From the U.S. Government Accountability Office, www.gao.gov Transcript for: Health Care for Women Veterans Description: Audio interview by GAO staff with Randy Williamson, Director, Health Care Related GAO Work: GAO-17-52: VA Health Care: Improved Monitoring Needed for Effective Oversight of Care for Women Veterans Released: December 2016 [ Background Music ] [ Narrator: ] Welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. It's December 2016. In 2010, GAO found weaknesses in health care for women veterans at VA medical facilities. A team led by Randy Williamson, a director in GAO's Health Care team, recently reviewed VA's programs to see what, if anything, has changed since then. Jacques Arsenault sat down with Randy to talk about what they found. [ Jacques Arsenault: ] Your team looked at health care services available to women veterans. What did you find about whether those are effective? [ Randy Williamson: ] We found a couple things. First, we looked at whether VA facilities were complying with their policies intended to protect the privacy, safety, and dignity of women veterans. We looked at six facilities and we found basically that none of the six facilities were complaint with all VA requirements in this area. Auditory and visual privacy at check-in was missing at all but one facility. Privacy curtains were missing and exam tables were facing the door. All of these things can compromise the privacy of women veterans when they are examined. Also, access to exam rooms was unrestricted in some locations. Bathrooms were not always stocked with sanitary napkins and tampons and so on. There were about 15 different privacy factors that we looked at and basically none of the facilities did everything right on all of them. Another thing we looked at was the availability of primary care physicians and gynecologists and we found basically that the number of providers trained in women's health has grown over the last 5 or 6 years, but there are still medical facilities lacking providers for women. VA is aware of those shortages and are taking steps hopefully to rectify that. [ Jacques Arsenault: ] Now, this isn't the first time that GAO has looked at health care for women veterans. Your team looked at this back in 2010. Does the current situation represent an improvement or are we seeing some of the same problems that have been in existence? [ Randy Williamson: ] We're seeing some of the same problems. In 2010, we looked at 19 facilities and found the same kinds of privacy issues in terms of the exam rooms and so on that we found here. You know, the privacy is very important to women, especially-- keep in mind that many women who seek VA care have been victims of military sexual trauma and protecting their privacy and dignity is extremely important. So, in 2010, we found the same kinds of things. In 2016, we validated those again, but in 2016 it was-- the prevalence was a lot less. It was more severe in 2010. So, things are getting better, but there are still some progress that needs to be made. [ Jacques Arsenault: ] And, when you looked at the other side, the availability of services, has that changed? Has that improved since 2010? [ Randy Williamson: ] Yes, somewhat. I mean there has been growth in the number of providers that-- and gynecologists-- primary care providers and gynecologists that VA has on board. But, again, we found that about 20 percent of the VA facilities this time around didn't have primary care providers in the women's health area. Also, about one-quarter of the medical centers lacked an onsite gynecologist, and when these kind of things happen, they are forced-VA is forced to send women to community care through the Choice Program. [ Jacques Arsenault: ] So, looking at that Choice Program which allows veterans to access providers in the community if the VA can't provide the services directly, is that an effective option for women veterans? [ Randy Williamson: ] We know it can be, but, again,there have been problems with access to appointments and untimely appointments under the Choice Program. For example, 30 percent or more of the routine Choice appointments are not being scheduled within the required timeframe, which is 5 days, and about one-quarter of the urgent Choice appointments are occurring within the required timeframe, which is 2 days. So, that'll still be a major challenge for VA, getting the Choice Program up and running like it should be. [ Jacques Arsenault: ] Can you talk about the recommendations that GAO is making to VHA in this report? [ Randy Williamson: ] Yes. There are kind of two major ones. The first is to address the facilities' noncompliance with privacy and safety requirements and there we're recommending that VA strengthen its inspection process at the facilities and that central office improve their oversight of this process by spot-checking or validating data. Also, to help ensure that women veterans obtain health care they need, we are recommending that VA monitor women's health access-they're not doing that now-to key areas of sex-specific care in the community and we're targeting specifically mammography, maternity care, and gynecology. Those are three important areas that really need to be monitored. [ Jacques Arsenault: ] And finally, then, what would you say is the bottom line of this report? [ Randy Williamson: ] Things are getting better. Facilities are improving in their compliance rates, but there are still some significant problems. There are significant problems complying with VA requirements intended to protect the privacy, safety, and dignity of women veterans when they receive care. That is a major one that needs to be fixed. Also concerning are challenges VA faces with ensuring that women veterans have access to sex-specific care-not only at its own facilities, but through community providers providing care under Choice. We think that if VA adopts these recommendations, that things will improve significantly for women veterans. [ Background Music ] [ Narrator: ] To learn more, visit GAO.gov and be sure to tune in to the next episode of GAO's Watchdog Report for more from the congressional watchdog, the U.S. Government Accountability Office.