March 13, 2020

Udall Pushes for VA to Increase Protections for Veterans during Coronavirus Outbreak

WASHINGTON—U.S. Senator Tom Udall (D-N.M.) sent a letter with Senator Jon Tester (D-Mont.) and 10 of their colleagues to the U.S. Department of Veterans Affairs (VA) to ensure that the Veteran’s Health Administration is taking appropriate measures to protect veterans from the spread of the novel coronavirus. Udall is a member of the Senate Appropriations Subcommittee on Military Construction, Veterans Affairs and Related Agencies that oversees the VA budget and Senator Tester is the Ranking Democratic Member on the Senate Veterans Affairs Committee with jurisdiction over veterans policy.  

VA is the nation’s largest health care system with 172 medical facilities and 1,241 outpatient sites, 9 million enrolled veterans, and employing more than 322,000 staff across the country. The VA has reported cases of COVID-19 and presumptive positive cases among veterans across the country.

According to the latest available data, the VA reports that there are 158,994 veterans in New Mexico, 77,284 of whom are over the age of 65. The department employs over 2100 personnel in the state to service the VA’s main clinic in Albuquerque and 13 community-based health centers throughout the state.

“…We write to request details regarding VA’s approach to coronavirus preparedness and how the Department’s response has changed. We recognize that the COVID-19 outbreak is an evolving situation, with a growing impact on the U.S. and global community, and want to ensure that the VA has all of the resources needed to keep veterans, staff, and communities safe,” the senators wrote.

“We appreciate your leadership during this emergency response effort and are hopeful that VA can be on the forefront of a successful domestic response to COVID-19,” the senators continued.

The senators concluded by asking VA to provide responses to a number of questions regarding

- The department’s preparedness to respond to the COVID-19 outbreak;
- Plans to coordinate with state and local government to meet the needs of veterans;
- Availability and quality of emergency supplies and equipment, such as respirators;
- The agency’s steps to prepare for the so-called “Fourth Mission,” in which VA may be called on to provide health care to individuals responding to or affected by a natural disaster or national emergency; 
- Pre-screening protocols in VA clinics to limit coronavirus exposure;
- Plans to care for the veterans most vulnerable to COVID-19;
- Current efforts to provide veterans and Veterans Service Organizations with information about COVID-19, protection measures, and resources for veterans;
- An explanation for why VA did not submit a supplemental funding request for a response to the outbreak.

In addition to Udall and Tester, the letter was signed by U.S. Senators Jeff Merkley (D-Ore.), Patty Murray (D-Wash.), Bernie Sanders (I-Vt.), Sherrod Brown (D-Ohio), Richard Blumenthal (D-Conn.), Mazie Hirono (D-Hawaii), Ron Wyden (D-Ore.), Bob Casey (D-Penn.), Tammy Baldwin (D-Wisc.) and Elizabeth Warren (D-Mass.). 

The full text of the letter can be found HERE and below.  

Dear Dr. Stone,

Thank you for your response to our February 6, 2020 letter on what steps the Department of Veterans Affairs (VA) is taking to protect the health and safety of veterans and staff during the 2019 Novel Coronavirus (COVID-19) outbreak. Now that VA has recorded six COVID-19 cases across the Western U.S. and Louisiana, we write to request how VA’s approach to coronavirus preparedness and response has changed. We recognize that the COVID-19 outbreak is an evolving situation, with a growing impact on the U.S. and global community, and want to ensure that the VA has all of the resources needed to keep veterans, staff, and communities safe. We appreciate your leadership during this emergency response effort and are hopeful that VA can be on the forefront of a successful domestic response to COVID-19.

We request your timely response to the following questions on VA’s preparedness and response efforts for COVID-19:

Agency Response and Preparedness

- Who at VA is responsible for the Agency’s internal response to COVID-19?
- Who within each VISN is responsible for VISN response and oversight of facilities within its boundaries?
- Can VA provide a weekly update with data on current medical supply levels, amount of test kits available, number of patients tested for COVID-19 and the status of all test results, current bed occupancy rates, current staffing levels, and number of staff being quarantined and/or tested for COVID-19?

Responsibility for Coordination with Federal, State and local government

- Who at VA is responsible for coordinating the Department’s response with Federal, State and local governments?

Emergency Supplies and Respiratory Support

- The Boston Globe reported that in one Veterans Integrated Service Network (VISN), “some emergency stockpiles of respirator masks have deteriorated in storage and can’t be used.” Does VA have a sufficient supply of working respirator masks (e.g. N-95 masks) for the COVID-19 response? And, have respirator masks across all VISNs, VA Medical Centers (VAMCs) and Community-Based Outpatient Clinics (CBOCs) been checked to determine usability?
- Have all of VA’s All Hazards Emergency Caches (AHECs) been checked for both adequate supply and usability of those supplies?
- Should VA exhaust its supplies of respirators and AHECs, what options would the Department have for additional supplies?
- Given the reported strain on respiratory support equipment, including ventilators, on hospitals caring for coronavirus patients abroad, is VA confident that its supply of such equipment is adequate to support its 1) current patient population and 2) a potential surge if VA’s responsibilities under the Agency’s Fourth Mission are activated?

Supporting State & Federal Response Efforts

- In line with VA’s Fourth Mission, has VA been included in discussions on under what circumstances the President or Secretary of Health and Human Services would declare a major disaster or emergency and/or activate the National Disaster Medical System, thereby triggering VA’s responsibilities under section 1785, title 38, United States Code? 
- Will VA be deploying more health care providers using the Disaster Emergency Personnel System (DEMPS)? How will those deployments be determined?
- How does VA determine when to activate an AHEC and have any AHECs been activated for COVID-19 to-date? Will VA use the AHECs to support federal, state, local, or tribal response efforts? Can the Indian Health Service access essential medicines or supplies from the AHEC?

Patient Screening and Isolation

- Is pre-screening for entry now in place for patients, staff, contractors, and visitors at all VAMCs and health clinics?  If not, when will all VA facilities have this capability?  What does pre-screening entail?  
- Do VA Police and other VA employees conducting the COVID-19 pre-screenings at VA facilities, VAMCs and CBOCs, have the protective equipment and training needed to prevent viral transmission? 
- Are samples being tested in-house or sent to State and/or Federal labs? If testing is not being done at VA, are there plans to explore this option? For testing that has already been completed, what is the average length of time for results?
- Should a patient arrive at a VA facility without a negative air pressure isolation room, what follows?  What options do rural veterans have who are served by sometimes very small CBOCs?  Your letter dated March 4, 2020 noted that VA has 894 isolation beds – with two-thirds already occupied for non-coronavirus issues. What is the Agency’s plan to address this potential shortfall? 

Caring for the Most Vulnerable Veterans

- Given that COVID-19 has the highest risk of mortality among individuals who are older and/or have co-morbidities, what is VA doing to especially protect older, sicker veterans?
- What COVID-19 preparedness policies are in place for VA’s Community Living Centers (CLCs)?
- How is VA communicating and collaborating with State Veterans Homes and Community Nursing Homes, where many veterans receive long-term care? 

Communication with Veterans and VSOs

- Is the VA engaging in any efforts, by themselves or in partnership with the VSOs, to ensure that veterans have accurate information on COVID-19, including information on how to avoid scams and how to identify inaccurate information related to the virus, including how it spreads and questionable claims regarding treatments or therapeutics?
- Is VA working with the Department of Defense to disseminate information about COVID-19 to transitioning servicemembers, including through the Transition Assistance Program? 

Funding

- It is essential that VA is equipped to continue providing essential health services for veterans, as well as to respond to the novel coronavirus.  VA did not request or receive additional funding in the coronavirus supplemental funding package.  How is VA currently funding the additional workload require to respond and prepare for this unexpected coronavirus?  
- What is the Department’s plan if VA needs any additional resources for responding to the COVID-19 outbreak?

We are thankful for the dedicated staff across the Department who are working tirelessly to respond to this public health emergency and keep veterans and their communities safe. Thank you for your partnership in serving veterans and protecting the dedicated staff who care for them. 

Sincerely,