Greater Compliance with Policies Needed Related to the Management of Emergent Care for Patients Presenting with Acute Sexual Assault

Report Information

Issue Date
Report Number
21-01445-30
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Healthcare Inspections
Report Type
National Healthcare Review
Report Topic
Care Coordination
VA Police
Women’s Health
Major Management Challenges
Healthcare Services
Recommendations
8
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary

The VA Office of Inspector General (OIG) conducted a national review to determine compliance with Veterans Health Administration (VHA) policy on the management of emergent care needs of acute sexual assault victim-survivors. Sexual assault is an invasive form of interpersonal violence that can have medical, psychological, and legal consequences, requiring a coordinated and compassionate response from medical providers and law enforcement officers when victim-survivors seek care.

The OIG found deficiencies in adherence to VHA policy, including requirements to ensure the provision of sexually transmitted infection prophylaxis and pregnancy prophylaxis when clinically indicated, to offer psychological counseling, and in the documentation of signature informed consent for forensic examinations. The majority of VHA facilities utilized community sexual assault forensic examiner (SAFE) resources to provide forensic examinations, which was identified as a best practice for most VHA sites.

Care related to acute sexual assault is a low frequency but crucial occurrence in VHA, presenting challenges maintaining staff knowledge and training. Additionally, facility and community resources as well as jurisdictional requirements on reporting and evidence collection for acute sexual assault vary across facilities. VHA policy establishes requirements to ensure that veterans have access to safe, high-quality care. However, supplemental facility policy or guidance is needed to ensure facility procedures align with local community resources and jurisdictional requirements to ensure frontline staff have easy access to current clinical practices when responding to acute sexual assault. The OIG determined that opportunities exist for many facilities to improve guidance addressing management of acute sexual assault patients. Improved facility guidance would help ensure implementation of VHA policy by providing frontline staff and VA police with relevant, accessible local procedures and resources when responding to patients presenting with acute sexual assault.

The OIG made eight recommendations to the Under Secretary for Health related to practice deficiencies and improving guidance.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The Under Secretary for Health makes certain the Veterans Health Administration complies with requirements that all acute sexual assault victim-survivors are offered prophylaxis for sexually transmitted infection when clinically indicated and monitors compliance.

No. 2
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The Under Secretary for Health verifies compliance with Veterans Health Administration requirements that all acute sexual assault victim-survivors are offered prophylaxis for pregnancy when clinically indicated and monitors compliance.

No. 3
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The Under Secretary for Health ensures all sexual assault victim-survivors are offered mental health resources, either directly through Veterans Health Administration or through the community and monitors compliance.

No. 4
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The Under Secretary for Health ensures compliance with Veterans Health Administration requirements for documentation of signature informed consent for forensic examinations conducted by staff at Veterans Health Administration facilities and monitors compliance.

No. 5
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The Under Secretary for Health coordinates with VA Office of Security and Law Enforcement to provide direction that facility policy or guidance include facility and jurisdiction-specific information necessary for frontline staff to act in accordance with jurisdiction and Veterans Health Administration requirements for VA police responding to sexual assaults.

No. 6
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The Under Secretary for Health ensures Veterans Health Administration’s policy specifies the required elements to include in Veterans Health Administration facilities’ policies or guidance on acute sexual assault, including jurisdiction-specific requirements, and considers an online national policy with an appendix containing each facility’s supplemental information.

No. 7
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The Under Secretary for Health makes certain that facility level management of acute sexual assault policy or guidance is updated to incorporate information on facility-specific resources and jurisdictional requirements as warranted, and educates staff as needed.

No. 8
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The Under Secretary for Health ensures that VA Police Chiefs review facility policy and guidance for police responding to sexual assaults and update to incorporate information on facility-specific resources and processes, including jurisdictional requirements, as warranted, and educates facility police officers as needed.