Sexual Assault in VA Facilities

Author: Courtney Boeckman, M.A.

The news media continually highlights studies documenting the dangers faced by medical professionals, particularly doctors and nurses in emergency room departments or psychiatric wards. According to a Journal of Critical Nursing survey conducted in Australia, approximately three-fourths of the nurses who responded had experienced an act of workplace violence within the previous 12 months. While half of these nurses verbally reported the act to supervisors, less than a fourth of the nurses filed an official report.^[1] A survey conducted by the Emergency Nurses Association (ENA) in 2009 produced similar results.^[2] Approximately half of the emergency room nurses who participated in the survey reported experiencing violent acts at the hands of patients. The Occupational Safety and Health Administration acknowledged the prevalence of violence against nurses when Evelyn Bain, the head of the Massachusetts Nurses Association Occupation Health and Safety Office was quoted as saying “workplace violence has really just been head and shoulders above that.”^[3] Ms. Bain was referring to the fact that workplace violence had greatly surpassed the previous most frequent complaint of back or health problems created by the job. 

However, until recently, the United States Department of Veterans Affairs’ (VA) Veterans Health Administration (VHA) has been overlooked in regard to these studies. The VHA staffs nearly 250,000 individuals, at over 1,400 locations across the country, making it the country’s largest integrated health care system.^[4] Currently, the VA is treating more young veterans and more female veterans than in the past. This is due to an increased number of soldiers returning from the wars in Iraq and Afghanistan. Based upon this changing demographic, there is an increased difficulty in ensuring a safe environment for all patients and VA employees. Recently, the Government Accountability Office (GAO) was asked by the House Committee on Veterans Affairs to review a number of issues related to sexual assaults in the VA facilities, including the accuracy of the figures reported, contributing factors to any failure to report an assault, ability of staff to identify sexual assault-related risks, and safety and security measures in place to prevent assaults. The GAO gathered and reviewed information from a variety of VA facilities related to incidents of sexual assault which occurred between January 2007 and July 2010. According to the GAO, VA staff, patients, and visitors, male or female, were victims of sexual assaults. The findings were published in June 2011.

Between January 2007 and July 2010, approximately 300 incidents of sexual assault were reported to VA police; however, many of those incidents were never escalated to VA officials or the VA Office of Inspector General (OIG), as required by regulations.^[5] Additionally, of those sexual assault incidents in which rape was alleged, only one-third were reported to the VA OIG. According to the GAO, a variety of factors contributed to the underreporting of these incidents, most notably including “unclear guidance and deficiencies in VA’s oversight.” The GAO continued to identify flaws in the VA’s risk assessment of patients, particularly the fact that all legal history, to include prior assaults, is obtained directly from the patient without independent verification. Moreover, the patient’s medical records often fail to contain a complete legal history for the patient and no guidance is provided to healthcare workers regarding how to obtain such documentation. Without a complete knowledge of a patient’s history, VA staff cannot adequately assess the patient’s risk level, thus placing both the VA staff and other patients at risk. While the GAO determined that the VA facilities have security measures in place to prevent acts of sexual assault, many of those measures were found to be deficient. Specifically, the GAO found that the VA police are understaffed at many locations; the surveillance cameras are inadequately monitored; and alarm systems, that include panic buttons, malfunctioned or failed to alert VA police and other personnel of an incident.

The House Committee on Veterans Affairs held a meeting on June 13, 2011 to discuss the results of the GAO study and options for improvement.  Per a press release dated June 13, 2011, “VA officials had not yet implemented a system-wide safeguard to protect veterans and VA employees from sexual assault.”  VA officials could not provide data for the most recent time period of 2010-2011 and cited continued confusion over who had jurisdiction in conducting investigations.  The House Committee was very concerned after the meeting, with Rep. Ann Marie Buerkle, Chairwoman of the Subcommittee on Health, saying “I am very concerned with what I have heard today.  It is not clear to me that VA has taken this report seriously, and came before this Committee unprepared to answer the questions that we, the public, and our veterans have.”  Representative Jeff Miller, Chairman of the House Committee on Veterans Affairs, finished by saying, “The safety and security of our veterans is paramount and we pledge to stay on top of this developing situation within the VA to ensure that justice is done for victims and that this behavior never happens again.”