Department of Veterans Affairs 

Office of Inspector General 

Combined Assessment Program 

Review of the 

St. Cloud VA Medical Center 

St. Cloud, Minnesota 

Report No. 07-00708-170 July 18, 2007

VA Office of Inspector General 

Washington, DC 20420 
Office of Inspector General 

Combined Assessment Program Reviews 

Combined Assessment Program (CAP) reviews are part of the Office of Inspector 

General's (OIG's) efforts to ensure that high quality health care and benefits 

services are provided to our Nation's veterans. CAP reviews combine the 

knowledge and skills of the OIG's Offices of Healthcare Inspections and 

Investigations to provide collaborative assessments of VA medical facilities on a 

cyclical basis. The purposes of CAP reviews are to: 

• Evaluate how well VA facilities are accomplishing their missions of providing 

veterans convenient access to high quality medical services. 

• Provide fraud and integrity awareness training to increase employee 

understanding of the potential for program fraud and the requirement to refer 

suspected criminal activity to the OIG. 

In addition to this typical coverage, CAP reviews may examine issues or 

allegations referred by VA employees, patients, Members of Congress, or others. 

To Report Suspected Wrongdoing in VA Programs and Operations 

Call the OIG Hotline – (800) 488-8244 
Combined Assessment Program Review of the St. Cloud VA Medical Center, St. Cloud, Minnesota 

Contents 

Page 

Executive Summary ..............................................................................................i

Introduction ..........................................................................................................1

Medical Center Profile..................................................................................................... 1

Objectives and Scope of the Combined Assessment Program Review........................... 2

Results of Review.................................................................................................3

Organizational Strengths ................................................................................................. 3

Community Partnership Event Wins Veterans Health Administration Award ........... 3

Scheduling Call Center Surpasses Timeliness Goal .................................................... 3

Opportunities for Improvement ....................................................................................... 4

Quality Management Program ..................................................................................... 4

Computerized Patient Record System Business Rules ................................................ 5

Environment of Care .................................................................................................... 6

Other Areas Reviewed..................................................................................................... 7

Survey of Healthcare Experiences of Patients ............................................................. 7

Community Based Outpatient Clinics.......................................................................... 8 

Appendixes

A. VISN Director Comments ........................................................................................ 9

B. Medical Center Director Comments ........................................................................ 10

C. OIG Contact and Staff Acknowledgments............................................................... 13

D. Report Distribution .................................................................................................. 14

VA Office of Inspector General 
Combined Assessment Program Review of the St. Cloud VA Medical Center, St. Cloud, Minnesota 

Executive Summary 

Introduction 

During the week of February 26–March 2, 2007, the Office of Inspector General (OIG) 

conducted a Combined Assessment Program (CAP) review of the St. Cloud VA Medical 

Center (the medical center), St. Cloud, MN. The purpose of the review was to evaluate 

selected operations, focusing on quality management (QM) and patient care 

administration. During the review, we provided fraud and integrity awareness training to 

208 medical center employees. The medical center is part of Veterans Integrated Service 

Network (VISN) 23. 

Results of Review 

The CAP review covered six areas. The medical center complied with selected standards 

in the following three areas: 

• Survey of Healthcare Experiences of Patients (SHEP). 

• Community based outpatient clinics (CBOCs). 

• Patient transportation services (follow-up from the previous CAP review). 

We identified the following organizational strengths: 

• Community partnership event wins Veterans Health Administration (VHA) award. 

• Scheduling call center surpasses timeliness goal. 

We identified three areas that needed additional management attention. To improve 

operations, we made the following recommendations: 

• Establish an effective peer review process that complies with VHA policy. 

• Ensure that computerized patient record system (CPRS) business rules comply with 

VHA policy and Office of Information (OI) guidance. 

• Replace rope-style emergency call system cords in the medical center. 

This report was prepared under the direction of Ms. Verena Briley-Hudson, Director, and 

Ms. Wachita Haywood, Associate Director, Chicago Office of Healthcare Inspections. 

VA Office of Inspector General i 
Combined Assessment Program Review of the St. Cloud VA Medical Center, St. Cloud, Minnesota 

Comments 

The VISN and Medical Center Directors agreed with the CAP review findings and 

provided acceptable improvement plans. (See Appendixes A and B, pages 9–12, for the 

full text of the Directors’ comments.) We will follow up on planned improvement 

actions until they are completed. 

 (original signed by:) 

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

Assistant Inspector General for 

Healthcare Inspections

VA Office of Inspector General ii 
Combined Assessment Program Review of the St. Cloud VA Medical Center, St. Cloud, Minnesota 

Introduction 

Medical Center Profile 

Organization. Located in St. Cloud, 

MN, the St. Cloud VA Medical Center 

provides a broad range of inpatient and 

outpatient health care services. 

Outpatient care is also provided at two 

CBOCs located in Brainerd and 

Montevideo, MN. The medical center 

is part of VISN 23 and serves a veteran 

population of about 60,029 veterans in 

a primary service area that includes 

18 counties the State.

Programs. The medical center 

provides medical, acute and chronic 

mental health, extended care, and outpatient specialty care services. There are 15 

operating (35 authorized) hospital beds, 45 Psychosocial Residential Rehabilitation 

Treatment Program (PRRTP) beds, 103 Domiciliary Residential Rehabilitation Treatment 

Program (DRRTP) beds, and 217 Nursing Home Care Unit (NHCU) beds. The medical 

center has no sharing agreements; however, fee-basis services are provided by St. Cloud 

Hospital, St. Joseph’s Medical Center in Brainerd, and Chippewa County-Montevideo 

Hospital in Montevideo. 

Affiliations and Research. The medical center provides training opportunities for 

students in registered and licensed practical nursing, physical and occupational therapies, 

chaplaincy, social work, pharmacy, dietetics, and psychology. In fiscal year (FY) 2006, 

the medical center’s research program had four active studies and two new studies 

submitted for consideration. The medical center has a general post fund for research and 

education. An important area of research is post-traumatic stress disorder.

Resources. In FY 2006, medical care expenditures totaled $112.6 million. FY 2007 

staffing includes 985.9 full-time equivalent (FTE) employees, including 27.2 physician 

and 312.2 nursing FTE. 

Workload. In FY 2006, the medical center treated 30,210 unique patients, a 5.6 percent 

increase from FY 2005. The inpatient care workload included 799 discharges. There 

were 315 PRRTP discharges, 498 DRRTP discharges, and 669 NHCU discharges. The 

average daily census, including NHCU patients, was 326. The outpatient workload was 

238,257 visits. 

VA Office of Inspector General 1 
Combined Assessment Program Review of the St. Cloud VA Medical Center, St. Cloud, Minnesota 

Objectives and Scope of the Combined Assessment Program Review 

Objectives. CAP reviews are one element of the OIG’s efforts to ensure that our 

Nation’s veterans receive high quality VA health care services. The objectives of the 

CAP review are to: 

• Conduct recurring evaluations of selected health care facility operations, focusing on 

patient care administration and QM. 

• Provide fraud and integrity awareness training to increase employee understanding of 

the potential for program fraud and the requirement to refer suspected criminal 

activity to the OIG. 

Scope. We reviewed selected clinical and administrative activities to evaluate the 

effectiveness of QM and patient care administration. QM is the process of monitoring 

the quality of care to identify and correct harmful or potentially harmful practices or 

conditions. Patient care administration is the process of planning and delivering patient 

care. In addition, we conducted follow-up on selected aspects of our previous CAP 

review (Combined Assessment Program Review of the VA Medical Center, St. Cloud, 

Minnesota, Report No. 04-00059-110, March 18, 2004). 

It is of note that VHA’s Office of the Medical Inspector (OMI) published a report 

March 13, 2007, titled Final Report: Site Visit to the Minneapolis Veterans Affairs 

Medical Center and the St. Cloud Veterans Affairs Medical Center, Department of 

Veterans Affairs, VISN 23. This report covered the circumstances of the healthcare 

delivered to, and the suicide of, an Operation Iraqi Freedom/Operation Enduring 

Freedom (OIF/OEF) veteran who had been receiving care from the Minneapolis VA 

Medical Center and had sought care at the St. Cloud VA Medical Center. The OIG also 

issued a report on the same case, titled Healthcare Inspection – Review of the Care and 

Death of a Veteran Patient, VA Medical Centers St. Cloud and Minneapolis, Minnesota, 

07-01349-127, issued May 10, 2007. Because of the issues involved in this case, followup will be done separately and is not being done as part of this CAP report. 

In performing the review, we inspected work areas; interviewed managers and 

employees; and reviewed clinical and administrative records. The review covered 

selected aspects of the following programs and activities: 

CBOCs 

CPRS Business Rules 

Environment of Care 

Patient Transportation Services 

QM Program 

SHEP 

The review covered medical center operations for FY 2006 and FY 2007 through 

February 23, 2007, and was done in accordance with OIG standard operating procedures 

for CAP reviews. 

VA Office of Inspector General 2 
Combined Assessment Program Review of the St. Cloud VA Medical Center, St. Cloud, Minnesota 

During this review, we also presented three fraud and integrity awareness briefings 

attended by 208 employees. These briefings covered procedures for reporting suspected 

criminal activity to the OIG and included case-specific examples illustrating procurement 

fraud, conflicts of interest, and bribery. 

In this report we make recommendations for improvement. Recommendations pertain to 

issues that are significant enough to be monitored by the OIG until corrective actions are 

implemented. Some reviews with no findings are not further discussed. Areas needing 

improvement are discussed in the “Opportunities for Improvement” section (pages 4–6). 

Results of Review 

Organizational Strengths 

Community Partnership Event Wins Veterans Health Administration 

Award 

In August 2005, the medical center partnered with 59 local businesses and organizations 

to host the first Operation Welcome Home event honoring returning Operation Enduring 

Freedom/Operation Iraqi Freedom veterans. During this event, both veterans and their 

families were honored for their service and sacrifices. Participants attended educational 

sessions on accessing VA benefits, health care, and services and sessions on readjustment 

and stress management. The medical center continues to be actively involved with 

ongoing outreach efforts. Since the event, the medical center has enrolled over 1,380 

veterans of these conflicts. 

As a result of their efforts, in August 2006, the medical center received a first place 

award in the national VHA Excellence in Public Affairs Awards Program competition in 

the category of Communications Programs – Special Events. 

Scheduling Call Center Surpasses Timeliness Goal 

The medical center established a performance measure of answering incoming telephone 

calls that come into the Primary Care/Specialty Care scheduling call center within 

90 seconds or less. With a target score of 80 percent, the medical center has consistently 

met or exceeded the measure. During FY 2006, the call center received 9,098 more calls 

than in FY 2005. Despite the increased volume, call center staff increased the percentage 

of calls answered within 90 seconds or less by 21 percent during the same time frame. 

VA Office of Inspector General 3 
Combined Assessment Program Review of the St. Cloud VA Medical Center, St. Cloud, Minnesota 

Opportunities for Improvement 

Quality Management Program 

Condition Needing Improvement. The QM program was comprehensive and generally 

effective in providing oversight of the quality of care. Senior managers actively 

supported and participated in the program’s activities. We identified one program area 

that required management attention.

Peer Review. The peer review process did not include all components required by VHA 

Directive 2004-054, Peer Review for Quality Management.

1

 Peer review is a 

confidential, non-punitive, and systematic process to evaluate the quality of care at the 

individual provider level. The peer review process includes an initial review by a peer of 

the same discipline to determine the level of care,2

 with subsequent Peer Review 

Committee (PRC) evaluation and concurrence with the findings. 

Education. VHA policy requires that all individuals involved in the peer review process 

receive formal education regarding the peer review process, their responsibilities, and the 

medical center’s legal and ethical requirements. Clinical staff members of the Medical 

Executive Board function as the PRC, and all clinical staff at the medical center may 

serve as peer reviewers. None had received this education. 

Timeliness. VHA policy requires that initial peer reviews must be completed within 

45 days from the date of determination that a peer review is necessary. Of the six peer 

reviews initiated since January 2006, two were not completed within this timeframe. One 

required 5 months to complete, and the second required 9 months to complete. VHA 

policy requires that final evaluations by the PRC be completed within 120 days from the 

date of determination that a peer review is necessary. VHA policy also requires that 

initial peer reviews resulting in a Level 2 or 3 be evaluated by the PRC. None of the six 

peer reviews had been evaluated by the PRC, and three of those peer reviews were 

designated Level 3 by the initial peer reviewer. 

Documentation. VHA policy requires that formal discussions about peer reviews be 

recorded in formal meeting minutes. The medical center’s PRC had no recorded minutes 

for the 12 months prior to this CAP review. 

Quarterly Tracking. VHA policy requires that quarterly tracking of peer reviews include 

the number of reviews, outcome levels, number of changes from one level to another, 

 

1

 Issued September 24, 2004. 

2

 Peer review levels: Level 1 – Most experienced, competent practitioners would have managed the case similarly; 

Level 2 – Most experienced, competent practitioners might have managed the case differently; Level 3 – Most 

experienced, competent practitioners would have managed the case differently. 

VA Office of Inspector General 4 
Combined Assessment Program Review of the St. Cloud VA Medical Center, St. Cloud, Minnesota 

follow-up actions, and recommendations that result from completed peer reviews. There 

was no tracking of peer review activity. 

When conducted systematically and credibly, peer reviews can result in both immediate 

and long-term improvements in patient care by revealing areas for improvement in 

individual providers’ practices. When peer review is not conducted in accordance with 

policy, managers cannot be assured that patients consistently receive treatment and 

services according to accepted community standards. 

Recommendation 1. We recommended that the VISN Director ensure that the Medical 

Center Director takes action to establish an effective peer review process that complies 

with VHA policy. 

The VISN and Medical Center Directors agreed with the findings and recommendation 

and reported that they are developing processes to comply with VHA peer review policy. 

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

Computerized Patient Record System Business Rules 

Condition Needing Improvement. We found that one medical center business rule was 

not in compliance with VHA and medical center information and technology policies. A 

software informational patch was sent from the VHA OI on October 20, 2004, to all 

medical centers, addressing a number of issues relating to the editing of electronically 

signed documents in the Veterans Integrated Health Systems Technology and 

Architecture system. OI cautioned that “the practice of editing a document that was 

signed by the author might have a patient safety implication and should not be allowed.” 

On June 7, 2006, VHA issued a memorandum to all VISN directors instructing all VA 

medical centers to comply with the informational patch sent in October 2004.

Business rules define what functions certain groups or individuals are allowed to perform 

in CPRS. OI has recommended institution of a VHA-wide software change that limits 

the ability to edit or delete a signed medical record document to the medical center’s 

Privacy Officer. The medical center had one rule that allowed the deletion of a medical 

record document by a clinical coordinator. The medical center staff took action to 

remove this business rule during the CAP review.

Recommendation 2. We recommended that the VISN Director ensure that the Medical 

Center Director requires that CPRS business rules comply with VHA policy and OI 

guidance. 

The VISN and Medical Center Directors agreed with the finding and recommendation 

and reported that the business rule allowing deletion of a medical record document by a 

clinical coordinator was removed February 28, 2007, and the medical center is in 

VA Office of Inspector General 5 
Combined Assessment Program Review of the St. Cloud VA Medical Center, St. Cloud, Minnesota 

compliance with VHA policy and OI guidance. We consider this recommendation 

closed. 

Environment of Care 

Condition Needing Improvement. VHA policy requires that medical centers be clean, 

sanitary, and maintained to optimize infection control and patient safety. We inspected 

four inpatient units, four primary care areas, and the CBOC in Brainerd. Employees at all 

levels were committed to keeping the medical center clean and effectively maintained. 

Infection control practices were consistent, and during FY 2006, the hospital-acquired 

rate for Methicillin-resistant Staphylococcus Aureus infection was 0.0002 per 1000 bed 

days of care. We identified one condition that required management attention.

Emergency Call System Cords. Emergency call system cords must be accessible and 

easily cleaned, as they are often located in shower areas and near commodes and sinks. 

The medical center generally used plastic cords; however, we observed rope-style 

emergency call system cords, which are difficult to clean, in public restrooms in the 

primary care area. We recommended that the rope-style cords be replaced with the same 

type of plastic cords used in the inpatient units. 

Recommendation 3. We recommended that the VISN Director ensure that the Medical 

Center Director requires all rope-style emergency call cords to be replaced. 

The VISN and Medical Center Directors agreed with the finding and recommendation 

and reported that Facilities Management Service completed the emergency call cord 

installation on March 15, 2007. We consider this recommendation closed. 

VA Office of Inspector General 6 
Combined Assessment Program Review of the St. Cloud VA Medical Center, St. Cloud, Minnesota 

Other Areas Reviewed 

Survey of Healthcare Experiences of Patients 

Veteran patient satisfaction surveying is designed to promote health care quality 

assessment and improvement strategies that address patients’ needs and concerns, as 

defined by patients. In 1995, VHA began surveying patients using a standardized 

instrument modeled from the Picker Institute, a non-profit health care surveying group. 

The Performance Analysis Center for Excellence of the Office of Quality & Performance 

is the analytical, methodological, and reporting staff for the SHEP. Performance 

Measure 21 of the VHA Executive Career Field Performance Plan for FY 2006 states that 

in FY 2006, the percent of patients reporting overall satisfaction as Very Good or 

Excellent will meet or exceed targets for the performance period October 2005–June 

2006 in: (Figures in the tables below represent percentages %). 

Meets 

Target 

Exceeds 

Target 

Ambulatory Care 77% 80% 

Inpatients (Discharged 10/2004–6/2005) 76% 79% 

The following graphs show the medical center’s SHEP results for inpatients and 

outpatients: 

AccessCoordination of CareCourtesyEducation & InformationEmotional SupportFamily InvolvementPhysical ComfortPreferencesTransitionOverall Quality

National 81.35 78.90 89.90 67.92 65.97 75.95 83.43 74.66 70.11 **

VISN 84.70 80.80 90.20 68.10 66.00 76.00 85.70 74.80 69.60 **

Medical Center 86.90 86.80 91.20 70.80 67.90 84.80 78.70 76.50 71.40 **

**Not reported

AccessContinuity of CareCourtesyEducation & InformationEmotional SupportOverall CoordinationPharmacy MailedPharmacy PickupPreferencesSpecialist CareVisit Coordination

National 81.1 77.9 94.7 72.8 83.1 75.6 81.9 65.9 81.4 80.7 84.4

VISN 85.9 76.3 96.9 72.2 83.8 75.6 83.4 72.2 81.2 80.2 86.7

Outpatient Clinics 90.5 75.1 97.7 72.2 84 73.3 85.2 72.5 83.9 80.5 87.3

 St. Cloud VAMC Inpatient SHEP Results

St. Cloud VAMC Outpatient SHEP Results

VA Office of Inspector General 7 
Combined Assessment Program Review of the St. Cloud VA Medical Center, St. Cloud, Minnesota 

The medical center’s inpatient SHEP scores were significantly better than the national 

averages for eight dimensions of care and were above the target score as defined by 

Performance Measure 21 in six of the nine dimensions reported. Outpatient SHEP scores 

were significantly better than the national averages for 2 dimensions of care and 

surpassed the target scores in 7 of 11 dimensions. SHEP results were discussed and 

compared with patient advocate data monthly at Customer Service Council meetings. 

SHEP results were communicated to employees through town hall meetings, servicelevel meetings, electronic mail messages, and a newsletter. The medical center Director 

meets with new employees during their first week of employment to emphasize the 

importance of customer service and conducts annual meetings with all employees in 

groups of 50 to inform them of medical center accomplishments and customer service 

initiatives. We made no recommendations. 

Community Based Outpatient Clinics 

The purpose of the review was to assess the effectiveness of CBOC operations and VHA 

oversight to determine whether CBOCs are in compliance with selected standards of 

operations (patient safety, QM, credentialing and privileging, emergency management 

plan) and whether CBOCs improve access, convenience, and timeliness of VA health 

care services. 

We interviewed employees at the medical center and the Brainerd CBOC and reviewed 

documentation and self-assessment tools on descriptions of services provided, including 

the warfarin clinic. The medical center and CBOC warfarin clinics were both managed 

by a pharmacist, with primary care physician oversight, and maintained the same 

standards and expectations. CBOC patients received education from a pharmacist before 

they received their first dose of warfarin. Patients’ laboratory values and follow-up care 

were managed by a pharmacist with primary care physician oversight. Patients received 

a brochure with a toll-free telephone number to help facilitate prompt reporting of new 

medications or other vital information. 

The CBOC was clean and effectively maintained with no safety or infection control 

vulnerabilities. The emergency management plan was current, and all clinical providers 

were educated in and knowledgeable about rendering emergency care to veterans. All 

clinical providers were certified in cardio-pulmonary resuscitation. The automated 

electronic heart defibrillator was inspected, and functionality documentation was up to 

date. A review of four CBOC clinical providers’ credentialing and privileging files and 

two CBOC nurses’ official personnel folders showed that appropriate background 

screenings were completed. 

VA Office of Inspector General 8 
Combined Assessment Program Review of the St. Cloud VA Medical Center, St. Cloud, Minnesota

Appendix A 

VISN Director Comments 

Department of 

Veterans Affairs Memorandum

Date: March 27, 2007 

From: Network Director, VA Midwest Healthcare Network – VISN 23, 

Minneapolis, MN 

Subject: Combined Assessment Program Review of the St. Cloud VA 

Medical Center, St. Cloud, Minnesota

To: Office of Inspector General 

I have reviewed the findings of the Combined Assessment 

Program Review submitted from the Department of 

Veterans Affairs (VA) Medical Center, St. Cloud, 

Minnesota. I am in agreement with the findings of the 

review, corrective action plan, and completion dates. 

If you need further information, please contact Mr. Barry 

Bahl, St. Cloud Medical Center Director, at (320) 255-

6315. 

ROBERT A. PETZEL, M.D. 

VA Office of Inspector General 9 
Combined Assessment Program Review of the St. Cloud VA Medical Center, St. Cloud, Minnesota

Appendix B 

Medical Center Director Comments 

Department of 

Veterans Affairs Memorandum

Date: March 26, 2007 

From: Director, St. Cloud VA Medical Center (656/00) 

Subject: Combined Assessment Program Review of the St. Cloud VA 

Medical Center, St. Cloud, Minnesota

To: Office of Inspector General 

I have reviewed the findings within the report of the 

Combined Assessment Program Review of the St. Cloud 

VA Medical Center, St. Cloud, Minnesota. I am in 

agreement with the findings of the review. 

Corrective action plans have been established with 

planned completion dates, as outlined in the attached 

report. 

(original signed by:) 

BARRY BAHL 

VA Office of Inspector General 10 
Combined Assessment Program Review of the St. Cloud VA Medical Center, St. Cloud, Minnesota

Director’s Comments 

to Office of Inspector General’s Report 

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

recommendations in the Office of Inspector General Report: 

OIG Recommendations

Recommended Improvement Action 1. We recommended that the VISN 

Director ensure that the Medical Center Director takes action to establish an 

effective peer review process that complies with VHA policy. 

Concur Target Completion Date: April 30, 2007 

Planned Action: Membership on the Peer Review Committee will be 

reviewed and changed. The Peer Review Committee will be scheduled to 

meet on a quarterly basis and report to the Medical Executive Board. All 

peer reviews completed since the last meeting will be reviewed and 

discussed. Minutes of the Peer Review Committee will be maintained by 

the secretary to the Chief of Staff. Members of the medical staff that can be 

assigned to perform a peer review and clerical and management staff 

involved in the peer review process will receive annual education regarding 

the peer review process, their responsibilities, and the medical center’s 

legal and ethical requirements. This education will be conducted at a 

special medical staff meeting by the Chief of Staff and recorded in training 

records. The QM Program Analyst will continue to track all requested peer 

reviews and facilitate timely completion by the peer reviewers. A quarterly 

report will be prepared and forwarded to the Peer Review Committee.

Recommended Improvement Action 2. We recommended that the VISN 

Director ensure that the Medical Center Director requires that CPRS 

business rules comply with VHA policy and OI guidance. 

Concur Completion Date: February 28, 2007 

Planned Action: The business rule that had allowed the deletion of a 

medical record document by a clinical coordinator was removed by 

2/28/07. The medical center is in compliance with VHA policy and OI 

guidance.

VA Office of Inspector General 11 
Combined Assessment Program Review of the St. Cloud VA Medical Center, St. Cloud, Minnesota

Recommended Improvement Action 3. We recommended that the VISN 

Director ensure that the Medical Center Director requires all rope-style 

emergency call cords to be replaced. 

Concur Completion Date: March 15, 2007 

Planned Action: Facilities Management Service completed the installation 

of the nurse call cords on 3/15/07. 

VA Office of Inspector General 12 
Combined Assessment Program Review of the St. Cloud VA Medical Center, St. Cloud, Minnesota

Appendix C 

OIG Contact and Staff Acknowledgments 

OIG Contact Verena Briley-Hudson, Director 

Chicago Office of Healthcare Inspections 

(708) 202-2672 

Acknowledgments Judy Brown 

Paula Chapman 

Wachita Haywood 

Stefan Larese 

Jennifer Reed 

Leslie Rogers 

Randy Rupp 

VA Office of Inspector General 13 
Combined Assessment Program Review of the St. Cloud VA Medical Center, St. Cloud, Minnesota

Appendix D 

Report Distribution 

VA Distribution

Office of the Secretary 

Veterans Health Administration 

Assistant Secretaries 

General Counsel 

Director, Veterans Integrated Service Network (10N23) 

Director, St. Cloud VA Medical Center (656/00) 

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: Norm Coleman, Amy Klobuchar 

U.S. House of Representatives: Michele Bachmann, James L. Oberstar, Collin C. 

Peterson 

This report is available at http://www.va.gov/oig/publications/reports-list.asp. 

VA Office of Inspector General 14