What GAO Found
The Indian Health Service’s (IHS) policies related to provider misconduct and substandard performance outline several key aspects of oversight, such as protecting children against sexual abuse by providers, ethical and professional conduct, and processes for managing an alleged case of misconduct. Although the Department of Health and Human Services (HHS) or IHS headquarters have established most of these policies, area offices that are responsible for overseeing facility operations and facilities, such as hospitals, may develop and issue their own policies as long as they are consistent with headquarters’ policies, according to officials.
Although some oversight activities are performed at IHS headquarters, IHS has delegated primary responsibility for oversight of provider misconduct and substandard performance to the area offices. However, GAO found some inconsistencies in oversight activities across IHS areas and facilities. For example,
Although all nine area offices require that new supervisors attend mandatory supervisory training, most area offices provided additional trainings related to provider misconduct and substandard performance. The content of these additional trainings varied across area offices. For example, three area offices offered training on conducting investigations of alleged misconduct, while other area offices did not. Officials from IHS headquarters told GAO they do not systematically review trainings developed by the areas to ensure they are consistent with policy or IHS-wide training.
- Facility governing boards—made up of IHS area office officials, including the Area Director, and facility officials, such as the Chief Executive Officer—are responsible for overseeing each facility’s quality of and access to care. They generally review information related to provider misconduct and substandard performance. However, there is no standard format used by governing boards to document their review, making it difficult to determine the extent this oversight is consistently conducted. In some cases, there was no documentation by governing boards of a discussion about provider misconduct or substandard performance. For example, none of the seven governing board meeting minutes provided from one area office documented their discussion of patient complaints. In other cases, there was detailed documentation of the governing board’s review. Additionally, governing boards did not always clearly document how or why an oversight decision, such as whether to grant privileges to a provider, had been made based on their review of available information.
These inconsistencies in IHS’s oversight activities could limit the agency’s efforts to oversee provider misconduct and substandard performance. For example, by not reviewing trainings developed by area offices, IHS headquarters may also be unable to identify gaps in staff knowledge or best practices that could be applied across area offices. Addressing these inconsistencies would better position the agency to effectively protect patients from abuse and harm resulting from provider misconduct or substandard performance.
Why GAO Did This Study
IHS provides care to American Indians and Alaska Natives (AI/AN) through a system of federally and tribally operated facilities. Recent cases of alleged and confirmed misconduct and substandard performance by IHS employees have raised questions about protecting the AI/AN population from abuse and harm. For example, in February 2020, a former IHS pediatrician was sentenced to five consecutive lifetime terms for multiple sex offenses against children. Several studies have been initiated or completed in response, and IHS has reported efforts to enhance safe and quality care for its patients.
GAO was asked to review IHS oversight of misconduct and substandard performance. This report (1) describes IHS policies related to provider misconduct and substandard performance and (2) assesses IHS oversight of provider misconduct and substandard performance. GAO reviewed policies and documents, including minutes from 80 governing board meetings from January 2018 to December 2019. GAO also interviewed IHS officials from headquarters, all nine area offices with two or more federally operated facilities, and two federally operated facilities.
What GAO Recommends
GAO is making three recommendations, including that IHS should establish a process to review area office trainings as well as establish a standard approach for documenting governing board review of information. HHS concurred with these recommendations.
For more information, contact Jessica Farb at (202) 512-7114 or email@example.com.
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- North Carolina Sport Supplement Company and Its Owner Plead Guilty to Unlawful Distribution of Steroid-like DrugsBy Sam NewsNovember 25, 2020A North Carolina resident and his sport supplement company pleaded guilty today to a felony charge relating to the introduction of unapproved new drugs into interstate commerce, the Department of Justice announced.[Read More…]
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- Aircraft Carriers: Homeport Changes Are Primarily Determined by Maintenance RequirementsBy Sam NewsApril 22, 2021What GAO Found The Navy has a process for proposing and implementing homeport changes that considers a range of factors. The first key step in this process involves the Navy developing and updating an annual plan, known as the Strategic Laydown and Dispersal Plan, that guides the Navy's positioning of operating forces worldwide. Based on the plan, fleet commanders then identify requirements for any changes to homeports and submit requests to schedule a homeport change. Throughout the process, Navy leadership and a working group of stakeholders from across the Navy provide input and analysis. Among other things , the working group develops and assesses proposed changes among the possible aircraft carrier homeports based on their expertise and evaluates various homeport installation factors, such as maintenance dry docks (see figure) or ship power and maintenance facilities. The Navy also considers local factors including crew support and quality of life, such as schools and morale, and possible impacts to the natural and physical environment. The Navy has strengthened its process by implementing prior GAO recommendations, and has other planned actions underway to further improve and update its guidance. Recent Navy Aircraft Carrier Homeport Locations and Dry Dock at Puget Sound Naval Shipyard The Navy made 15 aircraft carrier homeport changes in fiscal years 2011 through 2020 among the five available homeports. The driving factor for all 15 changes was maintenance. For example, 10 of the 15 changes involved ships moving to or returning from shipyards in Bremerton or Norfolk for planned dry-dock maintenance or midlife refueling. In 2015 and 2019, the Navy decided to homeport aircraft carriers in Bremerton and San Diego because Everett lacked nuclear maintenance facilities, which were available at the Navy's other aircraft carrier homeport locations. Previously, carriers homeported in Everett received regularly scheduled maintenance at the shipyard in Bremerton but did not conduct an official homeport change. The Navy reported that during these maintenance periods that lasted 6 months or more, the crew commuted 3 to 4 hours daily, which negatively affected maintenance and crew morale. As a result, the Navy decided not to return an aircraft carrier to Everett. According to Navy officials, factors in addition to maintenance needs also informed the changes, including a long-held plan to homeport three aircraft carriers in San Diego. Why GAO Did This Study The Navy relies on 11 aircraft carriers homeported on the East and West Coasts and in Japan to support U.S. defense strategic objectives and operations. These nuclear-powered ships require complex infrastructure, technology, and maintenance, some of which may not be available near their homeport. Changing an aircraft carrier's homeport means moving the ship's approximately 3,200 sailors, a fluctuation of 5,000 or more people depending on the number of family members involved. In House Report 116-120, accompanying a bill for the National Defense Authorization Act for Fiscal Year 2020, the House Armed Services Committee noted that the Navy reversed previous plans to homeport an aircraft carrier at Naval Station Everett, Washington. The House Report also included a provision for GAO to review the Navy's process to assign aircraft carriers' homeports. This report examines, for Navy aircraft carriers, (1) the extent to which the Navy has a process for making homeport changes, and considers local installation and other factors in the homeporting process, and (2) homeport changes from fiscal years 2011 through 2020 and the reasons for them. GAO analyzed Navy instructions and related policies, laws, and regulations; homeport plans and maintenance schedules; and fiscal years 2011–2020 documentation of homeport changes. GAO also interviewed Navy officials, including from relevant commands and homeports. For more information, contact Diana Maurer at (202) 512-9627 or MaurerD@gao.gov.[Read More…]
- Secretary Blinken’s Call with Kuwaiti Foreign Minister al-SabahBy Sam NewsFebruary 25, 2021
- Engineering Firm And Its Former Executive Indicted On Antitrust And Fraud ChargesBy Sam NewsOctober 23, 2020A federal grand jury in Raleigh, North Carolina returned an indictment charging Contech Engineered Solutions LLC and Brent Brewbaker, a former executive at the company, for participating in long-standing conspiracies to rig bids and defraud the North Carolina Department of Transportation (NC DOT), the Department of Justice announced.[Read More…]
- California Man Charged with Federal Hate Crime for Attempting to Stab Black ManBy Sam NewsSeptember 29, 2020Assistant Attorney General Eric Dreiband for the Civil Rights Division, and U.S. Attorney David L. Anderson for the Northern District of California, and Special Agent in Charge Jack Bennett for the FBI San Francisco Division announced today that a California man has been charged with a federal hate crime for attacking a black man with a knife on a street in Santa Cruz, California.[Read More…]
- Passengers with Disabilities: Airport Accessibility Barriers and Practices and DOT’s Oversight of Airlines’ Disability-Related TrainingBy Sam NewsApril 14, 2021What GAO Found Passengers with disabilities face infrastructure, information, and customer service barriers at U.S. airports, according to representatives of selected airports, disability advocacy organizations, as well as a review of relevant literature. Infrastructure barriers can include complex terminal layouts and long distances between gates and can be difficult for some to navigate. Essential travel information is not always available in a format accessible to all. For example, a person with hearing loss could miss crucial gate information that is solely provided over a loudspeaker. A passenger might not receive appropriately sensitive service, such as wheelchair assistance, at the airport, although the service provided is required by the Air Carrier Access Act of 1986 (ACAA) regulations. According to stakeholders, while no solution meets all needs, a number of practices can help reduce or eliminate some of these barriers to equal access at airports. For example, some selected airports use external disability community and passenger groups to proactively engage in identifying barriers and develop solutions. Other airports have implemented technology-based solutions, such as mobile phone applications to make airport navigation easier. Examples of Stakeholder-Identified Features to Assist Airport Passengers with Disabilities The Office of Aviation Consumer Protection within the Department of Transportation (DOT) is responsible for oversight of airlines' compliance with the ACAA. In 2008, DOT updated its entire ACAA regulation, including adding new training requirements for airline personnel, such as requiring training to be recurrent. Following this update, DOT conducted outreach to domestic and foreign airlines on the changes and reviewed airlines' disability training sessions and materials. Agency officials said that in recent years, DOT has conducted reviews of airlines' training only when passengers' complaints indicate a possible problem, as officials' analyses have not shown training generally to be a significant cause of service violations. DOT officials and stakeholders said other factors, such as limited availability of staff to assist passengers with disabilities, at times may affect the service passengers with disabilities receive. DOT is assessing some of these factors through the statutorily mandated ACAA Advisory Committee, formed in late 2019 to make recommendations to improve accessibility to air travel. The committee met in 2020, established three subcommittees, and plans to reconvene by summer 2021. Why GAO Did This Study Approximately 43 million people in the United States have some type of disability, which may affect mobility, vision, hearing, and cognition. Without accessible airport facilities and accommodations—such as appropriate assistance from the check-in counter to the gate, or effective communication of flight information—air travel for people with disabilities can be extremely challenging. The FAA Reauthorization Act of 2018 includes provisions for GAO to review leading airport accessibility practices for passengers with disabilities, as well as required training for airline and contract service personnel who assist these passengers within the airport. This report examines, among other objectives: stakeholder-identified barriers that passengers with disabilities face when accessing airport facilities, accessibility practices to assist passengers with disabilities, as well as how DOT has overseen airlines' disability-related training. GAO reviewed relevant federal laws, regulations, DOT documents, literature, as well as information describing disability training provided by selected airlines and contractors. GAO interviewed a non-generalizable sample of stakeholders, including those at 16 U.S. airports selected based on size and geography, eight large and low-cost domestic airlines selected based on the greatest number of disability-related passenger complaints and enplanements, and six aviation service contractors working for those airlines. GAO also conducted interviews with DOT officials and 10 disability advocacy organizations, among others. For more information, contact Heather Krause at (202) 512-2834 or email@example.com.[Read More…]
- Attorney General William P. Barr and DEA Acting Administrator Timothy J. Shea Announce Results of Operation Crystal ShieldBy Sam NewsSeptember 10, 2020Nearly 29,000 Pounds of [Read More…]
- Secretary Blinken’s Call with African Union Commission Chairperson FakiBy Sam NewsJanuary 29, 2021
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- Farm Programs: USDA Should Take Additional Steps to Ensure Compliance with Wetland Conservation ProvisionsBy Sam NewsMay 5, 2021What GAO Found The U.S. Department of Agriculture's (USDA) Natural Resources Conservation Service (NRCS) has taken steps to increase the consistency of their determinations about where wetlands exist on farmers' lands. For example, NRCS state offices formed teams to make such determinations in the prairie pothole region (see fig.), which covers parts of Iowa, Minnesota, North Dakota, and South Dakota. These offices also standardized their wetland determination procedures and included more details, such as the types of data that can be used to identify wetland boundaries. Under wetland conservation provisions in federal law, to receive the benefits of certain USDA farm programs, farmers must not convert wetlands to cropland. Wetlands and Cropland in the Prairie Pothole Region NRCS's primary method to ensure compliance with wetland conservation provisions is conducting annual compliance checks of selected tracts of land for farmers in USDA programs. To select tracts, NRCS draws a national random sample. The sample is to include about 1 percent of tracts subject to wetland the provisions nationally, so many tracts are not sampled for years. For 2014 through 2018, NRCS identified fewer than five farmers with wetland conservation violations per year on the approximately 417,000 tracts in North Dakota and South Dakota—the states with the most wetland acres. Agency officials said NRCS has limited resources to conduct more checks. However, some USDA agencies emphasize risk-based criteria, rather than a random sample, in selecting tracts to check for compliance with other provisions. Doing so makes the checks more efficient by targeting the tracts most likely to have violations. If NRCS used a risk-based approach for its compliance checks (e.g., using information on acres cultivated annually on tracts), it could more efficiently ensure compliance with wetland conservation provisions. If NRCS finds violations, USDA's Farm Service Agency (FSA) may withhold program benefits from farmers, or it may grant waivers to farmers who acted in good faith, without intent to commit violations. FSA granted 243 of 301 requests for good-faith waivers from 2010 to 2018, according to FSA data. FSA relies on committees of fellow farmers to decide on waivers by considering factors such as prior violations. GAO found that some committees relied on weak justification to grant waivers even if farmers had prior violations and that FSA had not specified what is adequate justification. By specifying what constitutes adequate justification, FSA could better ensure it provides benefits only to eligible farmers. Why GAO Did This Study Wetlands perform vital ecological functions, and draining them can harm water quality and wildlife habitat. Many wetlands were drained for farming before enactment of wetland conservation provisions in 1985. However, millions of acres of wetlands, known as potholes, remain in the prairie pothole region. NRCS determines where wetlands exist on the land of farmers who participate in USDA farm programs, and it identifies violations of wetland provisions. FSA administers farm program benefits. In 2017, USDA's Office of Inspector General reported that NRCS had implemented wetland determination procedures in the prairie pothole region inconsistently. GAO was asked to review USDA's implementation of wetland conservation provisions in the prairie pothole region. This report examines, among other objectives, the steps NRCS has taken to increase the consistency of wetland determinations and the approaches NRCS and FSA use to ensure compliance with the provisions. GAO reviewed agency manuals, data, and files on wetland determinations and waivers, and interviewed agency officials and stakeholder groups.[Read More…]
- Duff to Retire as Administrative Office Director; Judge Mauskopf Named as SuccessorBy Sam NewsIn U.S CourtsJanuary 5, 2021James C. Duff has announced he will retire as the director of the Administrative Office of the U.S. Courts on Jan. 31. Chief Justice John G. Roberts, Jr., has appointed Chief Judge Roslynn R. Mauskopf, of the Eastern District of New York, as his successor, effective Feb. 1.[Read More…]
- Assistant Secretary for East Asian and Pacific Affairs David R. Stilwell on the Secretary’s Travel to Japan, Mongolia, and the Republic of KoreaBy Sam NewsOctober 2, 2020David R. Stilwell, [Read More…]
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