Department of Veterans Affairs 

Office of Inspector General 

Office of Healthcare Inspections 

Report No. 13-00670-262 

Healthcare Inspection 

Follow-Up Review of the Pause in 

Providing Inpatient Care 

VA Northern Indiana 

Healthcare System 

Fort Wayne, Indiana 

August 28, 2014 

Washington, DC 20420 
 

To Report Suspected Wrongdoing in VA Programs and Operations: 

Telephone: 1-800-488-8244 

E-Mail: vaoighotline@va.gov 

Web site: www.va.gov/oig 
 

 

Follow-Up Review of the Pause in Providing Inpatient Care, VANIHCS, Fort Wayne, IN 

Executive Summary 

The VA Office of Inspector General Office of Health Care Inspections conducted an 

oversight review to follow up on the published report, Healthcare Inspection - Review of 

Circumstances Leading to a Pause in Providing Inpatient Care at the VA Northern 

Indiana Healthcare System, Fort Wayne, Indiana, Report No. 2013-00670-265 issued 

on August 2, 2013. The purpose of the review was to evaluate VHA’s progress in 

implementing the action plan outlined in the 2013 report. 

In November 2012, Senator Joe Donnelly and Congressman Marlin Stutzman 

requested the OIG conduct an inspection about the suspension (pause), initiated in 

October 2012, of all inpatient admissions at the VA Northern Indiana Healthcare System 

(VANIHCS), Fort Wayne campus (facility). The pause was part of the Veterans 

Integrated Service Network (VISN) 11 proactive risk management decisions that were 

warranted based on clinical and administrative circumstances that affected the facility at 

the time. 

At the time of our follow-up review, 16 medical beds with telemetry capability on the 

acute medical unit were open; however, the Intensive Care Unit (ICU) remained closed. 

As a result, the facility did not accept medically complex patients and offered only 

limited surgical procedures. Consequently, many area veterans continue to receive 

Non-VA Care. 

Although VHA approved the facility’s proposal to reopen the ICU as a Level 4 ICU, an 

official date had not been established as of July 2, 2014. We found the facility has 

taken actions to actively recruit qualified clinical and leadership staff, but some clinical 

staff positions needed to be filled prior to the reopening of the ICU and some leadership 

positions remained vacant. 

We recommended the VISN Director ensure continued monitoring and implementation 

of actions for the reopening of the ICU. We recommended the VISN Director and the 

VANIHCS Director ensure recruitment efforts continue for vacant leadership and clinical 

staff positions. We recommended the VANIHCS Director ensure that nursing leaders 

assess the utilization of the nursing staff to systemically plan assignments during times 

when the acute medical unit’s census is low. 

Comments 

The VISN and Facility Directors concurred with our recommendations and provided an 

acceptable action plan. (See Appendixes A and B, pages 12–15 for the Directors’ 

comments.) We will follow up on the planned actions until they are completed. 

JOHN D. DAIGH, JR., M.D. 

Assistant Inspector General for 

Healthcare Inspections 

VA Office of Inspector General i 
 

 

 

Follow-Up Review of the Pause in Providing Inpatient Care, VANIHCS, Fort Wayne, IN 

Purpose 

The VA Office of Inspector General (OIG) Office of Health Care Inspections conducted 

an oversight review to follow up on recommendations OIG made in Healthcare 

Inspection - Review of Circumstances Leading to a Pause in Providing Inpatient Care at 

the VA Northern Indiana Healthcare System Fort Wayne, Indiana, Report 

No. 2013-00670-265 issued on August 2, 2013.1 The purpose of the review was to 

evaluate VHA’s progress in implementing the action plan outlined in the 2013 report. 

Background 

The VA Northern Indiana Healthcare System (VANIHCS) consists of two campuses 

located in Fort Wayne and Marion, IN, and is part of the Veterans Integrated Service 

Network (VISN) 11. 

VANIHCS’ catchment area had 35,775 unique patients in March 2014.2 The Fort 

Wayne campus (facility) provides outpatient primary care and inpatient medical 

services. Prior to the pause, the facility had 22 operational medical beds with some 

telemetry capability and 4 Intensive Care Unit (ICU) operational beds for a total of 

26 authorized beds. At the time of our review, the facility had 16 operational medical 

beds with telemetry capability on the acute medical unit. The Marion campus provides 

outpatient primary care and mental health (MH) services, inpatient chronic and acute 

psychiatric care, and community living center services. 

In November 2012, Senator Joe Donnelly and Congressman Marlin Stutzman 

requested the OIG conduct a review related to the suspension (pause), initiated in 

October 2012, of all inpatient admissions at the facility. The pause did not involve the 

Marion campus. The pause was part of the VISN’s proactive risk management 

decisions based on clinical and administrative circumstances that affected the facility 

at the time. 

The VISN’s active oversight role in implementing the pause and its continued review of 

the facility’s progress has been essential in addressing administrative and clinical 

actions to ensure high quality health care delivery. The VISN and the facility 

implemented a phased-in process to return the facility back to operational status for 

inpatient services. The facility’s leaders also initiated communication efforts to inform 

internal and external stakeholders on the facility’s status. 

In the 2013 OIG report, we noted that the facility was not at full capacity or at normal 

operations and recommended that the Veterans Health Administration (VHA) develop a 

policy for guidance when major clinical services are paused at a VA facility. We also 

recommended that the VISN Director ensure a review of the facility ICU level of care 

1

 http://www.va.gov/oig/pubs/VAOIG-13-00670-265.pdf. 2 http://www.va.gov/vetdata/glossary.asp. A veteran patient is counted as a unique patient in each division from
 

which they receive care.
 

VA Office of Inspector General 1 
 

Follow-Up Review of the Pause in Providing Inpatient Care, VANIHCS, Fort Wayne, IN 

and support services be completed to determine the appropriate designation and that 

qualified clinical staff are available to provide care. Finally, we recommended that the 

VANIHCS Director ensure that efforts continue to recruit qualified staff for vacant 

leadership positions, nurse competencies are consistently completed and validated 

annually, and the facility fully implements the nurse staffing methodology. 

Scope and Methodology 

Our review was limited to operations at the Fort Wayne campus of the VANIHCS. 

We conducted an oversight review on January 28–30, 2014. We interviewed the VISN 

Director and Chief Medical Officer. We also interviewed VANIHCS leaders, to include 

the Director, Associate Directors for the Fort Wayne and Marion campuses, Chief of 

Staff (COS), Chief of Surgery, Associate Director for Patient Care Services, Quality 

Manager, Resource Manager for Patient Care Services, Chief and Associate Chief of 

Human Resources, Public Affairs Officer, Chief of Organizational Improvement, and the 

Patient Advocate. We reviewed VHA directives, facility policies and procedures, 

administrative documents, nurse competency records, quality management data 

documents, patient advocate records, and other relevant documentation. 

We conducted the inspection in accordance with Quality Standards for Inspection 

and Evaluation published by the Council of the Inspectors General on Integrity and 

Efficiency. 

VA Office of Inspector General 2 
 

Follow-Up Review of the Pause in Providing Inpatient Care, VANIHCS, Fort Wayne, IN 

Inspection Results 

Issue 1: VHA Policy Guidance 

In our 2013 report, we recommended that VHA develop policy for guidance when major 

clinical services are paused at a VA facility. In its initial status monitoring report to the 

OIG in December 2013, VHA responded: 

VHA Directive 2009-0013

 and VHA Handbook 1000.014 are VHA’s current 

policies on reductions or changes in major clinical services at a facility. 

Because these policies can be construed to apply only to permanent 

changes, VHA will reinforce the Directive and Handbook apply to both 

temporary (paused) as well as permanent changes and will clarify how to 

implement them. The Deputy Under Secretary for Health for Operations 

and Management and the Assistant Deputy Under Secretary for Health for 

Clinical Operations will provide policy guidance to key leadership during 

the Network Directors meeting and the Chief Medical Officers/Quality 

Management Officers meeting. 

During our follow-up review, we learned that, in September and October 2013, VHA met 

with the Chief Medical Officers and Quality Management Officers regarding policy 

guidance for changes to temporary and permanent major clinical services and 

reinforced to leaders that VHA Directive 2009-001 and VHA Handbook 1000.01 apply to 

both temporary and permanent major clinical services changes. We consider this 

recommendation closed. 

Issue 2: ICU Level of Care 

In our 2013 report, we recommended that the VISN Director ensure that a review of the 

facility ICU level of care and support services was completed to determine the 

appropriate designation. In its initial status monitoring report to the OIG in 

December 2013, VHA responded: 

Based on data analysis and a review of other information, VANIHCS is in 

the process of developing a proposal in accordance with the requirements 

outlined in VHA Directive 2009-001...to reopen the Level 4 ICU. The 

Network Director and VA Central Office will review this proposal. 

VANIHCS implemented an ICU Steering Committee to ensure processes, 

competencies, and staff members are in place to open ICU. 

Status of the Facility Action Plan and Operations 

As a result of the pause, the facility developed a four-step, phased inpatient unit plan: 

3

 VHA Directive 2009-001, Restructuring of VHA Clinical Programs, January 5, 2009. 4

 VHA Handbook 1000.01, Inpatient Bed Change Program and Procedures, December 22, 2010. 

VA Office of Inspector General 3 
 

 

 

Follow-Up Review of the Pause in Providing Inpatient Care, VANIHCS, Fort Wayne, IN 

Phase 1: Admissions to the acute medical unit for chemotherapy 

Phase 2: Admissions to the acute medical unit for general medical and 

surgical care in six-bed increments 

Phase 3: Admissions to acute medical unit for telemetry 

Phase 4: Reopen the ICU 

At the time of this review, Phases 1, 2, and 3 were implemented and Phase 4 was 

pending. There were 16 operational medical beds with telemetry capability on the acute 

medical unit. The progressive reopening of the facility’s operating beds is displayed in 

Exhibit 1. 

Exhibit 1. Operational Bed Numbers - December 2, 2012 through January 31, 20145 

0 

2 

4 

6 

8 

10 

12 

14 

16 

Phase 1: 

Chemotherapy 

Admissions 

Phase 2: 

General 

Medical 

Admissions 

Phase 3: 

Telemetry 

Admissions 

Phase 4: 

Reopening of 

the ICU 

Number of Operational Beds

12/3/2012 

3/27/2013 

6/11/2013 

7/31/2013 

9/30/2013 

10/4/2013 

1/31/2014 

Source: OIG 

During our follow-up review, the facility had 16 operational medical beds with telemetry 

capability on the acute medical unit and the ICU was closed. Because the ICU was 

closed, admission criteria were strictly defined, and the facility did not accept patients 

who might possibly require a higher level of care after admission. We also learned 

surgical procedures were limited because of the ICU closure. 

We reviewed average daily census (ADC) data and found the acute medical unit had 

low ADC and patients who required care beyond the scope of services outlined in the 

admission criteria were transferred to the community under Non-VA Care.6 

5

 Exhibit formulated from data provided by the facility. 

6

 Non-VA Care is used when VA medical facilities are not “feasibly available.” http://www.nonvacare.va.gov
 

VA Office of Inspector General 4 
 

 

 

 

         

Follow-Up Review of the Pause in Providing Inpatient Care, VANIHCS, Fort Wayne, IN 

In fiscal year (FY) 2012, the facility’s acute medical unit7 ADC was 15.7. In FY 2013, 

the ADC was 2.3 patients.8

 From October 1, 2013, through January 31, 2014, the ADC 

was 5.3 patients. 

From January 1 through January 31 2014, the daily patient transfers under Non-VA 

Care ranged from 0 to 14 patients, and the average daily transfer rate was 5 patients. 

On January 29, the facility had 0 inpatients. On that day, 2 patients were transferred 

under Non-VA Care, and 28 patients were already authorized for and receiving Non-VA 

Care. 

The facility reported the cost of total Non-VA Care was approximately $25 million in 

FY 2012 and $37 million in FY 2013 and was projected to be higher in FY 2014. During 

interviews, VISN and facility leaders acknowledged that the cost of providing inpatient 

Non-VA Care while simultaneously staffing a unit with low ADCs was high (per facility 

report—approximately $4 million in FY 2013) but emphasized the veterans were getting 

the care they needed. 

We determined that, from October 2013 through March 2014, the facility provided 

non-VA care to 1,190 patients while maintaining 16 beds on the acute medical unit. The 

number of patients authorized to receive inpatient Non-VA Care from October 2013 

through March 2014 is displayed in Exhibit 2. 

Exhibit 2. Inpatient Non-VA Care from October 2013 through March 20149 

0

50

100

150

200

250

October November December January February March

Number of Patients Under Non‐VA

Care

Source: OIG 

We interviewed the facility’s patient advocate to determine if facility patients had 

complained about referrals to Non-VA care rather than admission to the facility. The 

7

 The facility’s acute medical unit had 22 beds during fiscal year 2012. 

8

 The pause impacted the overall FY 2013 ADC for the acute medical unit. 9

 Exhibit formulated from data provided by the facility. 

VA Office of Inspector General 5 
 

 

Follow-Up Review of the Pause in Providing Inpatient Care, VANIHCS, Fort Wayne, IN 

patient advocate did not receive any inquiries, complaints, compliments, or concerns 

related to access of inpatient care at the facility from FY 2013 through March 31, 2014. 

Reopening the ICU 

VHA has 4 levels of classifications for ICU level of care, which is based on the 

complexity of the services provided. Level 1 and 2 ICUs provide complex services, a 

Level 3 ICU provides moderate services, and a Level 4 ICU provides basic services.10 

Prior to the pause, the facility’s ICU classification was Level 3. 

On February 8, 2013, a facility committee was established and tasked to develop a 

proposal to reopen the ICU. The ICU proposal plan was initiated on May 20, and on 

December 18, the facility finalized a detailed proposal to reopen the ICU as a Level 4 

ICU.11 The VISN approved and forwarded the proposal to VA Central Office (VACO) 

and, on December 27, VACO approved the proposal. The VA Under Secretary for 

Health approved the ICU proposal on March 13, 2014. 

Facility leaders told us that they expect the facility will admit an increased number of 

patients with more complex medical problems to the acute care medical unit, and 

surgeons will be able to perform more procedures after ICU services resume. However, 

as of the date of this report, the ICU remained closed with no official date for its 

reopening. 

Overall, the VISN and the facility have developed and initiated corrective actions to 

address the phased-in progression of the admission of patients to the acute medical unit 

for chemotherapy, medical, and telemetry services. Staffing remains at full operational 

status for the acute medical unit despite the unit’s low ADC. The ICU remains closed, 

and patients continue to be transferred under Non-VA Care. Because the ICU level of 

care and support services are not fully implemented, this recommendation will remain 

open. 

Issue 3: Qualified Clinical Staff 

In our 2013 report, we recommended that the VISN Director ensure qualified clinical 

staff are available to provide care. In its initial status monitoring report to the OIG in 

December 2013, VHA responded: 

VANIHCS continues to recruit qualified clinical staff for physician 

recruitment and all physician and Nurse Practitioner (NP) vacancy 

announcements are open-continuous and include the maximum allowable 

recruitment and relocation incentives and an Education Debt Reduction 

Program incentive as well. VANIHCS has created a physician recruiter 

position dedicated to filling physician positions and expanded recruitment 

efforts... 

10 Almenoff, P., Sales, A., Rounds S., et al. Intensive care services in the Veterans Health Administration. Chest 2007, 

132:1455-62.
 11 Planned ICU services and procedures include ventilator support, arterial lines, and cardioversion.
 

VA Office of Inspector General 6 
 

Follow-Up Review of the Pause in Providing Inpatient Care, VANIHCS, Fort Wayne, IN 

During our follow-up review, we determined that VISN and facility leaders made active 

recruitment efforts and used a variety of hiring programs and incentives to identify and 

employ qualified clinical staff. Facility leaders told us that barriers to hiring qualified 

applicants were the length of time it took to hire staff, the credentialing clearance 

process, and difficulty attracting qualified candidates. The facility leaders stated that 

professional clinical staff recruitment is a continuous process at the facility. We learned 

the VISN planned to hire a physician recruiter, and the facility had appointed physician, 

nurse, and administrative recruiters within the human resource department. 

Nurse recruitment efforts are ongoing, and from October 11, 2012 through 

March 19, 2014, the facility hired 19 RNs. The average time between an RN’s 

application date to the employment date is 4 months, and orientation training for nursing 

staff requires approximately 1 month. Nursing leaders stated that an additional six RN 

full-time positions would be needed for the ICU to be fully staffed. Based on the 

average times cited above, it would take 5 months for additional facility ICU RNs to be 

hired and complete orientation. 

We determined corrective actions have been taken to recruit and hire qualified clinical 

staff positions. Because some clinical staff positions remain vacant, this 

recommendation remains open. 

Issue 4: Recruitment and Appointment of Leadership Positions 

In our 2013 report, we recommended that the VANIHCS Director ensure that efforts 

continue to recruit qualified staff for vacant leadership positions. In its initial status 

monitoring report to the OIG in December 2013, VHA responded: 

VANIHCS hired an ED Lead Physician, who entered on duty on August 

25, 2013. A tentative selection was made for the Chief of MH position and 

the candidate was notified on November 29, 2013. The COS is in the 

process of reviewing applicant information for the Assistant Chief, MH 

position, which is a new position for the leadership team. We continue to 

recruit for a Chief of Geriatrics and Extended Care position. Recruitment 

incentives of up to 25 percent are authorized to maximize recruitment 

efforts as well as making the announcement open-continuous and placed 

on national job boards. Recruitment expansion has included utilization of 

VA and VHA resources, utilization of national trade journals and 

publications, utilization of commercial recruitment web sites, and direct 

contact with eleven medical schools to search for potential candidates. 

VANIHCS selected an internal staff member for the Associate Chief Nurse 

(ACNS) for Operations, and ACNS, Primary Care positions. The previous 

ACNS for MH and Ambulatory Care has been divided into two separate 

positions (ACNS, MH and ACNS, Primary Care) to allow increased 

nursing leadership in each area. The vacant Chief Nurse, MH position 

was posted December 9, 2013 and includes the maximum allowable use 

of relocation and recruitment incentives. VANIHCS hired a General Scale15 Associate Director, who entered on duty October 20, 2013. 

VA Office of Inspector General 7 
 

 

Follow-Up Review of the Pause in Providing Inpatient Care, VANIHCS, Fort Wayne, IN 

During our follow-up review, we determined that several administrative and clinical 

leadership positions were appointed; however, some of the facility’s leadership and 

management positions continue to be vacant. The exhibit below notes the status of 

VANIHCS positions as of March 28, 2014: 

Exhibit 3. Status of VANIHCS Positions12 

Vacancy Offer Date Start Date 

Chief of Extended Care and 

Rehabilitation Service 

Open and Continuous posting Open 

Chief of Primary Care Open and Continuous posting Open 

Chief of MH November 29, 2013 March 9, 2014 

Assistant Chief for MH Open Open 

ED Director (An in-house hospitalist 

was detailed into the ED physician 

position effective March 18, 2013) 

Tentative offer given to 

selected applicant on February 

26, 2014. 

Anticipated June 2014 

Source: OIG 

The facility has expanded recruitment efforts and incentive bonuses to attract qualified 

candidates for leadership positions; however, the Chief of Extended Care and 

Rehabilitation and the Assistant Chief of MH Services positions have been open since 

May 1, 2013. The Chief of Primary Care position was originally filled on 

March 24, 2013; however, it was again vacant due to the employee’s departure from the 

facility. The facility’s effort to increase nursing leadership resulted in appointments to 

ACNS positions although the ACNS position for MH is currently vacant. 

The facility’s executive staff believed the stabilization of leadership positions is vital to 

improving conditions at the facility and acknowledged that recruitment of staff is a 

continuous process. We determined that corrective actions were taken to recruit and 

hire qualified staff for leadership positions. Because some leadership positions remain 

vacant, this recommendation remains open. 

Issue 5: Nurse Competencies 

In our 2013 report, we recommended that the VANIHCS Director ensure that nurse 

competencies are consistently completed and validated annually. In its initial status 

monitoring report to the OIG in December 2013, VHA responded: 

VANIHCS Nursing Service Policy (NS)-2, RN Competency Program has 

been published (September 2013). The Associate Director for Patient 

Care Services (ADPCS) completed a 100 percent review of all nurse staff 

competencies and certified compliance for all RNs, Licensed Practical 

Nurses, and Nurse Assistants assigned to direct patient care in 

12 Exhibit formulated from data provided by the facility. 

VA Office of Inspector General 8 
 

 

Follow-Up Review of the Pause in Providing Inpatient Care, VANIHCS, Fort Wayne, IN 

accordance with the unit specific competencies identified for each area of 

practice as per policy NS-2. A random sample of nursing staff 

competencies was submitted to the Director for further 

certification/validation. A memorandum certifying 100 percent validation of 

nursing competencies was submitted to Veteran Affairs Central Office on 

November 4, 2013. 

During our follow-up review, we determined that in November 2013, the Associate 

Director for Patient Care Services completed a 100 percent validation of all nurse staff 

competencies. 

In January 2014, we reviewed 12 nurse competency folders which included RNs, 

Licensed Practical Nurses, and nurse assistants. We evaluated nurse competency 

documentation to determine whether key elements on annual assessments included 

dates, methods used to determine competency, and employee’s plus supervisor’s 

signatures. We found that all 12 folders generally met requirements. 

Corrective actions were taken and the facility generally met requirements. We consider 

this recommendation closed. 

Issue 6: Nurse Staffing Methodology 

In our 2013 report, we recommended that the VANIHCS Director ensure that the facility 

fully implements the nurse staffing methodology and complete all required steps. In its 

initial status monitoring report to the OIG in December 2013, VHA responded: 

VANIHCS has implemented all requirements of the nurse staffing 

methodology and ensured the numbers, types, and assignments of 

nursing personnel are consistent with VHA directive and facility strategic 

plans. VANIHCS Nursing Service Policy NS-49, Staffing Methodology for 

Nursing Personnel, has been published (August 2013). A Facility Expert 

Panel completed all required Staffing Methodology Training. 

During our follow-up review, we determined that the facility had fully implemented the 

nurse staffing methodology and generally met requirements consistent with the relevant 

VHA Directive.13 Because the facility fully implemented the nurse staffing methodology 

and generally met requirements, we consider the original recommendation closed. 

We evaluated the facility’s nurse staffing levels for the acute medical unit and found that 

recommended nurse staffing levels were consistently above the targeted levels, and the 

facility did not have a formal plan and tracking system to fully utilize staff when the unit’s 

census is low. 

Facility leaders reported that nurse staffing levels are maintained for the acute medical 

unit at an operational standard of an ADC of 16 patients, regardless of the actual 

workload. As a result of the low ADC on the acute medical unit, the unit nursing staff 

13 VHA Directive 2010-034, Staffing Methodology for VHA Nursing Personnel, July 19, 2010. 

VA Office of Inspector General 9 
 

Follow-Up Review of the Pause in Providing Inpatient Care, VANIHCS, Fort Wayne, IN 

have been detailed to the Non-VA Care program or the Oncology clinic. Additionally, 

the unit nursing staff have assisted in updating local policies and procedures, and 

participated in educational opportunities such as completion of competencies, mock 

drills, and simulations. Facility leaders emphasized that these nurse activities will 

ensure preparation of qualified, skilled staff when the facility is at full operational 

capacity. 

We recommended that nursing leaders assess the utilization of the nursing staff to 

systemically plan assignments during times when the acute medical unit’s census is 

low. 

Conclusions 

We determined that the VISN and facility leaders have exercised appropriate oversight 

and implemented corrective actions to their infrastructure to resolve some of the 

conditions identified in the 2013 OIG report. 

VHA reinforced to leaders that previously published clinical program and bed change 

policies and directives apply to both temporary and permanent major clinical services 

changes. The original Recommendation 1 is closed. 

As the ICU remains closed, the type of patients admitted to the acute medical unit is 

limited and patients are transferred to the community under Non-VA Care. The lack of 

an ICU also hampers the facility’s ability to perform some surgical procedures. The 

facility completed a proposal that included the analysis and evaluation of required 

equipment, procedures and services, and staffing prior to the reopening of an ICU. 

VACO approved the proposal and action items are ongoing. An official date of 

reopening the facility’s ICU had not been established as of July 2, 2014. 

The facility has taken actions to actively recruit leadership positions and qualified clinical 

staff. However, some leadership positions remain vacant and clinical staff positions will 

need to be appointed prior to the reopening of the ICU. The original Recommendations 

2, 3, and 4 will remain open for continued monitoring of actions to ensure the level of 

care, clinical staff, and leadership positions are adequately identified and resolved. 

We found that nurse competencies are now consistently completed and validated and 

consider the original Recommendation 5 closed. Because the facility fully implemented 

the nurse staffing methodology and generally met requirements, we consider the 

original Recommendation 6 closed. However, we made a new recommendation that 

nursing leaders assess the utilization of the nursing staff to systemically plan 

assignments during times when the acute medical unit’s census is low. 

VA Office of Inspector General 10 
Follow-Up Review of the Pause in Providing Inpatient Care, VANIHCS, Fort Wayne, IN 

Recommendations 

Three original recommendations remain open, and a new nurse staffing 

recommendation has been added. We will follow up on VISN 11 and VANIHCS 

planned corrective actions until completed. 

1. We recommended that the Veterans Integrated Service Network Director ensure 

continued monitoring and implementation of actions for the reopening of the Intensive 

Care Unit. 

2. We recommended that the Veterans Integrated Service Network Director ensure that 

efforts continue to recruit qualified clinical staff to provide care. 

3. We recommended that the VA Northern Indiana Healthcare System Director ensure 

that efforts continue to recruit qualified staff for vacant leadership positions. 

4. We recommended that the VA Northern Indiana Healthcare System Director ensure 

that nursing leaders assess the utilization of the nursing staff to systemically plan 

assignments during times when the acute medical unit’s census is low. 

VA Office of Inspector General 11 
 

 

 

Follow-Up Review of the Pause in Providing Inpatient Care, VANIHCS, Fort Wayne, IN 

Appendix A 

VISN Director Comments 

Department of 

Veterans Affairs Memorandum 

Date: July 2, 2014 

From: Director, Veterans In Partnership Network (10N11) 

Subject: Draft Report—Healthcare Inspection-Follow-Up Review of the 

Pause in Providing Inpatient Care, VA Northern Indiana 

Healthcare System, Fort Wayne, IN 

To: Director, Region Office of Healthcare Inspections (54KC) 

Director, Management Review Service (VHA 10AR MRS OIG Hotline) 

1. I concur with the findings and recommendations in the report. 

2. If you have any questions regarding the responses and actions to the 

recommendations in the report, please contact me. 

For 

VA Office of Inspector General 12 
 

 

 

 

Follow-Up Review of the Pause in Providing Inpatient Care, VANIHCS, Fort Wayne, IN 

Appendix B 

System Director Comments 

Department of 

Veterans Affairs	 Memorandum 

Date: July 2, 2014 

From: Director, VA Northern Indiana Health Care System, Fort Wayne, IN 

(610A4/00) 

Subject: Draft Report—Healthcare Inspection-Follow-Up Review of the 

Pause in Providing Inpatient Care, VA Northern Indiana 

Healthcare System, Fort Wayne, IN 

To: Director, Veterans In Partnership Network (10N11) 

I concur with the VA Northern Indiana Healthcare System’s response and 

action plans as detailed within this report. 

Thank you, 

Denise M. Deitzen, Director 

VA Office of Inspector General 13 
 

Follow-Up Review of the Pause in Providing Inpatient Care, VANIHCS, Fort Wayne, IN 

Comments to OIG’s Report 

The following Director’s comments are submitted in response to the recommendations 

in the OIG report: 

OIG Recommendations 

Recommendation 1. We recommended that the Veterans Integrated Service Network 

Director ensure continued monitoring and implementation of actions for the reopening of 

the Intensive Care Unit. 

Concur 

Target date for completion: October 28, 2014 

Facility response: A copy of the Proposal to re-open Intensive Care Unit, which was 

approved by the Under Secretary for Health on March 13, 2014, was submitted to the 

OIG on March 28, 2014. VA Northern Indiana Healthcare System’s internal work group 

target to reopen Intensive Care Unit is Fall, 2014. VA Northern Indiana Healthcare 

System is in the process of finalizing policies, procedures, and competencies prior to 

opening. 

Recommendation 2. We recommended that the Veterans Integrated Service Network 

Director ensure that efforts continue to recruit qualified clinical staff to provide care. 

Concur 

Target date for completion: October 28, 2014 

Facility response: VA Northern Indiana Healthcare System continues to actively recruit 

qualified staff for clinical staff to provide care. Below is a status update of provider 

recruitment/hiring information for the timeframe of April 30, 2013 thru June 18, 2014. 

 Associate Chief of Staff for Primary Care. 

 Two Hospitalists have scheduled Enter on Duty dates. 

 One full-time Emergency Room Physician position was filled. 

 We have added a new position of Deputy, Chief of Staff to the organizational 

structure and are actively recruiting for this position. 

 One Physician who previously worked Nights part-time is now a full-time Night 

Shift Physician. 

 A tentative offer has been extended to a provider who was interviewed for the 

Intensive Care Unit Physician Director vacancy. 

	 VA Northern Indiana Healthcare System advertises on USAJobs, New England 

Journal of Medicine, The Journal of the American Medical Association, Medical 

Job Network, and several other Healthcare web sites; in addition to, advertising 

on 55 general recruitment web sites. 

VA Office of Inspector General 14 
 

Follow-Up Review of the Pause in Providing Inpatient Care, VANIHCS, Fort Wayne, IN 

Recommendation 3. We recommended that the VA Northern Indiana Healthcare 

System Director ensure that efforts continue to recruit qualified staff for vacant 

leadership positions. 

Concur 

Target date for completion: October 28, 2014 

Facility response: VA Northern Indiana Healthcare System continues to actively recruit 

qualified staff for vacant leadership positions. Below is a status update of provider 

recruitment/hiring information for the timeframe of April 30, 2013 thru June 18, 2014. 

 Associate Chief of Staff for Primary Care. 

 We have added a new position of Deputy, Chief of Staff to the organizational 

structure and are actively recruiting for this position. 

 A tentative offer has been extended to a provider who was interviewed for the 

Intensive Care Unit Physician Director vacancy. 

	 VA Northern Indiana Healthcare System advertises on USAJobs, New England 

Journal of Medicine, The Journal of the American Medical Association, Medical 

Job Network, and several other Healthcare web sites; in addition to, advertising 

on 55 general recruitment web sites. 

Recommendation 4. We recommended that the VA Northern Indiana Healthcare 

System Director ensure that nursing leaders assess the utilization of the nursing staff to 

systemically plan assignments during times when the acute medical unit’s census is 

low. 

Concur 

Target date for completion: August 20, 2014 

Facility response: VA Northern Indiana Healthcare System will develop a process to 

redeploy nursing staff at a minimum of 14 day interval assignments to better match 

census demands and organizational efficiencies while addressing staff satisfaction. 

VA Office of Inspector General 15 
Follow-Up Review of the Pause in Providing Inpatient Care, VANIHCS, Fort Wayne, IN 

Appendix C 

OIG Contact and Staff Acknowledgments 

Contact For more information about this report, please contact the OIG at 

(202) 461-4720. 

Contributors Cindy Niemack-Brown, CMSW, LMHP, Team Leader 

Stephanie Hensel, RN, JD 

Thomas Jamieson, MD 

James Seitz, RN, MBA 

VA Office of Inspector General 16 
 

 

Follow-Up Review of the Pause in Providing Inpatient Care, VANIHCS, Fort Wayne, IN 

Appendix D 

Report Distribution 

VA Distribution 

Office of the Secretary 

Veterans Health Administration 

Assistant Secretaries 

General Counsel 

Director, VISN 11, Veterans in Partnership (10N11) 

Director, VANIHCS (610A4/00) 

Non-VA Distribution 

House Committee on Veterans’ Affairs 

House Appropriations Subcommittee on Military Construction, Veterans Affairs, and 

Related Agencies 

House Committee on Oversight and Government Reform 

Senate Committee on Veterans’ Affairs 

Senate Appropriations Subcommittee on Military Construction, Veterans Affairs, and 

Related Agencies 

Senate Committee on Homeland Security and Governmental Affairs 

National Veterans Service Organizations 

Government Accountability Office 

Office of Management and Budget 

U.S. Senate: Sherrod Brown, Daniel Coats, Joe Donnelly, Rob Portman 

U.S. House of Representatives: Susan W. Brooks, Robert Latta, Luke Messer, 

Todd Rokita, Marlin Stutzman, Pete Visclosky, Jackie Walorski 

This report is available on our web site at www.va.gov/oig 

VA Office of Inspector General 17