphia VAMC employee indicted or sentenced for fraud since 2020.

A former manager at the Philadelphia Veterans Affairs Medical Center (VAMC) has been sentenced to 6 months in federal prison for his part in a bribery scheme.

Ralph Johnson was convicted of accepting $30,000 in kickbacks and bribes for steering contracts to Earron and Carlicha Starks, who ran Ekno Medical Supply and Collondale Medical Supply from 2009 to 2019. Johnson served as chief of environmental services at the medical center. He admitted to receiving cash in binders and packages mailed to his home between 2018 and 2019.

The Starkses pleaded guilty first to paying kickbacks on $7 million worth of contracts to Florida VA facilities, then participated in a sting that implicated Johnson.

The VA Office of Inspector General began investigating Johnson in 2018 after the Starkses, who were indicted for bribing staff at US Department of Veterans Affairs (VA) hospitals in Miami and West Palm Beach, Florida, said they also paid officials in VA facilities on the East Coast.

According to the Philadelphia Inquirer, the judge credited Johnson’s past military service and his “extensive cooperation” with federal authorities investigating fraud within the VA. Johnson apologized to his former employers: “Throughout these 2 and a half years [since the arrest] there’s not a day I don’t think about the wrongness that I did.”

In addition to the prison sentence, Johnson has been ordered to pay back, at $50 a month, the $440,000-plus he cost the Philadelphia VAMC in fraudulent and bloated contracts.

Johnson is at least the third Philadelphia VAMC employee indicted or sentenced for fraud since 2020.

A former manager at the Philadelphia Veterans Affairs Medical Center (VAMC) has been sentenced to 6 months in federal prison for his part in a bribery scheme.

Ralph Johnson was convicted of accepting $30,000 in kickbacks and bribes for steering contracts to Earron and Carlicha Starks, who ran Ekno Medical Supply and Collondale Medical Supply from 2009 to 2019. Johnson served as chief of environmental services at the medical center. He admitted to receiving cash in binders and packages mailed to his home between 2018 and 2019.

The Starkses pleaded guilty first to paying kickbacks on $7 million worth of contracts to Florida VA facilities, then participated in a sting that implicated Johnson.

The VA Office of Inspector General began investigating Johnson in 2018 after the Starkses, who were indicted for bribing staff at US Department of Veterans Affairs (VA) hospitals in Miami and West Palm Beach, Florida, said they also paid officials in VA facilities on the East Coast.

According to the Philadelphia Inquirer, the judge credited Johnson’s past military service and his “extensive cooperation” with federal authorities investigating fraud within the VA. Johnson apologized to his former employers: “Throughout these 2 and a half years [since the arrest] there’s not a day I don’t think about the wrongness that I did.”

In addition to the prison sentence, Johnson has been ordered to pay back, at $50 a month, the $440,000-plus he cost the Philadelphia VAMC in fraudulent and bloated contracts.

Johnson is at least the third Philadelphia VAMC employee indicted or sentenced for fraud since 2020.

In 2022, the US Department of Veterans Affairs (VA) Office of Inspector General (OIG) received 36 separate serious incident reports involving 32 medical facilities—including a bomb threat. In response to those reports, OIG teams of auditors and criminal investigators visited 70 VA medical facilities in September 2022 to assess security and to issue a formal report.

Noting that VA policy includes an “extensive list of security safeguards” for medical facilities to implement, the OIG focused its review on those that “a person with a reasonable level of security knowledge could assess.” According to their report, released in February, they identified a variety of security vulnerabilities and deficiencies, ranging from shortages of police officers to radios with poor signal strength.

For one, the OIG says, the facilities were designed to provide a welcoming environment, which means the public can enter the grounds freely at many different points. But the open-campus design makes it more difficult to balance security with easy and prompt access for patients. Consequently, the OIG says, “threats may originate from many locations within the medical facility campus itself or in the nearby community.”

Walking around the perimeters of the facility buildings, the OIG teams assessed the security level of 2960 public and nonpublic access doors. They found that 87% of public doors did not have an active security presence, and of those, 23% also did not have a security camera. Moreover, 17% of nonpublic doors were unlocked; 97% of those did not have a security presence, and 43% did not have a security camera. Even more concerning: Some of those doors led to sensitive or restricted facility areas. For example, at one midwestern facility, an unlocked nonpublic access door led to the surgical intensive care unit.

The OIG teams also assessed training records for 170 police officers across the 70 facilities and found that nearly all officers were compliant with training requirements. Most respondents also reported they received adequate training to perform their job duties and provided numerous positive indicators. Well trained or not, though, a notable problem in maintaining security, the OIG teams found, was there simply weren’t enough officers.

The OIG has repeatedly issued reports on significant police officer staffing shortages since at least 2018. VA police officers are not only empowered to make arrests, carry firearms while on duty, and investigate criminal activity within VA’s jurisdiction, but also assist individuals on medical campuses “in myriad ways,” the OIG notes. Staffing shortages are likely to compromise overall facility security, morale, and staff retention and underscore the need for maintaining communication with local law enforcement agencies for assistance, the OIG report points out.

In the OIG surveys, security personnel often noted they were understaffed. Although VA guidance calls for at least 2 VA police officers on duty at all times, 21% of respondents said they were aware of a duty shift during which minimum police staffing requirements were not met. About 37% of respondents expressed concerns about the physical security at their facilities. Some pointed out that the lack of VA police on duty could make it difficult to respond to threats like an active shooter.

In May 2022, the VA issued a directive that established minimum police coverage at medical facilities, as well as a police officer staffing decision tool to help determine appropriate officer levels. It required facilities to have an active security presence in their emergency departments around-the-clock by May 2023. As of September 2022, 58% of the facilities’ emergency departments did not yet have a visible security presence.

The teams also found issues with security devices: 19% of all cameras were not functional; at 24 facilities, more than 20% of the cameras were not working. A few facilities had “highly functional” systems that allowed personnel to monitor the campus thoroughly and even search for specific individuals—but they weren’t always operable.

At one western facility, it came down to a problem that would be frustrating at any time, but alarming for security management: Security personnel could not access the monitoring system because the required security certificates had expired, and no one knew the administrative password. If the system went offline, the OIG team was told, no one could fix the problem without password access. Neither VA’s Office of Information and Technology nor the contractor for the facility’s cameras could override the administrative password.

On the bright side, the OIG teams found that camera video feeds were being actively surveilled by security personnel at 60 of 70 facilities. All but 1 site kept camera footage for an average of 2 weeks or more.

VA policy states that, in addition to at least 2 intermediate weapons (such as batons and pepper spray) uniformed officers must always be issued radios for use while on duty. Survey respondents generally indicated they received their equipment and that it was adequate, but 15% said theirs lacked functionality, such as battery life and signal strength.

Based on the teams’ findings, the OIG made 6 recommendations: (1) delegating a responsible official to monitor and report monthly on facilities’ security-related vacancies; (2) authorizing sufficient staff to inspect VA police forces per the OIG’s 2018 unimplemented recommendation; (3) ensuring medical facility directors appropriately assess VA police staffing needs, authorize associated positions, and leverage available mechanisms to fill vacancies; (4) committing sufficient resources to ensure that facility security measures are adequate, current, and operational; (5) directing Veterans Integrated Services Network police chiefs, in coordination with medical facility directors, facility police chiefs, and facility emergency management leaders, to present a plan to remedy identified security weaknesses; and (6) establishing policy that standardizes the review and retention requirements for facility security camera footage.

The VA concurred with all recommendations and submitted corrective action plans.

In 2022, the US Department of Veterans Affairs (VA) Office of Inspector General (OIG) received 36 separate serious incident reports involving 32 medical facilities—including a bomb threat. In response to those reports, OIG teams of auditors and criminal investigators visited 70 VA medical facilities in September 2022 to assess security and to issue a formal report.

Noting that VA policy includes an “extensive list of security safeguards” for medical facilities to implement, the OIG focused its review on those that “a person with a reasonable level of security knowledge could assess.” According to their report, released in February, they identified a variety of security vulnerabilities and deficiencies, ranging from shortages of police officers to radios with poor signal strength.

For one, the OIG says, the facilities were designed to provide a welcoming environment, which means the public can enter the grounds freely at many different points. But the open-campus design makes it more difficult to balance security with easy and prompt access for patients. Consequently, the OIG says, “threats may originate from many locations within the medical facility campus itself or in the nearby community.”

Walking around the perimeters of the facility buildings, the OIG teams assessed the security level of 2960 public and nonpublic access doors. They found that 87% of public doors did not have an active security presence, and of those, 23% also did not have a security camera. Moreover, 17% of nonpublic doors were unlocked; 97% of those did not have a security presence, and 43% did not have a security camera. Even more concerning: Some of those doors led to sensitive or restricted facility areas. For example, at one midwestern facility, an unlocked nonpublic access door led to the surgical intensive care unit.

The OIG teams also assessed training records for 170 police officers across the 70 facilities and found that nearly all officers were compliant with training requirements. Most respondents also reported they received adequate training to perform their job duties and provided numerous positive indicators. Well trained or not, though, a notable problem in maintaining security, the OIG teams found, was there simply weren’t enough officers.

The OIG has repeatedly issued reports on significant police officer staffing shortages since at least 2018. VA police officers are not only empowered to make arrests, carry firearms while on duty, and investigate criminal activity within VA’s jurisdiction, but also assist individuals on medical campuses “in myriad ways,” the OIG notes. Staffing shortages are likely to compromise overall facility security, morale, and staff retention and underscore the need for maintaining communication with local law enforcement agencies for assistance, the OIG report points out.

In the OIG surveys, security personnel often noted they were understaffed. Although VA guidance calls for at least 2 VA police officers on duty at all times, 21% of respondents said they were aware of a duty shift during which minimum police staffing requirements were not met. About 37% of respondents expressed concerns about the physical security at their facilities. Some pointed out that the lack of VA police on duty could make it difficult to respond to threats like an active shooter.

In May 2022, the VA issued a directive that established minimum police coverage at medical facilities, as well as a police officer staffing decision tool to help determine appropriate officer levels. It required facilities to have an active security presence in their emergency departments around-the-clock by May 2023. As of September 2022, 58% of the facilities’ emergency departments did not yet have a visible security presence.

The teams also found issues with security devices: 19% of all cameras were not functional; at 24 facilities, more than 20% of the cameras were not working. A few facilities had “highly functional” systems that allowed personnel to monitor the campus thoroughly and even search for specific individuals—but they weren’t always operable.

At one western facility, it came down to a problem that would be frustrating at any time, but alarming for security management: Security personnel could not access the monitoring system because the required security certificates had expired, and no one knew the administrative password. If the system went offline, the OIG team was told, no one could fix the problem without password access. Neither VA’s Office of Information and Technology nor the contractor for the facility’s cameras could override the administrative password.

On the bright side, the OIG teams found that camera video feeds were being actively surveilled by security personnel at 60 of 70 facilities. All but 1 site kept camera footage for an average of 2 weeks or more.

VA policy states that, in addition to at least 2 intermediate weapons (such as batons and pepper spray) uniformed officers must always be issued radios for use while on duty. Survey respondents generally indicated they received their equipment and that it was adequate, but 15% said theirs lacked functionality, such as battery life and signal strength.

Based on the teams’ findings, the OIG made 6 recommendations: (1) delegating a responsible official to monitor and report monthly on facilities’ security-related vacancies; (2) authorizing sufficient staff to inspect VA police forces per the OIG’s 2018 unimplemented recommendation; (3) ensuring medical facility directors appropriately assess VA police staffing needs, authorize associated positions, and leverage available mechanisms to fill vacancies; (4) committing sufficient resources to ensure that facility security measures are adequate, current, and operational; (5) directing Veterans Integrated Services Network police chiefs, in coordination with medical facility directors, facility police chiefs, and facility emergency management leaders, to present a plan to remedy identified security weaknesses; and (6) establishing policy that standardizes the review and retention requirements for facility security camera footage.

The VA concurred with all recommendations and submitted corrective action plans.

In 2022, the US Department of Veterans Affairs (VA) Office of Inspector General (OIG) received 36 separate serious incident reports involving 32 medical facilities—including a bomb threat. In response to those reports, OIG teams of auditors and criminal investigators visited 70 VA medical facilities in September 2022 to assess security and to issue a formal report.

Noting that VA policy includes an “extensive list of security safeguards” for medical facilities to implement, the OIG focused its review on those that “a person with a reasonable level of security knowledge could assess.” According to their report, released in February, they identified a variety of security vulnerabilities and deficiencies, ranging from shortages of police officers to radios with poor signal strength.

For one, the OIG says, the facilities were designed to provide a welcoming environment, which means the public can enter the grounds freely at many different points. But the open-campus design makes it more difficult to balance security with easy and prompt access for patients. Consequently, the OIG says, “threats may originate from many locations within the medical facility campus itself or in the nearby community.”

Walking around the perimeters of the facility buildings, the OIG teams assessed the security level of 2960 public and nonpublic access doors. They found that 87% of public doors did not have an active security presence, and of those, 23% also did not have a security camera. Moreover, 17% of nonpublic doors were unlocked; 97% of those did not have a security presence, and 43% did not have a security camera. Even more concerning: Some of those doors led to sensitive or restricted facility areas. For example, at one midwestern facility, an unlocked nonpublic access door led to the surgical intensive care unit.

The OIG teams also assessed training records for 170 police officers across the 70 facilities and found that nearly all officers were compliant with training requirements. Most respondents also reported they received adequate training to perform their job duties and provided numerous positive indicators. Well trained or not, though, a notable problem in maintaining security, the OIG teams found, was there simply weren’t enough officers.

The OIG has repeatedly issued reports on significant police officer staffing shortages since at least 2018. VA police officers are not only empowered to make arrests, carry firearms while on duty, and investigate criminal activity within VA’s jurisdiction, but also assist individuals on medical campuses “in myriad ways,” the OIG notes. Staffing shortages are likely to compromise overall facility security, morale, and staff retention and underscore the need for maintaining communication with local law enforcement agencies for assistance, the OIG report points out.

In the OIG surveys, security personnel often noted they were understaffed. Although VA guidance calls for at least 2 VA police officers on duty at all times, 21% of respondents said they were aware of a duty shift during which minimum police staffing requirements were not met. About 37% of respondents expressed concerns about the physical security at their facilities. Some pointed out that the lack of VA police on duty could make it difficult to respond to threats like an active shooter.

In May 2022, the VA issued a directive that established minimum police coverage at medical facilities, as well as a police officer staffing decision tool to help determine appropriate officer levels. It required facilities to have an active security presence in their emergency departments around-the-clock by May 2023. As of September 2022, 58% of the facilities’ emergency departments did not yet have a visible security presence.

The teams also found issues with security devices: 19% of all cameras were not functional; at 24 facilities, more than 20% of the cameras were not working. A few facilities had “highly functional” systems that allowed personnel to monitor the campus thoroughly and even search for specific individuals—but they weren’t always operable.

At one western facility, it came down to a problem that would be frustrating at any time, but alarming for security management: Security personnel could not access the monitoring system because the required security certificates had expired, and no one knew the administrative password. If the system went offline, the OIG team was told, no one could fix the problem without password access. Neither VA’s Office of Information and Technology nor the contractor for the facility’s cameras could override the administrative password.

On the bright side, the OIG teams found that camera video feeds were being actively surveilled by security personnel at 60 of 70 facilities. All but 1 site kept camera footage for an average of 2 weeks or more.

VA policy states that, in addition to at least 2 intermediate weapons (such as batons and pepper spray) uniformed officers must always be issued radios for use while on duty. Survey respondents generally indicated they received their equipment and that it was adequate, but 15% said theirs lacked functionality, such as battery life and signal strength.

Based on the teams’ findings, the OIG made 6 recommendations: (1) delegating a responsible official to monitor and report monthly on facilities’ security-related vacancies; (2) authorizing sufficient staff to inspect VA police forces per the OIG’s 2018 unimplemented recommendation; (3) ensuring medical facility directors appropriately assess VA police staffing needs, authorize associated positions, and leverage available mechanisms to fill vacancies; (4) committing sufficient resources to ensure that facility security measures are adequate, current, and operational; (5) directing Veterans Integrated Services Network police chiefs, in coordination with medical facility directors, facility police chiefs, and facility emergency management leaders, to present a plan to remedy identified security weaknesses; and (6) establishing policy that standardizes the review and retention requirements for facility security camera footage.

The VA concurred with all recommendations and submitted corrective action plans.

New VA rule proposes to eliminate many copays for Native American veteran.

The US Department of Veterans Affairs (VA) has proposed a new rule that would waive medical copayments incurred on or after January 5, 2022, for eligible American Indian and Alaska Native (AI/AN) veterans.

The policy is intended to encourage veterans to seek regular primary care treatment, the VA says. “It’s no mystery to a lot of people that health care is sometimes hard to come by in many Native American communities,” Travis Trueblood, director of the VA Office of Tribal Health, told reporters in January. “So, this effort by VA will enhance getting people into the facilities, helping them feel welcome and getting them to use those benefits that they've earned.”

Copayments for more than 3 visits to community-based urgent care in any calendar year would still be required. Follow-up care provided by a VA-authorized primary care provider would be exempt from copays. Members of federally recognized tribes are already exempt from copays at Indian Health Service clinics.

Eligibility may be based in part on documentation issued by AI/AN tribal governments to show tribal membership. The VA has proposed the documentation requirement “as this recognizes tribal sovereignty and promotes the Nation-to-Nation relationship that exists between the United States and tribal governments.” The requirement, the notice says, is consistent with the preferences of tribal leaders.

The regulation implements a requirement in the Johnny Isakson and David P. Roe, MD, Veterans Health Care and Benefits Improvement Act of 2020, which prohibited the VA from collecting copayments from AI/AN veterans for hospital care or medical services. Senator Jon Tester (D-MT), chair of the Senate Veterans’ Affairs Committee, and Senator Jerry Moran (R-KS) introduced legislation in 2020 to enact the new policy in January 2022 , which is why the rule is retroactive.

Congress passed the measure as part of a package of veterans’ legislation at the end of 2020, and then-President Donald Trump signed it into law in January 2021. Trueblood said the nature of the federal rulemaking process makes it hard to say exactly when the change will take effect, but that no veteran will be turned away from VA care for not making a copayment, even before the rule is finalized. The VA plans to reimburse eligible veterans who received care in the past year for copayment costs.

“I’m encouraged to see VA answering my call to implement the law and remove burdensome copayments for Native veterans accessing their earned health care,” said Tester in a press release. “The fact is Native veterans have bravely answered the call to duty for generations. And I’ll continue to hold VA accountable in delivering these veterans their long-overdue support.”

New VA rule proposes to eliminate many copays for Native American veteran.

The US Department of Veterans Affairs (VA) has proposed a new rule that would waive medical copayments incurred on or after January 5, 2022, for eligible American Indian and Alaska Native (AI/AN) veterans.

The policy is intended to encourage veterans to seek regular primary care treatment, the VA says. “It’s no mystery to a lot of people that health care is sometimes hard to come by in many Native American communities,” Travis Trueblood, director of the VA Office of Tribal Health, told reporters in January. “So, this effort by VA will enhance getting people into the facilities, helping them feel welcome and getting them to use those benefits that they've earned.”

Copayments for more than 3 visits to community-based urgent care in any calendar year would still be required. Follow-up care provided by a VA-authorized primary care provider would be exempt from copays. Members of federally recognized tribes are already exempt from copays at Indian Health Service clinics.

Eligibility may be based in part on documentation issued by AI/AN tribal governments to show tribal membership. The VA has proposed the documentation requirement “as this recognizes tribal sovereignty and promotes the Nation-to-Nation relationship that exists between the United States and tribal governments.” The requirement, the notice says, is consistent with the preferences of tribal leaders.

The regulation implements a requirement in the Johnny Isakson and David P. Roe, MD, Veterans Health Care and Benefits Improvement Act of 2020, which prohibited the VA from collecting copayments from AI/AN veterans for hospital care or medical services. Senator Jon Tester (D-MT), chair of the Senate Veterans’ Affairs Committee, and Senator Jerry Moran (R-KS) introduced legislation in 2020 to enact the new policy in January 2022 , which is why the rule is retroactive.

Congress passed the measure as part of a package of veterans’ legislation at the end of 2020, and then-President Donald Trump signed it into law in January 2021. Trueblood said the nature of the federal rulemaking process makes it hard to say exactly when the change will take effect, but that no veteran will be turned away from VA care for not making a copayment, even before the rule is finalized. The VA plans to reimburse eligible veterans who received care in the past year for copayment costs.

“I’m encouraged to see VA answering my call to implement the law and remove burdensome copayments for Native veterans accessing their earned health care,” said Tester in a press release. “The fact is Native veterans have bravely answered the call to duty for generations. And I’ll continue to hold VA accountable in delivering these veterans their long-overdue support.”

New VA rule proposes to eliminate many copays for Native American veteran.

The US Department of Veterans Affairs (VA) has proposed a new rule that would waive medical copayments incurred on or after January 5, 2022, for eligible American Indian and Alaska Native (AI/AN) veterans.

The policy is intended to encourage veterans to seek regular primary care treatment, the VA says. “It’s no mystery to a lot of people that health care is sometimes hard to come by in many Native American communities,” Travis Trueblood, director of the VA Office of Tribal Health, told reporters in January. “So, this effort by VA will enhance getting people into the facilities, helping them feel welcome and getting them to use those benefits that they've earned.”

Copayments for more than 3 visits to community-based urgent care in any calendar year would still be required. Follow-up care provided by a VA-authorized primary care provider would be exempt from copays. Members of federally recognized tribes are already exempt from copays at Indian Health Service clinics.

Eligibility may be based in part on documentation issued by AI/AN tribal governments to show tribal membership. The VA has proposed the documentation requirement “as this recognizes tribal sovereignty and promotes the Nation-to-Nation relationship that exists between the United States and tribal governments.” The requirement, the notice says, is consistent with the preferences of tribal leaders.

The regulation implements a requirement in the Johnny Isakson and David P. Roe, MD, Veterans Health Care and Benefits Improvement Act of 2020, which prohibited the VA from collecting copayments from AI/AN veterans for hospital care or medical services. Senator Jon Tester (D-MT), chair of the Senate Veterans’ Affairs Committee, and Senator Jerry Moran (R-KS) introduced legislation in 2020 to enact the new policy in January 2022 , which is why the rule is retroactive.

Congress passed the measure as part of a package of veterans’ legislation at the end of 2020, and then-President Donald Trump signed it into law in January 2021. Trueblood said the nature of the federal rulemaking process makes it hard to say exactly when the change will take effect, but that no veteran will be turned away from VA care for not making a copayment, even before the rule is finalized. The VA plans to reimburse eligible veterans who received care in the past year for copayment costs.

“I’m encouraged to see VA answering my call to implement the law and remove burdensome copayments for Native veterans accessing their earned health care,” said Tester in a press release. “The fact is Native veterans have bravely answered the call to duty for generations. And I’ll continue to hold VA accountable in delivering these veterans their long-overdue support.”

Eight Navy sailors have died by suicide in less than a year. The most recent death was on January 23. Three sailors who died in the past 2 months have more than suicide in common: They were all stationed aboard Navy aircraft carriers undergoing refits: the USS George Washington and the USS Theodore Roosevelt. 

These deaths come only a month after the Navy released a report on 3 deaths by suicide on the George Washington, all of which happened in a single week last April. Military.com reported that the ship’s commander, Capt. Brent Gaut, had said 10 sailors had died by suicide in under a year. 

In November and December 2022, at least 4 sailors assigned to the Mid-Atlantic Regional Maintenance Center (MARMC) in Virginia died by suicide, multiplying concerns about a fleetwide mental health crisis. “I was inundated with the amount of hopelessness at that command,” Kayla Arestivo, a counselor brought in to help, told nbcnews.com. Sailors spoke of being overworked, undervalued, and not getting the mental health help they needed. “Part of it is toxic leadership. The sailors immediately pointed that out,” Arestivo said. 

She noted that many of the people assigned to MARMC are on limited duty due to mental or physical disabilities or have personal stressors that prevent them from full unrestricted duty. Electronics technician Kody Lee Decker, for instance, was on limited duty due to mental health issues when he died by suicide on October 29, 2022, according to a friend. Those people, Arestivo suggested, should have been provided help earlier.

Disabilities are not the only potential risk factors, though. Sailors living aboard the George Washington from April 2021 until April 2022 reported difficult and noisy living conditions with shortages of power, running water, and heat, and poor ventilation. Sailors would sleep in their cars or rent rooms in town rather than stay on board. 

The George Washington has been docked at Newport News [Virginia] Shipbuilding for a major overhaul and repairs since 2017 (expected to extend into 2023, nearly 2 years later than the original deadline). The Navy investigation acknowledged “overwhelming” stress and noted that the living conditions created by an “intense and complex” maintenance process were posing hardships for the sailors, including sleep deprivation. (The Theodore Roosevelt has been at the Puget Sound shipyard since August 2021, although none of the sailors live onboard.)

However, the Navy investigation concluded that the 3 April suicide deaths were not directly connected to living conditions. According to the US Fleet Forces Command, “each Sailor was experiencing unique and individualized life stressors, which were contributing factors leading to their deaths.” The 3 suicide deaths were deemed independent events, with no direct correlation among them.

But the report also charged that leaders were oblivious to the problems, and the mental health care the Navy offered was insufficient: “Multiple command members knew or should have known that MASR Mitchell-Sandor [who died by suicide] was experiencing displeasure with Navy life and could have intervened to help him better cope or seek out available support services.”

In the official response to the Navy report, Rear Adm. John Meier, Commander, Naval Air Force Atlantic, noted that he had convened a “second and broader investigation” to assess quality of life issues and other systemic issues for aircraft carriers undergoing extensive maintenance or construction in the Newport News shipyard. “It is safe to say,” he wrote, that “generations of Navy leaders had become accustomed to the reduced quality of life in the shipyard, and accepted the status quo as par for the course…” 

He agreed that the general stress of the environment was not the root cause of the deaths but was “certainly a contributing factor” in at least one case. The report, he said, placed too much emphasis on the sailor’s personal decisions to not improve his own living conditions (he was offered the opportunity to change berthing) and thus placed “too much burden on him for his situation.” Senior enlisted leadership knew that the sailor was sleeping in his car and counseled him, but Meier found no evidence of follow-through. More senior sailors or an assigned mentor should have been there to support the sailor, Meier said, and help him make decisions that were in his best interests. “This was a time for intrusive leadership.”

Adm. Daryl Caudle, Commander, US Fleet Forces Command, advised revising the wording in the report to say “No one at the command knew, or had a reason to know, of MASR [Xavier] Mitchell-Sandor’s previous suicidal ideations.” He also advised modifying the wording with: “Had the Navy been aware of MASR Mitchell-Sandor’s previous suicidal ideations, existing programs and procedures were in place that make it likely that he would have been placed in a ‘do not arm’ status and received necessary care.”

Vice Admiral Kenneth Whitesell, Commander, Naval Air Force, US Pacific Fleet, also endorsed the report findings with some revisions, saying, “We cannot assume these issues are isolated to a single ship, or to shipyards alone. Rather, these 3 tragic losses brought to light the ultimate need to remain laser-focused on providing care and guidance to our sailors.”

The Navy is providing mental health support to sailors, including an embedded mental health team and 2 civilian resiliency counselors who work on the George Washington. According to an action update in the report, Commander, Naval Air Force directed all CVNs and Naval Aviation Units to have a minimum of 1 safeTALK (Suicide Alertness For Everyone; Tell, Ask, Listen and KeepSafe) trained member onboard, and 2 to 3 safeTALK trained personnel in each division no later than December 31, 2022. 

At MARMC, Arestivo was brought in for several mandatory suicide prevention sessions but without systemic changes, she said, “We’re putting Band-Aids on bullet holes.”

She said she told MARMC’s commanding officer, “You will have another one.” The fourth sailor died by suicide 10 days later.

If you or someone you know is having thoughts of suicide, call or text 988 to reach the National Suicide Prevention Lifeline or contact the Veterans Crisis Line. 

Eight Navy sailors have died by suicide in less than a year. The most recent death was on January 23. Three sailors who died in the past 2 months have more than suicide in common: They were all stationed aboard Navy aircraft carriers undergoing refits: the USS George Washington and the USS Theodore Roosevelt. 

These deaths come only a month after the Navy released a report on 3 deaths by suicide on the George Washington, all of which happened in a single week last April. Military.com reported that the ship’s commander, Capt. Brent Gaut, had said 10 sailors had died by suicide in under a year. 

In November and December 2022, at least 4 sailors assigned to the Mid-Atlantic Regional Maintenance Center (MARMC) in Virginia died by suicide, multiplying concerns about a fleetwide mental health crisis. “I was inundated with the amount of hopelessness at that command,” Kayla Arestivo, a counselor brought in to help, told nbcnews.com. Sailors spoke of being overworked, undervalued, and not getting the mental health help they needed. “Part of it is toxic leadership. The sailors immediately pointed that out,” Arestivo said. 

She noted that many of the people assigned to MARMC are on limited duty due to mental or physical disabilities or have personal stressors that prevent them from full unrestricted duty. Electronics technician Kody Lee Decker, for instance, was on limited duty due to mental health issues when he died by suicide on October 29, 2022, according to a friend. Those people, Arestivo suggested, should have been provided help earlier.

Disabilities are not the only potential risk factors, though. Sailors living aboard the George Washington from April 2021 until April 2022 reported difficult and noisy living conditions with shortages of power, running water, and heat, and poor ventilation. Sailors would sleep in their cars or rent rooms in town rather than stay on board. 

The George Washington has been docked at Newport News [Virginia] Shipbuilding for a major overhaul and repairs since 2017 (expected to extend into 2023, nearly 2 years later than the original deadline). The Navy investigation acknowledged “overwhelming” stress and noted that the living conditions created by an “intense and complex” maintenance process were posing hardships for the sailors, including sleep deprivation. (The Theodore Roosevelt has been at the Puget Sound shipyard since August 2021, although none of the sailors live onboard.)

However, the Navy investigation concluded that the 3 April suicide deaths were not directly connected to living conditions. According to the US Fleet Forces Command, “each Sailor was experiencing unique and individualized life stressors, which were contributing factors leading to their deaths.” The 3 suicide deaths were deemed independent events, with no direct correlation among them.

But the report also charged that leaders were oblivious to the problems, and the mental health care the Navy offered was insufficient: “Multiple command members knew or should have known that MASR Mitchell-Sandor [who died by suicide] was experiencing displeasure with Navy life and could have intervened to help him better cope or seek out available support services.”

In the official response to the Navy report, Rear Adm. John Meier, Commander, Naval Air Force Atlantic, noted that he had convened a “second and broader investigation” to assess quality of life issues and other systemic issues for aircraft carriers undergoing extensive maintenance or construction in the Newport News shipyard. “It is safe to say,” he wrote, that “generations of Navy leaders had become accustomed to the reduced quality of life in the shipyard, and accepted the status quo as par for the course…” 

He agreed that the general stress of the environment was not the root cause of the deaths but was “certainly a contributing factor” in at least one case. The report, he said, placed too much emphasis on the sailor’s personal decisions to not improve his own living conditions (he was offered the opportunity to change berthing) and thus placed “too much burden on him for his situation.” Senior enlisted leadership knew that the sailor was sleeping in his car and counseled him, but Meier found no evidence of follow-through. More senior sailors or an assigned mentor should have been there to support the sailor, Meier said, and help him make decisions that were in his best interests. “This was a time for intrusive leadership.”

Adm. Daryl Caudle, Commander, US Fleet Forces Command, advised revising the wording in the report to say “No one at the command knew, or had a reason to know, of MASR [Xavier] Mitchell-Sandor’s previous suicidal ideations.” He also advised modifying the wording with: “Had the Navy been aware of MASR Mitchell-Sandor’s previous suicidal ideations, existing programs and procedures were in place that make it likely that he would have been placed in a ‘do not arm’ status and received necessary care.”

Vice Admiral Kenneth Whitesell, Commander, Naval Air Force, US Pacific Fleet, also endorsed the report findings with some revisions, saying, “We cannot assume these issues are isolated to a single ship, or to shipyards alone. Rather, these 3 tragic losses brought to light the ultimate need to remain laser-focused on providing care and guidance to our sailors.”

The Navy is providing mental health support to sailors, including an embedded mental health team and 2 civilian resiliency counselors who work on the George Washington. According to an action update in the report, Commander, Naval Air Force directed all CVNs and Naval Aviation Units to have a minimum of 1 safeTALK (Suicide Alertness For Everyone; Tell, Ask, Listen and KeepSafe) trained member onboard, and 2 to 3 safeTALK trained personnel in each division no later than December 31, 2022. 

At MARMC, Arestivo was brought in for several mandatory suicide prevention sessions but without systemic changes, she said, “We’re putting Band-Aids on bullet holes.”

She said she told MARMC’s commanding officer, “You will have another one.” The fourth sailor died by suicide 10 days later.

If you or someone you know is having thoughts of suicide, call or text 988 to reach the National Suicide Prevention Lifeline or contact the Veterans Crisis Line. 

Eight Navy sailors have died by suicide in less than a year. The most recent death was on January 23. Three sailors who died in the past 2 months have more than suicide in common: They were all stationed aboard Navy aircraft carriers undergoing refits: the USS George Washington and the USS Theodore Roosevelt. 

These deaths come only a month after the Navy released a report on 3 deaths by suicide on the George Washington, all of which happened in a single week last April. Military.com reported that the ship’s commander, Capt. Brent Gaut, had said 10 sailors had died by suicide in under a year. 

In November and December 2022, at least 4 sailors assigned to the Mid-Atlantic Regional Maintenance Center (MARMC) in Virginia died by suicide, multiplying concerns about a fleetwide mental health crisis. “I was inundated with the amount of hopelessness at that command,” Kayla Arestivo, a counselor brought in to help, told nbcnews.com. Sailors spoke of being overworked, undervalued, and not getting the mental health help they needed. “Part of it is toxic leadership. The sailors immediately pointed that out,” Arestivo said. 

She noted that many of the people assigned to MARMC are on limited duty due to mental or physical disabilities or have personal stressors that prevent them from full unrestricted duty. Electronics technician Kody Lee Decker, for instance, was on limited duty due to mental health issues when he died by suicide on October 29, 2022, according to a friend. Those people, Arestivo suggested, should have been provided help earlier.

Disabilities are not the only potential risk factors, though. Sailors living aboard the George Washington from April 2021 until April 2022 reported difficult and noisy living conditions with shortages of power, running water, and heat, and poor ventilation. Sailors would sleep in their cars or rent rooms in town rather than stay on board. 

The George Washington has been docked at Newport News [Virginia] Shipbuilding for a major overhaul and repairs since 2017 (expected to extend into 2023, nearly 2 years later than the original deadline). The Navy investigation acknowledged “overwhelming” stress and noted that the living conditions created by an “intense and complex” maintenance process were posing hardships for the sailors, including sleep deprivation. (The Theodore Roosevelt has been at the Puget Sound shipyard since August 2021, although none of the sailors live onboard.)

However, the Navy investigation concluded that the 3 April suicide deaths were not directly connected to living conditions. According to the US Fleet Forces Command, “each Sailor was experiencing unique and individualized life stressors, which were contributing factors leading to their deaths.” The 3 suicide deaths were deemed independent events, with no direct correlation among them.

But the report also charged that leaders were oblivious to the problems, and the mental health care the Navy offered was insufficient: “Multiple command members knew or should have known that MASR Mitchell-Sandor [who died by suicide] was experiencing displeasure with Navy life and could have intervened to help him better cope or seek out available support services.”

In the official response to the Navy report, Rear Adm. John Meier, Commander, Naval Air Force Atlantic, noted that he had convened a “second and broader investigation” to assess quality of life issues and other systemic issues for aircraft carriers undergoing extensive maintenance or construction in the Newport News shipyard. “It is safe to say,” he wrote, that “generations of Navy leaders had become accustomed to the reduced quality of life in the shipyard, and accepted the status quo as par for the course…” 

He agreed that the general stress of the environment was not the root cause of the deaths but was “certainly a contributing factor” in at least one case. The report, he said, placed too much emphasis on the sailor’s personal decisions to not improve his own living conditions (he was offered the opportunity to change berthing) and thus placed “too much burden on him for his situation.” Senior enlisted leadership knew that the sailor was sleeping in his car and counseled him, but Meier found no evidence of follow-through. More senior sailors or an assigned mentor should have been there to support the sailor, Meier said, and help him make decisions that were in his best interests. “This was a time for intrusive leadership.”

Adm. Daryl Caudle, Commander, US Fleet Forces Command, advised revising the wording in the report to say “No one at the command knew, or had a reason to know, of MASR [Xavier] Mitchell-Sandor’s previous suicidal ideations.” He also advised modifying the wording with: “Had the Navy been aware of MASR Mitchell-Sandor’s previous suicidal ideations, existing programs and procedures were in place that make it likely that he would have been placed in a ‘do not arm’ status and received necessary care.”

Vice Admiral Kenneth Whitesell, Commander, Naval Air Force, US Pacific Fleet, also endorsed the report findings with some revisions, saying, “We cannot assume these issues are isolated to a single ship, or to shipyards alone. Rather, these 3 tragic losses brought to light the ultimate need to remain laser-focused on providing care and guidance to our sailors.”

The Navy is providing mental health support to sailors, including an embedded mental health team and 2 civilian resiliency counselors who work on the George Washington. According to an action update in the report, Commander, Naval Air Force directed all CVNs and Naval Aviation Units to have a minimum of 1 safeTALK (Suicide Alertness For Everyone; Tell, Ask, Listen and KeepSafe) trained member onboard, and 2 to 3 safeTALK trained personnel in each division no later than December 31, 2022. 

At MARMC, Arestivo was brought in for several mandatory suicide prevention sessions but without systemic changes, she said, “We’re putting Band-Aids on bullet holes.”

She said she told MARMC’s commanding officer, “You will have another one.” The fourth sailor died by suicide 10 days later.

If you or someone you know is having thoughts of suicide, call or text 988 to reach the National Suicide Prevention Lifeline or contact the Veterans Crisis Line. 

Cases of nonventilator-associated hospital-acquired pneumonia (NV-HAP) declined by 32% between 2015 and 2020. Then, of course, COVID-19 changed the trajectory and rates began to rise. After February 2020, the incidence rate rose by 25% among veterans without COVID-19—but by 108% among those who had COVID-19. 

Those are findings from a study by researchers at Rocky Mountain Regional VA Medical Center, Aurora, Colorado. They studied data on 1,567,275 veterans admitted to 135 VA facilities in acute care settings between October 2015 and March 2021, with a stay of at least 48 hours.

They say, to their knowledge, this is the first published report of changes in NV-HAP risk associated with the onset of COVID-19 among all hospitalized veterans in a national health care system.

The questions for the researchers were: What drove the increase in NV-HAP rates? Was it the elevated risk among veterans with COVID-19, reduced NV-HAP prevention measures during the extreme pandemic-related stress on the system, and/or increased patient acuity among hospitalized veterans? 

They concluded that the observed increase in NV-HAP risk among all patients during the COVID-19 pandemic is “likely multifactorial.” The stresses on clinical workload may have hampered fundamental preventive nursing care, such as early mobility programs, consistent oral care, and aspiration precautions. The researchers also cite barriers including wearing personal protective equipment, which affected communication and the ability to get needed supplies to the bedside without cross-contamination.

Among patients with COVID-19 infections, the greater NV-HAP risk could be due to changes in the lower respiratory tract microbiome, disruption of the immune response, and synergism seen with COVID-19 infection. Moreover, they note, placing patients in a prone position to improve oxygenation might have raised the risk of NV-HAP.

The hospitalized veterans in the study also had a high burden of clinical comorbidities. Those with COVID-19 were more likely to have documented diagnosis of dementia in the previous year, compared with COVID-19-negative veterans or those hospitalized before the pandemic began. The researchers point out that dementia increased the risk of microaspiration, which can lead to secondary bacterial pneumonia.

In addition to reinforcing prevention efforts, the researchers suggest that NV-HAP monitoring via automated electronic surveillance could “serve as a cornerstone of a strong infection prevention program.” A system like that, installed before the pandemic, they say, might have identified the NV-HAP risk sooner. 

Most importantly, they add, strategies to reduce NV-HAP risk “should be designed with resilience to significant system stress such as the COVID-19 pandemic.” 

Cases of nonventilator-associated hospital-acquired pneumonia (NV-HAP) declined by 32% between 2015 and 2020. Then, of course, COVID-19 changed the trajectory and rates began to rise. After February 2020, the incidence rate rose by 25% among veterans without COVID-19—but by 108% among those who had COVID-19. 

Those are findings from a study by researchers at Rocky Mountain Regional VA Medical Center, Aurora, Colorado. They studied data on 1,567,275 veterans admitted to 135 VA facilities in acute care settings between October 2015 and March 2021, with a stay of at least 48 hours.

They say, to their knowledge, this is the first published report of changes in NV-HAP risk associated with the onset of COVID-19 among all hospitalized veterans in a national health care system.

The questions for the researchers were: What drove the increase in NV-HAP rates? Was it the elevated risk among veterans with COVID-19, reduced NV-HAP prevention measures during the extreme pandemic-related stress on the system, and/or increased patient acuity among hospitalized veterans? 

They concluded that the observed increase in NV-HAP risk among all patients during the COVID-19 pandemic is “likely multifactorial.” The stresses on clinical workload may have hampered fundamental preventive nursing care, such as early mobility programs, consistent oral care, and aspiration precautions. The researchers also cite barriers including wearing personal protective equipment, which affected communication and the ability to get needed supplies to the bedside without cross-contamination.

Among patients with COVID-19 infections, the greater NV-HAP risk could be due to changes in the lower respiratory tract microbiome, disruption of the immune response, and synergism seen with COVID-19 infection. Moreover, they note, placing patients in a prone position to improve oxygenation might have raised the risk of NV-HAP.

The hospitalized veterans in the study also had a high burden of clinical comorbidities. Those with COVID-19 were more likely to have documented diagnosis of dementia in the previous year, compared with COVID-19-negative veterans or those hospitalized before the pandemic began. The researchers point out that dementia increased the risk of microaspiration, which can lead to secondary bacterial pneumonia.

In addition to reinforcing prevention efforts, the researchers suggest that NV-HAP monitoring via automated electronic surveillance could “serve as a cornerstone of a strong infection prevention program.” A system like that, installed before the pandemic, they say, might have identified the NV-HAP risk sooner. 

Most importantly, they add, strategies to reduce NV-HAP risk “should be designed with resilience to significant system stress such as the COVID-19 pandemic.” 

Cases of nonventilator-associated hospital-acquired pneumonia (NV-HAP) declined by 32% between 2015 and 2020. Then, of course, COVID-19 changed the trajectory and rates began to rise. After February 2020, the incidence rate rose by 25% among veterans without COVID-19—but by 108% among those who had COVID-19. 

Those are findings from a study by researchers at Rocky Mountain Regional VA Medical Center, Aurora, Colorado. They studied data on 1,567,275 veterans admitted to 135 VA facilities in acute care settings between October 2015 and March 2021, with a stay of at least 48 hours.

They say, to their knowledge, this is the first published report of changes in NV-HAP risk associated with the onset of COVID-19 among all hospitalized veterans in a national health care system.

The questions for the researchers were: What drove the increase in NV-HAP rates? Was it the elevated risk among veterans with COVID-19, reduced NV-HAP prevention measures during the extreme pandemic-related stress on the system, and/or increased patient acuity among hospitalized veterans? 

They concluded that the observed increase in NV-HAP risk among all patients during the COVID-19 pandemic is “likely multifactorial.” The stresses on clinical workload may have hampered fundamental preventive nursing care, such as early mobility programs, consistent oral care, and aspiration precautions. The researchers also cite barriers including wearing personal protective equipment, which affected communication and the ability to get needed supplies to the bedside without cross-contamination.

Among patients with COVID-19 infections, the greater NV-HAP risk could be due to changes in the lower respiratory tract microbiome, disruption of the immune response, and synergism seen with COVID-19 infection. Moreover, they note, placing patients in a prone position to improve oxygenation might have raised the risk of NV-HAP.

The hospitalized veterans in the study also had a high burden of clinical comorbidities. Those with COVID-19 were more likely to have documented diagnosis of dementia in the previous year, compared with COVID-19-negative veterans or those hospitalized before the pandemic began. The researchers point out that dementia increased the risk of microaspiration, which can lead to secondary bacterial pneumonia.

In addition to reinforcing prevention efforts, the researchers suggest that NV-HAP monitoring via automated electronic surveillance could “serve as a cornerstone of a strong infection prevention program.” A system like that, installed before the pandemic, they say, might have identified the NV-HAP risk sooner. 

Most importantly, they add, strategies to reduce NV-HAP risk “should be designed with resilience to significant system stress such as the COVID-19 pandemic.” 

To paraphrase Winston Churchill, Gulf War Illness (GWI) is a mystery wrapped in an enigma—a complex interplay of multiple symptoms, caused by a variety of environmental and chemical hazards. To make things more difficult, there are no diagnostic biomarkers or objective laboratory tests with which to confirm a GWI case. Instead, clinicians rely on patients’ reports of symptoms and the absence of other explanations for the symptoms.

Looking to provide more information on the epidemiology and biology of GWI, US Department of Veterans Affairs (VA) researchers analyzed data from the VA Cooperative Studies Program 2006/Million Veteran Program 029 cohort, the largest sample of GW-era veterans available for research to date: 35,902 veterans, of whom 13,107 deployed to a post 9/11 Persian Gulf conflict.

The researchers used the Kansas (KS) and Centers for Disease Control and Prevention (CDC) definitions of GWI, both of which are based on patient self-reports. The KS GWI criteria for phenotype KS Sym+ require ≥ 2 mild symptoms or ≥ 1 moderate or severe symptoms in at least 3 of 6 domains: fatigue/sleep problems, pain, neurologic/cognitive/mood, gastrointestinal, respiratory, and skin. The criteria for phenotype KS Sym+/Dx- also exclude some diagnosed health conditions, such as cancer, diabetes mellitus, and heart disease. The researchers examined both of these phenotypes.

They also used 2 phenotypes of the CDC definition: CDC GWI is met if the veteran reports ≥ 1 symptoms in 2 of 3 domains (fatigue, musculoskeletal, and mood/cognition). The second, CDC GWI severe, is met if the veteran rates ≥ 1 symptoms as severe in ≥ 2 domains.

Of the veterans studied, 67.1% met the KS Sym+ phenotype; 21.5% met the KS Sym+/Dx– definition. A majority (81.1%) met the CDC GWI phenotype; 18.6% met the severe phenotype. The most prevalent KS GWI domains were neurologic/cognitive/mood (81.9%), fatigue/sleep problems (73.9%), and pain (71.5%).

Although their findings mainly laid a foundation for further research, the researchers pointed to some potential new avenues for exploration. For instance, “Importantly,” the researchers say, “we consistently observed that deployed relative to nondeployed veterans had higher odds of meeting each GWI phenotype.” For both deployed and nondeployed veterans, those who served in the Army or Marine Corps had higher odds of meeting the KS Sym+, CDC GWI, and CDC GWI severe phenotypes. Among the deployed, Reservists had higher odds of CDC GWI and CDC GWI severe than did active-duty veterans.

Their findings also revealed that older age was associated with lower odds of meeting the GWI phenotypes. “[S]omewhat surprisingly,” they note, this finding held in both nondeployed and deployed samples, even after adjusting for military rank during the war. The researchers cite other research that has suggested younger service members are at greater risk for GWI (because they’re more likely, for example, to be exposed to deployment-related toxins). Most studies, the researchers note, have shown GWI and related symptoms to be more common among enlisted personnel than officers. Biomarkers of aging, such as epigenetic age acceleration, they suggest, “may be useful in untangling the relationship between age and GWI case status.” 

Because they separately examined the association of demographic characteristics with the GWI phenotypes, the researchers also found that women, regardless of deployment status, had higher odds of meeting the GWI phenotypes compared with men.

Their findings will be used, the researchers say, “to understand how genetic variation is associated with the GWI phenotypes and to identify potential pathophysiologic underpinnings of GWI, pleiotropy with other traits, and gene by environment interactions.” With information from this large dataset of GW-era veterans, they will have a “powerful tool” for in-depth study of exposures and underlying genetic susceptibility to GWI—studies that could not be performed, they say, without the full description of the GWI phenotypes they have documented.

The study had several strengths, the researchers say. For example, unlike previous studies, this one had a sample size large enough to allow more representation of subpopulations, including age, sex, race, ethnicity, education, and military service. The researchers also collected data from surveys, especially data on veterans’ self-reported symptoms and other information “incompletely and infrequently documented in medical records.”

Finally, the data for the study were collected more than 27 years after the GW. It, therefore, gives an “updated, detailed description” of symptoms and conditions affecting GW-era veterans, decades after their return from service.

To paraphrase Winston Churchill, Gulf War Illness (GWI) is a mystery wrapped in an enigma—a complex interplay of multiple symptoms, caused by a variety of environmental and chemical hazards. To make things more difficult, there are no diagnostic biomarkers or objective laboratory tests with which to confirm a GWI case. Instead, clinicians rely on patients’ reports of symptoms and the absence of other explanations for the symptoms.

Looking to provide more information on the epidemiology and biology of GWI, US Department of Veterans Affairs (VA) researchers analyzed data from the VA Cooperative Studies Program 2006/Million Veteran Program 029 cohort, the largest sample of GW-era veterans available for research to date: 35,902 veterans, of whom 13,107 deployed to a post 9/11 Persian Gulf conflict.

The researchers used the Kansas (KS) and Centers for Disease Control and Prevention (CDC) definitions of GWI, both of which are based on patient self-reports. The KS GWI criteria for phenotype KS Sym+ require ≥ 2 mild symptoms or ≥ 1 moderate or severe symptoms in at least 3 of 6 domains: fatigue/sleep problems, pain, neurologic/cognitive/mood, gastrointestinal, respiratory, and skin. The criteria for phenotype KS Sym+/Dx- also exclude some diagnosed health conditions, such as cancer, diabetes mellitus, and heart disease. The researchers examined both of these phenotypes.

They also used 2 phenotypes of the CDC definition: CDC GWI is met if the veteran reports ≥ 1 symptoms in 2 of 3 domains (fatigue, musculoskeletal, and mood/cognition). The second, CDC GWI severe, is met if the veteran rates ≥ 1 symptoms as severe in ≥ 2 domains.

Of the veterans studied, 67.1% met the KS Sym+ phenotype; 21.5% met the KS Sym+/Dx– definition. A majority (81.1%) met the CDC GWI phenotype; 18.6% met the severe phenotype. The most prevalent KS GWI domains were neurologic/cognitive/mood (81.9%), fatigue/sleep problems (73.9%), and pain (71.5%).

Although their findings mainly laid a foundation for further research, the researchers pointed to some potential new avenues for exploration. For instance, “Importantly,” the researchers say, “we consistently observed that deployed relative to nondeployed veterans had higher odds of meeting each GWI phenotype.” For both deployed and nondeployed veterans, those who served in the Army or Marine Corps had higher odds of meeting the KS Sym+, CDC GWI, and CDC GWI severe phenotypes. Among the deployed, Reservists had higher odds of CDC GWI and CDC GWI severe than did active-duty veterans.

Their findings also revealed that older age was associated with lower odds of meeting the GWI phenotypes. “[S]omewhat surprisingly,” they note, this finding held in both nondeployed and deployed samples, even after adjusting for military rank during the war. The researchers cite other research that has suggested younger service members are at greater risk for GWI (because they’re more likely, for example, to be exposed to deployment-related toxins). Most studies, the researchers note, have shown GWI and related symptoms to be more common among enlisted personnel than officers. Biomarkers of aging, such as epigenetic age acceleration, they suggest, “may be useful in untangling the relationship between age and GWI case status.” 

Because they separately examined the association of demographic characteristics with the GWI phenotypes, the researchers also found that women, regardless of deployment status, had higher odds of meeting the GWI phenotypes compared with men.

Their findings will be used, the researchers say, “to understand how genetic variation is associated with the GWI phenotypes and to identify potential pathophysiologic underpinnings of GWI, pleiotropy with other traits, and gene by environment interactions.” With information from this large dataset of GW-era veterans, they will have a “powerful tool” for in-depth study of exposures and underlying genetic susceptibility to GWI—studies that could not be performed, they say, without the full description of the GWI phenotypes they have documented.

The study had several strengths, the researchers say. For example, unlike previous studies, this one had a sample size large enough to allow more representation of subpopulations, including age, sex, race, ethnicity, education, and military service. The researchers also collected data from surveys, especially data on veterans’ self-reported symptoms and other information “incompletely and infrequently documented in medical records.”

Finally, the data for the study were collected more than 27 years after the GW. It, therefore, gives an “updated, detailed description” of symptoms and conditions affecting GW-era veterans, decades after their return from service.

To paraphrase Winston Churchill, Gulf War Illness (GWI) is a mystery wrapped in an enigma—a complex interplay of multiple symptoms, caused by a variety of environmental and chemical hazards. To make things more difficult, there are no diagnostic biomarkers or objective laboratory tests with which to confirm a GWI case. Instead, clinicians rely on patients’ reports of symptoms and the absence of other explanations for the symptoms.

Looking to provide more information on the epidemiology and biology of GWI, US Department of Veterans Affairs (VA) researchers analyzed data from the VA Cooperative Studies Program 2006/Million Veteran Program 029 cohort, the largest sample of GW-era veterans available for research to date: 35,902 veterans, of whom 13,107 deployed to a post 9/11 Persian Gulf conflict.

The researchers used the Kansas (KS) and Centers for Disease Control and Prevention (CDC) definitions of GWI, both of which are based on patient self-reports. The KS GWI criteria for phenotype KS Sym+ require ≥ 2 mild symptoms or ≥ 1 moderate or severe symptoms in at least 3 of 6 domains: fatigue/sleep problems, pain, neurologic/cognitive/mood, gastrointestinal, respiratory, and skin. The criteria for phenotype KS Sym+/Dx- also exclude some diagnosed health conditions, such as cancer, diabetes mellitus, and heart disease. The researchers examined both of these phenotypes.

They also used 2 phenotypes of the CDC definition: CDC GWI is met if the veteran reports ≥ 1 symptoms in 2 of 3 domains (fatigue, musculoskeletal, and mood/cognition). The second, CDC GWI severe, is met if the veteran rates ≥ 1 symptoms as severe in ≥ 2 domains.

Of the veterans studied, 67.1% met the KS Sym+ phenotype; 21.5% met the KS Sym+/Dx– definition. A majority (81.1%) met the CDC GWI phenotype; 18.6% met the severe phenotype. The most prevalent KS GWI domains were neurologic/cognitive/mood (81.9%), fatigue/sleep problems (73.9%), and pain (71.5%).

Although their findings mainly laid a foundation for further research, the researchers pointed to some potential new avenues for exploration. For instance, “Importantly,” the researchers say, “we consistently observed that deployed relative to nondeployed veterans had higher odds of meeting each GWI phenotype.” For both deployed and nondeployed veterans, those who served in the Army or Marine Corps had higher odds of meeting the KS Sym+, CDC GWI, and CDC GWI severe phenotypes. Among the deployed, Reservists had higher odds of CDC GWI and CDC GWI severe than did active-duty veterans.

Their findings also revealed that older age was associated with lower odds of meeting the GWI phenotypes. “[S]omewhat surprisingly,” they note, this finding held in both nondeployed and deployed samples, even after adjusting for military rank during the war. The researchers cite other research that has suggested younger service members are at greater risk for GWI (because they’re more likely, for example, to be exposed to deployment-related toxins). Most studies, the researchers note, have shown GWI and related symptoms to be more common among enlisted personnel than officers. Biomarkers of aging, such as epigenetic age acceleration, they suggest, “may be useful in untangling the relationship between age and GWI case status.” 

Because they separately examined the association of demographic characteristics with the GWI phenotypes, the researchers also found that women, regardless of deployment status, had higher odds of meeting the GWI phenotypes compared with men.

Their findings will be used, the researchers say, “to understand how genetic variation is associated with the GWI phenotypes and to identify potential pathophysiologic underpinnings of GWI, pleiotropy with other traits, and gene by environment interactions.” With information from this large dataset of GW-era veterans, they will have a “powerful tool” for in-depth study of exposures and underlying genetic susceptibility to GWI—studies that could not be performed, they say, without the full description of the GWI phenotypes they have documented.

The study had several strengths, the researchers say. For example, unlike previous studies, this one had a sample size large enough to allow more representation of subpopulations, including age, sex, race, ethnicity, education, and military service. The researchers also collected data from surveys, especially data on veterans’ self-reported symptoms and other information “incompletely and infrequently documented in medical records.”

Finally, the data for the study were collected more than 27 years after the GW. It, therefore, gives an “updated, detailed description” of symptoms and conditions affecting GW-era veterans, decades after their return from service.