Reports
Search reports, investigative results, and agency plansShowing 11 - 20 of 24 results
Department of Veterans Affairs OIG
Deficiencies in COVID-19 Screening and Facility Response for a Patient Who Died at the Michael E. DeBakey VA Medical Center in Houston, Texas
The VA Office of Inspector General (OIG) conducted a healthcare inspection regarding allegations of incompletely screening for COVID-19 and treatment of a patient with serious mental illness who presented for same-day care at the Michael E. DeBakey VA Medical Center (facility). The OIG substantiated that facility staff did not complete the patient’s COVID-19 temperature screening. The OIG substantiated that facility staff failed to medically manage the patient with COVID-19 symptoms, sent the patient to the drive-through testing area without medical evaluation, and did not isolate the patient...
Department of Homeland Security OIG
Violations of Detention Standards at Adams County Correctional Center
During our unannounced inspection of Adams in Natchez, Mississippi, we identified violations of ICE detention standards that threatened the health, safety, and rights of detainees. We made seven recommendations to ICE’s Executive Associate Director of Enforcement and Removal Operations (ERO) to ensure the New Orleans ERO Field Office overseeing Adams addresses identified issues and ensures facility compliance with relevant detention standards. ICE concurred with all seven recommendations.
Department of Homeland Security OIG
Violations of Detention Standards at Adams County Correctional Center
During our unannounced inspection of Adams in Natchez, Mississippi, we identified violations of ICE detention standards that threatened the health, safety, and rights of detainees. We made seven recommendations to ICE’s Executive Associate Director of Enforcement and Removal Operations (ERO) to ensure the New Orleans ERO Field Office overseeing Adams addresses identified issues and ensures facility compliance with relevant detention standards. ICE concurred with all seven recommendations.
Department of Veterans Affairs OIG
Inadequate Resident Supervision and Documentation of an Ophthalmology Procedure at the Oklahoma City VA Health Care System in Oklahoma
The VA Office of Inspector General (OIG) conducted an inspection in response to allegations related to ophthalmology resident supervision and quality of care by an attending ophthalmologist (subject ophthalmologist) at the Oklahoma City VA Health Care System in Oklahoma. The OIG substantiated that the subject ophthalmologist failed to provide adequate resident supervision and entered inaccurate documentation related to supervision for a single patient case. The ophthalmology residents were unable to reach the subject ophthalmologist when the patient experienced a complication during an eye...
Department of Homeland Security OIG
Violations of Detention Standards at Pulaski County Jail
During our unannounced inspection of Pulaski County Jail, we identified violations of U.S. Immigration and Customs Enforcement (ICE) detention standards that threatened the health, safety, and rights of detainees. In addressing COVID-19, Pulaski did not consistently enforce precautions including use of facial coverings and social distancing, which may have contributed to repeated COVID-19 transmissions at the facility. Pulaski did not meet standards for classification, medical care, segregation, or detainee communication. We found that the facility was not providing a color-coded visual...
Department of Homeland Security OIG
Violations of Detention Standards Amidst COVID-19 Outbreak at La Palma Correctional Center in Eloy, AZ
We identified violations of U.S. Immigration and Customs Enforcement (ICE) detention standards that threatened the health, safety, and rights of detainees. La Palma Correctional Center (LPCC) complied with the ICE detention standard regarding classification. However, detainee reports and grievances allege an environment of mistreatment and verbal abuse, including in response to peaceful detainee protests of the facility’s handling of the pandemic. In addressing the coronavirus disease 2019 (COVID-19), LPCC did not enforce ICE’s precautions including facial coverings and social distancing...
Department of Veterans Affairs OIG
Medication Delivery Delays Prior to and During the COVID-19 Pandemic at the Manila Outpatient Clinic in Pasay City, Philippines
The VA Office of Inspector General (OIG) conducted an inspection to assess allegations related to delayed medication delivery from the VA Manila Outpatient Clinic (clinic) pharmacy in Pasay City, Philippines, prior to and during the COVID-19 pandemic. The OIG substantiated a patient experienced medication delivery delays and did not timely receive morphine from the clinic pharmacy in October and November 2019. While the patient requested a renewal in a timely manner, pharmacists could not fill the medication because there was no available stock from the Veterans Health Administration’s (VHA)...
National Reconnaissance Office OIG
Evaluation of the National Reconnaissance Office's Implementation of Section 3610 Authorized by the Coronavirus Aid, Relief, and Economic Security Act
On 27 March 2020, Congress passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which provided emergency assistance and healthcare response for individuals, families, and businesses affected by the Coronavirus disease. Section 3610 of the CARES Act provided agencies discretionary authority to reimburse costs of paid leave to federal contractors and subcontractors using existing appropriations to keep these individuals in a ready state and to protect the life and safety of government and contractor personnel. Given the unprecedented circumstances surrounding these Section 3610...
National Reconnaissance Office OIG
Evaluation of the National Reconnaissance Office’s COVID-19 Pandemic Response
The National Reconnaissance Office (NRO) OIG conducted this evaluation to identify any best practices implemented or challenges encountered by NRO Headquarters and selected field sites in responding to the pandemic. Areas of evaluation contained in this report include mission sustainment, policy, leadership, facilities and logistics, health and safety, communications, and human resources. This report is fundamentally informational and contains perspectives and opinions of NRO’s leadership and workforce.
Department of Homeland Security OIG
Early Experiences with COVID-19 at Border Patrol Stations and OFO Ports of Entry
o We surveyed staff at Border Patrol stations and OFO ports of entry from April 22, 2020 to May 1, 2020. The 136 Border Patrol stations and 307 OFO ports of entry that responded to our survey described various actions they have taken to prevent and mitigate the pandemic’s spread among travelers, detained individuals, and staff. These actions include increased cleaning and disinfecting of common areas, and having personal protective equipment for staff, as well as supplies available to those individuals with whom they come into contact. However, facilities reported concerns with their inability...