In 2010, the United States Government Accountability Office (GAO) conducted a study regarding the accessibility of sex-specific care for women veterans. This study revealed marked weaknesses at VA medical facilities – specifically, the GOA noted that, of the 19 VA medical facilities visited in 2010, none were in compliance with the Veterans Health Administration’s (VHA) policies governing care for women veterans. These policies, meant to ensure women’s privacy, safety, and dignity, govern auditory privacy at check-in and in interview areas, the location of exam rooms, and the presence of privacy curtains in exam and inpatient rooms. Due to the lack of compliance, the GAO recommended that the VA take several remedial measures to strengthen the provision and oversight of care for women veterans. The VA agreed with the GAO’s recommendations, and appeared to have made progress, including the implementation of a policy requiring all women veterans have access to a PCP specially trained in women’s healthcare services. However, due to continued concerns regarding women’s healthcare, the GAO was asked to conduct a follow-up study to evaluate the following:
(1) the extent to which VAMCs complied with requirements related to the environment of care for women veterans and VHA’s oversight with regard to compliance;
(2) the availability of VHA medical providers who can provide sex-specific care for women; and
(3) VHA’s efforts to provide and monitor access to sex-specific care through the use of outside facilities.
Last month, December 2016, the GAO released the results of its follow-up study, revealing that women’s care and accessibility to sex-specific care remains lacking. As part of the study, six VAMCs were visited. Based on these site visits, the observed compliance with requirements related to women’s care ranged from 65 percent to 81 percent – a compliance rate far better than 2010, but still demonstrating the need for more oversight with regard to women’s care. During these visits, 155 instances of noncompliance with VHA policy were noted, yet 152 of these were not reported. Unfortunately, documented rates of compliance are based on the number self-reported instances of noncompliance. Because it appears that the majority of noncompliance goes unreported, it is likely that actual compliance is far less than the GAO could determine.
In addition to continued noncompliance with policies intended to preserve women’s privacy, safety, and dignity, a shocking twenty-seven percent of all VAMCs still do not have an onsite gynecologist. Although the number of VHA women’s health primary care providers has increased over time, almost one-fifth of VA clinics do not have a women’s health primary care provider. The GAO noted “[t]he fact that nearly 18 percent of VAMCs and outpatient clinics providing primary care lacked a women’s health primary care provider in fiscal year 2015 suggests that VHA may face challenges ensuring that all women veterans have timely access to these providers, as required under VHA policy.” Additionally, while women are sometimes offered sex-specific care through programs such as Choice, VHA does not monitor access to sex-specific Choice care for women veterans or delays with regard to these programs. Monitoring delays could minimize future occurrence.
The results of the 2016 GAO report demonstrate that, although some progress has been made since 2010, “VHA still has a significant problem ensuring that its medical facilities are complying with VHA’s environment of care requirements, which are intended to protect the privacy, safety, and dignity of women veterans when they receive care.”