ODVA Audit

SPECIAL AUDIT
Oklahoma Department
of Veterans Affairs
For the period July 1, 2014 through June 30, 2017
Oklahoma State
Auditor & Inspector
Gary A. Jones, CPA, CFE
Oklahoma Department of Veterans Affairs
Special Audit Report
For the Period

July 1, 2014 through June 30, 2017
August 1, 2018
TO THE HONORABLE MIKE HUNTER, OKLAHOMA ATTORNEY GENERAL
Pursuant to your request and in accordance with the requirements of 74 O.S. § 18(f), we
performed an audit with respect to the Oklahoma Department of Veterans Affairs for the period
July 1, 2014 through June 30, 2017.
The objectives of our audit primarily included, but were not limited to, concerns surrounding
the control environment and communication breakdown at the agency, changes in the level of
care for residents of the seven state veterans centers, various financial and operational
questions, and events related to the Talihina center. The results of this audit are presented in the
accompanying report.
Because the procedures performed do not constitute an audit conducted in accordance with
generally accepted auditing standards, we do not express an opinion on the account balances or
financial statements of the Oklahoma Department of Veterans Affairs for the period July 1, 2014
through June 30, 2017.
We also wish to take this opportunity to express our appreciation for the assistance and
cooperation extended to our office during the course of our engagement.
Sincerely,
GARY A. JONES, CPA, CFE

OKLAHOMA STATE AUDITOR & INSPECTOR
Table of Contents
Executive Summary .......................................................................................................... i
Background of This Engagement................................................................................... 1

ODVA Background.......................................................................................................... 3
Control Environment & Tone at the Top

Hostile Tone at the Top ................................................................................................... 5
Low Employee Morale .................................................................................................... 7
Staffing, Turnover, and Salary Concerns...................................................................... 8
Communication ................................................................................................................ 9
Other Control Environment Concerns ........................................................................ 14
Snap Decisions................................................................................................... 14
Consolidations ................................................................................................... 15
Favoritism, Bias, and Other Issues with Central Office Staff...................... 19
Commission ....................................................................................................... 22
Level of Care .................................................................................................................. 24
Talihina Veterans Center

Background and Events in Talihina ............................................................................ 32
Additional Information Related to Capital Project Cancellations .......................... 38
Employee Perspective ................................................................................................... 45
Results of Procedures and Employee Surveys

Sources of Revenue ........................................................................................................ 48
Budgeting of Carryover Funds .................................................................................... 49
Annual Budgets by Location ........................................................................................ 50
FY 2018 Budget ............................................................................................................... 50
Policies and Procedures ................................................................................................ 51
Cost per Bed .................................................................................................................... 52
Service-Connected Compensation............................................................................... 53
Central Office Travel Expenditures ............................................................................. 54
Statutory Exemption Allows ODVA to Hire Attorney............................................. 54
Contracts with Arts Council and Related Issues ....................................................... 55
ODVA Employee Bonus Programs ............................................................................. 56
Medicare/Medicaid Funding: Software and Other Issues ...................................... 57
MDS Coordinators ......................................................................................................... 59
Administrative Overhead ............................................................................................. 60
Headquarters Move and New Building Renovation ................................................ 61
Specialty Diets and Menu Standardization ................................................................ 61
Accessibility of EKG Machines and Crash Carts in Centers .................................... 62
Outsourcing of Laboratory Activities ......................................................................... 63
Cancelled Capital Projects ............................................................................................ 66
Recommendations.......................................................................................................... 67
JUNE 2018
Oklahoma State Department of Veterans Affairs

Special Audit Report
Executive Summary
Background
We were engaged at the request of the Attorney General, pursuant to 74 O.S. § 18f, to address a
wide variety of concerns expressed by legislators, citizens, and ODVA staff.
As a result of continual operational changes, removal of key financial staff, central
management’s interference in our communications, and growing reluctance of staff to be open
with us due to a fear of retribution, we lost our ability to rely upon information provided by the
agency. We then elected to cease detailed procedures, and focus on surveying employees and
reporting the current circumstances at the agency, along with any completed information from
our procedures.
What We Found
This report covers a wide variety of nuanced and interwoven topics. Here are the key findings
related to three of the most significant areas.
Tone at the Top and Communication
A culture of fear and intimidation exists at ODVA. Employees across the state actively fear for
their jobs and report experiencing dictatorial and aggressive leadership from the central office.
They expressed that management makes changes without explanation, and ridicules those who
offer input or disagree. Morale is reportedly at an all-time low, with staff left feeling
unsupported, without adequate resources, and reminded regularly that they are replaceable.
A silo effect appears to be at work at the agency, with central management and varying
divisions “cut off” from one another. Center management feels cut off from the Oklahoma
Veterans Commission; centers feel cut off from one other. A lack of clear directives at both the
central and veterans center levels obstructs the flow of information from the top down,
hindering project implementation and aggravating employee concerns.
Staff are frustrated by perceived central office favoritism and bias in staffing and incentives.
While the central office expands, center staff believe funds are being removed from veteran care
for that purpose. Management argues that cuts to staffing and services are due to a decline in
state appropriations, while staff are aware that state funds account for only a minor portion of
the agency’s overall revenues, which did not in fact decline over the audit period.
Overall, this toxic environment increases risk and lowers morale throughout the agency, no
doubt impacting the quality of care and services provided.
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Level of Care
Responses to our employee surveys and interview questions echoed one of the initial questions
driving this audit with concerns that the level of care provided to residents of the state veterans
centers is declining. In recent years, laboratory services at the centers have been outsourced,
with reports that other services are soon to follow, as staffing shortages and turnover frustrate
center employees. Access to medical providers is reportedly being restricted, and specialty diets
have been limited while center menus were standardized. It is clear the historical level of in-
house care at the centers is declining.
However, as the veterans centers are licensed as long-term care facilities, these changes do not
appear to violate applicable regulations. Rather, they illustrate staff’s concerns that the centers
are being turned into nursing homes, that management is occupied with raising profits while
meeting minimal regulatory requirements, and that central office does not share their respect
and admiration for the residents in their care. These changes also contradict ODVA’s mission of
“providing to the Veterans residing in the state of Oklahoma the highest quality support and
care available anywhere in the Nation.”
Talihina Veterans Center
Management has presented varied reasons for wanting to relocate the Talihina Veterans Center,
and staff there is convinced that central management has a vendetta against the center, fearing
for their jobs and residents’ wellbeing. Whether or not the center is eventually moved, there are
residents living there and employees working there today, and by all appearances that will
continue to be the case until a new facility can be made ready. Estimates for that time period
have typically been in the range of five years. Providing quality care for the residents in the
interim necessitates that the agency maintains the center at an acceptable level, staffs the facility
adequately, and supports that staff in providing care and operating the center.
What We Recommend
1. The Commission should evaluate and address the negative control environment and
communication breakdown in the most efficient and positive manner possible. The
Commission should also recognize its authority and responsibility in appointing the
director, as outlined in 72 O.S. § 63.3.
2. Management should establish a system of clear communication that relays information
from the bottom of the organization to the top and vice versa.
3. The Commission should seek an independent evaluation of cost effectiveness and
impacts to services prior to relocating any veterans center.
4. Management should ensure policies and procedures are standardized or customized to
the extent that best ensures the agency meets its mission and complies with appropriate
requirements. Staff should receive adequate review time and training when policy
changes occur.
5. Management should ensure appropriate cost-benefit analyses are performed prior to
outsourcing key services or making other significant operational changes.
6. Management should pursue an independent examination of current financial controls
and other significant operational areas as outlined at the end of this report, as well as
any other areas that have undergone substantial changes.
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This As a result of concerns about the Oklahoma Department of Veterans

Engagement: Affairs (ODVA or the agency) expressed by legislators and citizens, the
Background Attorney General requested the assistance of the State Auditor and
Inspector (SAI) in an engagement pursuant to 74 O.S. § 18f.
The various questions and concerns that initially prompted the
engagement were compounded by stories regarding ODVA in the media,
upcoming legislation impacting the agency, and worries shared by
administrators and staff once we began interviews. This resulted in
nearly 30 topics being addressed in our original planned procedures,
varying from budgeting and financial issues to staffing, capital projects,
center operations and resident care, and to overall issues of management
attitude and communication within the agency.
During the engagement, some aspects of operations at ODVA appeared
to deteriorate. We were contacted frequently by staff and citizens,
including those with a vested interest in the Talihina center, and these
discussions became more serious and urgent. The business offices at the
veterans centers were dismantled and their main responsibilities
consolidated into the central office in Oklahoma City; five of the seven
business managers were terminated and the other two transferred to
central office. The agency’s chief financial officer, who had previously
served as our main contact, took leave for an extended period of time and
subsequently, other long-time central office staff either took extended
leave or separated from the agency. Management’s operational changes
and centralization of certain duties continued, sometimes inappropriately
using unrelated recommendations from SAI’s past audits as justification
for the changes. They also made uninformed statements about the
progress and impending results of this engagement to staff and outside
parties.
We experienced increasing difficulty in obtaining information from the
veterans centers, due in part to the removal of the business managers, but
also because central office began intervening in questions we had
directed to the centers, insisting on fulfilling some requests centrally and
instructing center staff on which questions they were permitted to
answer.
From the time of our first meetings at the centers, it was clear that we
were observed entering and leaving the facilities; and we were later
informed that administrators were contacted by central management as
soon as we left with inquiries as to what we had discussed. Throughout
our procedures we continued to receive warnings and concerns that any
contact between our office and ODVA staff was monitored, and that most
employees could not be open with us due to fear of retribution. (These
concerns were later further validated by responses to our employee
survey, which included many comments to the effect that respondents
feared being fired or other retaliation, that they would need protection to
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come forward, that we were being watched, or that they would try to
reach out using separate channels or in the future.)
It soon became clear that we no longer had willing, independent sources
of information regarding the individual veterans centers, and further
determined we could not rely upon, or in some cases verify, information
provided by central office. It was clear center personnel feared for their
jobs and did not feel comfortable contacting us. This situation resulted in
what is referred to as a “scope impairment” in a typical performance
audit, meaning a constraint imposed on the audit approach by limited
access to reliable evidence, or certain records or individuals. 1 It also put
us in a position of potentially putting further jobs at risk if we insisted
upon direct contact with staff.
We discussed the situation with the Attorney General’s office and agreed
to alter our planned procedures as necessary and to perform an
anonymous employee survey of ODVA staff across the state. Survey
recipients included most financial and administrative staff at the central
office and veterans centers, as well as a random sample of staff from
throughout the rest of the agency. Recipients were instructed that they
could provide the electronic survey link or auditors’ contact information
to other interested employees, including past employees who had been
present during the audit period. In total, 254 responses were received,
including several dozen sent by fax and by mail.
In order to bring to light our serious concerns about the negative control
environment and damaging tone at the top of ODVA, which we consider
to be one of the most pressing overall issues currently impacting agency
staff, finances, and the level of care provided at the veterans’ centers, it
was important to cease detailed procedures focusing on the past so we
could provide this information about the current environment to decision
makers as soon as possible.
This report includes the results of procedures we were able to perform,
with the level of detail or support that was available and appropriate, as
well as a list of topics that bear further consideration. For issues we noted
that were not applicable to the contents of the report or not supported by
sufficient information to be considered significant to the report, we have
listed additional issues and allegations for the Attorney General’s
consideration in a separate memo and provided that, along with
supporting documents, to his office.
1
Performance audit scopes and related limitations are discussed in the Government Accountability Office’s
Government Auditing Standards, 2011 revision, Chapter 7. Section 7.11 specifically states auditors should report any
significant constraints imposed on the audit approach by information limitations or scope impairments, including
denials or excessive delays of access to certain records or individuals. While an engagement under 74 O.S. § 18f is not
statutorily bound to auditing standards, this standard illustrates why an auditor cannot in good conscience perform
procedures or report results based upon what he or she believes to be insufficient or unreliable evidence.
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For general procedures, we focused on the period of July 1, 2014 through

June 30, 2017. However, as events and changes continued to unfold at
ODVA, we extended this period as needed to report as fully as possible.
The responses to the employee surveys referred to throughout this report
were received in March 2018 and offer the most immediate information
about the current agency environment. However, even after the close of
that survey, staff has continued to reach out to us with questions and
concerns.
ODVA The Oklahoma Department of Veterans Affairs was created by the

Background Oklahoma Legislature in 1947 and is responsible for the administration of
the general duties of the Oklahoma Veterans Commission (Commission),
including assistance to veterans and their dependents in obtaining
benefits.
ODVA provides benefits, services, and care to veterans living in
Oklahoma through claims and benefits assistance and residential care.
Just over 1,300 veterans reside in its seven long-term care centers located
in Norman, Clinton, Ardmore, Sulphur, Claremore, Talihina, and
Lawton. Each center has its own administrator and limited administrative
staff, in addition to its medical and food service functions. The central
office houses the executive director and central business staff and
provides support services and oversight for the seven veterans centers
and other divisions.
The agency’s stated mission is that, “In partnership with the Secretary of
Veterans Affairs, the Oklahoma Department of Veterans Affairs, state and
local agencies, and veterans services organizations, the state of Oklahoma
will facilitate in providing to the veterans residing in the state of
Oklahoma the highest quality support and care available anywhere in the
nation.”
The Commission is the controlling board for the agency and each
veterans center. It is responsible to the Governor for carrying out the laws
enacted by the Oklahoma Legislature and for administering the veterans
program in Oklahoma. The Commission consists of nine members
appointed by the Governor, with the advice and consent of the Senate,
from lists of five names submitted by the American Legion, the Veterans
of Foreign wars, the Disabled American Veterans, the Paralyzed Veterans
of America, the Military Order of the Purple Heart, and the National
Guard Association of Oklahoma. One member is selected from each of
these groups and three members are at large, one of whom may be a
nonveteran with a family member residing in a state veteran center.
Commissioners serve a term of three years.
The Commission has authorized and charged the director with the
responsibility of administering its programs. The director active during
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our official audit period retired in January 2018, and the audit period
deputy director was appointed director at that time.
Commission members as of June 2018 are:

Tom Richey ................................. Chairman/Paralyzed Veterans of America
Larry Van Schuyver ............ Vice-Chair/Military Order of the Purple Heart
Jon Arthur ............................................................ Disabled American Veterans
Jerry Ball ..................................................................................... America Legion
Paul Costilow......................................................................... At-Large Member
Pat Fite .................................................................................... At-Large Member
Gary Secor ................................................................. Veterans of Foreign Wars
Lloyd Smithson .................................................... National Guard Association
Gaylord “Z” Thomas ............................................................ At-Large Member
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CONTROL ENVIRONMENT & TONE AT THE TOP
Hostile Tone at Management’s ethics, integrity, attitude, and operating style are the
the Top foundation of all other internal control components that help an entity
achieve its objectives and minimize risk. According to government
internal control standards produced by the federal Government
Accountability Office (GAO standards) 2, an effective internal control
system has in place policies and procedures that reduce the risk of errors,
fraud, and professional misconduct within the organization. Key factors
in this system are the environment established by management, and
effective information and communication to achieve the agency’s
objectives.
The agency-wide control environment has a pervasive influence that
affects all activities of the organization. The governing board, executive
director, and entire management team must all contribute to creating a
positive control environment or “tone at the top.” The governing board
sets the proper tone for the control environment when it establishes and
communicates a code of ethics, requires ethical and honest behavior from
all employees, observes the same rules it expects others to follow, and
requires appropriate conduct from everyone in the organization.
Management’s philosophy and methods of employee direction and
development also greatly influence this environment. Management
demonstrates the importance of integrity and ethical values through their
directives, attitudes, and behavior.
It was made clear to us immediately upon beginning interviews and
regularly throughout our contact with staff statewide that a culture of
fear and intimidation exists at ODVA. Employees across the state
reported fearing for their jobs and experiencing dictatorial and aggressive
leadership from the central office. This top level of the agency was
described as generating a “toxic environment,” having a “very strong
barrier of intimidation,” as being, in employees’ words, dictatorial,
totalitarian, and vengeful, and it was remarked of central management
that “when they say jump, you ask how high.” Most reports we received
credited the audit period deputy director (now director) and the director
of clinical compliance with creating and sustaining this negative agency-
wide environment.
Of 144 survey respondents with an opinion 3, 60% believe central office
management “Seldom” or “Never” demonstrates high ethical standards.
2
Unless otherwise stated, references to GAO standards throughout this report refer to the United States Government
Accountability Office’s (GAO) Standards for Internal Control in the Federal Government. While this publication addresses
controls in the federal government, the criteria it contains can be treated as best practices. The theory of controls
applies uniformly to federal or state government.
3
Some survey respondents elected not to answer all survey questions, or were not provided certain questions based
upon their position and location. “No opinion” and blank responses are excluded from survey figures in this report.
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The concerns and perspectives expressed most frequently in survey

responses, and supported by our discussions with staff throughout our
procedures, included the following:
• Central office management often sends directives without
explanation, and without gathering input or feedback. Frequently
these are knee-jerk decisions that are later changed or retracted.
• Management lacks relevant experience in long-term care and
health care, and does not seek input from experienced staff; this
reportedly leads to bad decisions and staff feeling their
knowledge and experience is being ignored.
o One respondent explained it as follows: “Central office
staff that make decisions directly involving patient care
have never taken part in actuality seeing or doing what is
done by front line staff. Central office tells us how to do
our job with no concept or concern of how their directives
effect the care of our residents, staff, or resident families.”
o Staff are concerned central management doesn’t
understand the impact of their actions on patient care.
o Lower level staff who consider themselves the “backbone”
of the agency also feel ignored and expendable.
• When staff asks for an explanation or tries to give input, they’re
belittled, degraded, or met with sarcasm and rudeness.
• Staff and center management are intimidated and threatened with
termination or demotion. Administrators are rendered powerless
and not treated as equals.
• Most central office staff is condescending and rude in
conversation and correspondence.
• The overall agency environment is stressful and anxiety-
producing. Numerous employees relayed that they and their
coworkers are terrified of losing their jobs.
• Central office cares primarily about politics and generating
revenue, and derives enjoyment and satisfaction from controlling
and threatening others.
• The central office essentially manages by fear, as illustrated in the
following comments:
o “I have heard more than once words to the effect of ‘Get
on board or get off the boat.’ when reasonable questions
have been asked about changes.”
o “It is futile to resist any changes or bring up any concerns.”
o Central office leaders “intimidate, harass, bully and
threaten staff.”
o “The employees at Central Office appear to be riding the
wave of a power trip. They employ the ‘rule with an iron
fist’ mentality yet deny attempting to micro-manage our
homes.”
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o “Our central office is a ‘Toxic leadership’ installing fear in

most every employee.”
Two other comments stood out as summarizing many of the feelings that
resonated in our survey results:
“This is the most punitive, negative, secretive, dysfunctional
environment I have ever worked in. I feel my job is in jeopardy
every day that I go to work. The ODVA is run from central office
by lies, deceit, and secrets. The Center administration tries to
communicate to the staff, but is often unable to due to the lack of
communication and/or threats from central office. Everyone I
know is constantly looking for a new job and keeping resumes
updated because of the fear of being the next department to be
shut down and outsourced.”
“Our leadership is comparable to a dictatorship. Our
management, a puppet regime. The result is that staff are left
without proper resources and reminded daily how replaceable
and unimportant they are.”
Employees did express repeatedly that there is still effective teamwork
within their center or local department and that they love having the
opportunity to serve the veterans. Indeed, at all levels, center staff’s
passion for their work appears to only increase their frustration at having
that work impacted by unexplained staff cuts and policy changes. They
clarified that the pressure and uncertainty they are now experiencing is
diminishing any positive aspects left in their work.
Low Employee The fact that management’s philosophy and methods of direction greatly
Morale influence the agency’s control environment is evident in the low morale
currently articulated by employees throughout ODVA. Numerous survey
respondents included comments such as, “I have never seen the morale of
staff this low before,” and, “The satisfaction amongst workers is at an all-
time low.” Veterans center staff members at all levels reported fearing for
their jobs, feeling unsupported and replaceable, and specifically feeling
that the central administration of the past few years is at fault. They
conveyed that central office staff is cut off and decisions impacting center
jobs are made in a vacuum. Multiple employees remarked that morale is
low while turnover is high, and many expressed disgust and
disheartenment at the change in environment and declining level of care
for the veterans.
Several final survey comments illustrate this experience:
• “I have been discouraged by the lack of understanding towards
the effect on resident care when business/financial decisions are
made, as well as the personal effect to the employees and their
families.”
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• “Morale and unity suffer as a result of poor leadership and lack of

communication. When problems arise within our organization,
there is no ‘safe ground’ or support to assist w/the problem.”
• “Everyone feels as if we are walking on a tightrope and could fall
off at any moment. We have been told everyone except nurses are
expendable. The quality of care at our centers is not as good as it
was previously because of the cuts that have been made. We have
lost several key staff members.”
• “There is no job security here. We work with an axe over our
heads knowing any day our position could be eliminated. Morale
is understandably low.”
Staffing, Employees responding to our survey voiced numerous concerns specific

Turnover, and to the staffing levels at the centers, turnover rates, and having worked as
Salary Concerns much as two decades without receiving a raise.
• Complaints about high turnover rates came from centers across
the state. Employees voiced related concerns about the agency
losing valuable employees while less competent employees
remain employed and are “moved around” rather than
disciplined.
• Many employees reported difficulties due to understaffing,
particularly in direct care, including
o Employees working unpaid overtime
o Not enough staff on the floor to care for veterans with
multi-system diseases and many medications
o Multiple complaints about having only two to three people
on the floor at night to care for as many as 50 veterans
o Not enough time to complete charts and new forms
o One employee describing the understaffing as operating in
“continuous gap fill mode”
• Nursing departments have reports regularly added to their
workload, and a nursing schedule implemented by central office
has allegedly caused long-time nurses to quit.
• Many comments discussed not having received a raise in as much
as one to two decades. Staff don’t feel valued or supported – not
only financially, but functionally and emotionally. As two
respondents put it:
o “It's no secret we go years without a raise. This contributes
to anxiety and affects every area of care for our vets and
our family's welfare.”
o “They make it harder and harder until your mental and
physical health suffer.”
• Concerns were repeatedly expressed about the effectiveness of
employees hired through the Galt Foundation staffing service, as
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well as the Galt hiring process, and Galt employees’ segregation

from standard state employees.
We were recently informed that central management has revoked a
promise previously made to patient care assistants (PCA) hired through
Galt that they would have the option of becoming ODVA employees after
one year of employment. Employees who had been hired with this
promise in place during the past year no longer have this option. We
were also informed that food service employees hired through Galt had
the option to become state employees, whereas nursing staff did not.
Communication GAO standards also provide best practices for an entity such as ODVA in
the area of communication:
Management should communicate the necessary quality
information to achieve the entity’s objectives, both internally and
externally.
Management communicates quality information throughout the
entity using established reporting lines. Quality information is
communicated down, across, up, and around reporting lines to all
levels of the entity.
As part of establishing an organizational structure, management
considers how units interact in order to fulfill their overall
responsibilities. Management establishes reporting lines within an
organizational structure so that units can communicate the quality
information necessary for each unit to fulfill its overall
responsibilities.
As these standards emphasize, accurate and timely communication is
essential within the organization, at all levels, as well as with outside
parties. Methods of communication should be designed to flow
effectively through all levels of the entity.
ODVA employees are experiencing a culture of change, fear, and
intimidation, and a serious breakdown in internal communication
appears to be a key cause of that challenging environment. Of 146 survey
respondents with an opinion, 70% believe central office management
“Seldom” or “Never” provides a clear sense of purpose and direction.
Countless comments referred to management, varying divisions, and
centers as “cut off” or “isolated.” They discussed central leadership being
secretive, lying, and purposefully fostering division, and complained of a
lack of staff meetings and clear directives at both the central and veterans
center levels, hindering the flow of information from the top down. Many
staff members do not understand the reasoning behind decisions that
impact their work, and receive information second and third hand, with
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opinions and possible misinformation attached, or learn about agency

news through the newspaper or TV.
Administrators feel they are not allowed to talk to commissioners, and
related that they have been threatened or scolded for doing so. In the
past, commission meetings were held at the veterans centers, and some
commissioners reportedly made it a point to regularly visit the centers
most accessible to them. The administrators and other center staff valued
these opportunities to connect with the commissioners and appreciated
their interest in center operations, and their interaction with the veterans.
Commission meetings are now held in Oklahoma City, and visits by
commissioners are reportedly rare. This cut in communication has been a
somewhat shocking change for center staff, who are concerned that the
Commission may not be aware of the extent of issues at the centers, from
construction projects to difficulties with central office management.
In addition to seeing the Commission cut off from the workings of the
agency, various administrators and center staff reported feeling
purposefully cut off from each other and discouraged from pooling
information, comparing procedures, or making visits between centers.
This appears to be an effort to effectively turn each veterans center into a
silo, receiving one-way communication from the central office. This silo
effect impedes the flow of quality information between levels and units of
the organization, hindering the agency from meetings its objectives and,
as evident in our discussions throughout this report, damaging employee
morale, increasing risk, and impacting the quality of resident care.
One survey respondent succinctly summarized what has occurred in
other areas of the agency: “Quickly after General Deering took the reins,
this Agency eliminated the regular meetings and feedback from clinical
staff in the State Veterans Homes (particularly Medical Directors,
Directors of Nursing, Lab Directors, & Pharmacy).” As another employee
pointed out, feedback is necessary for continuous improvement, and the
feedback loop within the agency has been cut.
The responses to our employee survey included some interesting
discussions of the silo effect, alleging that management prefers hiring
young staff with no state experience who might be more easily
manipulated and kept in the dark, and that knowledgeable staff was let
go. They also mentioned that past administrations were more teamwork
oriented. Clearly ODVA employees are keenly aware of this
communication breakdown and conscious of its effects.
Some employees are also concerned that the centers are not treated
equally, some receiving harsher treatment, stricter rule enforcement, or
worse cuts to staff or budgets. The most extreme example of this appears
to be the treatment of the Talihina center, but general inequity in the
treatment of the other six centers, their administrators, and their staffs
were often mentioned as well.
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Internal communications have continued to deteriorate over recent

months. As we began our procedures, administrators were concerned not
only that they had been cut off from commission meetings but that the
audit period agency director visited their administrator meetings only
briefly to “cheerlead,” and not to offer any real information or listen to
their ideas and concerns. Most recently, we discovered that the central
office has cancelled and postponed administrator meetings. The center
administrators recently requested to hold a meeting and presented a list
of topics they wanted to discuss; central management addressed the
topics with short responses and set a meeting for several months in the
future. Commission meetings have also decreased in frequency and are
now held at the central office, whereas previously they were held at
centers statewide.
While several administrators we met with expressed that they attempt to
present information from the central office in a positive light and keep up
morale, our survey responses made it clear that staff is aware of central
management’s attitude even when they do not experience it directly. Staff
reported that their administrators were being threatened and retaliated
against, even “bullied,” by central management.
A variety of other concerns related to communication were brought to
our attention through our surveys and interviews. For example, the
agency’s channel for reporting improprieties or grievances funnels
directly to executive management, not a neutral party, so staff does not
feel comfortable using it. According to one survey comment, the then-
deputy director stated in a meeting in 2015 that he would 'try to be less
caustic' when speaking. The survey respondent felt the caustic language
had continued and that the clinical compliance director speaks in the
same manner. These leaders reportedly speak in an unprofessional tone
and scold employees in front of third parties and other staff.
Of 209 survey respondents with an opinion, 53% disagree to some extent
with the statement, “Management effectively communicates its decisions
to all employees.” Communication from the central office is generally
conducted by phone or email, and is often inconsistent and unclear.
According to center staff, top management rarely visit centers, and the
visits they do make are perceived as being only when something is wrong
or for disciplinary purposes. Multiple administrators noted instances
when the deputy director or director of clinical compliance showed up
unannounced, especially after a disagreement; visited a center when the
administrator was out on approved leave; or bypassed administrators
and went directly to speak to their staffs.
Again of 209 survey respondents with an opinion, 52% disagree to some
extent with the statement, “An atmosphere of mutual trust and open
communication has been established within the organization,” and 51%
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disagree with the statement, “The interaction between management and

our organization enables us to perform our jobs effectively.”
The agency has also suffered challenges in project implementation due at
least in part to a lack of planning and communication. An overnight
change from established, customized nursing policies to agency-wide
standardized policies, without input from center administration or
nursing leadership, caused much confusion and concern, and occurred
without time to review the policies or train staff. This is discussed further
on page 51.
The agency’s implementation of PointClickCare software 4 in the centers
caused concerns about what staff perceived as arbitrary deadlines, central
office threats of disciplinary action if training was not timely, general
limitations in the new program, and determining what information was
transitioning to this software versus still housed in other programs. Most
recently, we received several comments regarding pharmacy software
that had been purchased by the agency and whether or not it may be
compatible with PointClickCare or be usable by the agency. The variety
of details and estimated costs (generally over $2 million) we were given
by staff for this implementation reflect the lack of communication about
the project within the agency. We also learned that central management
had terminated their connection with a long-time OMES employee, who
was well versed in the agency’s systems, after a disagreement regarding
compatibility. Central office has now assigned the continued
PointClickCare implementation to a recent central office hire whose
background has been questioned by many employees (see further
discussion of LPN on page 22).
It is possible that, due to the atmosphere of fear and intimidation present
throughout the agency, management is not even aware of the extent of
concerns and difficulties being experienced at the centers, due to their
staff’s reluctance to raise a question or bring up a problem. We reviewed
an email chain begun by the deputy director in June 2017 as we were
initially interviewing center administrators and staff, and a legislative
interim study with some similar topics was occurring. In the initial email,
the deputy director asked administrators a slew of questions that make it
clear he is aware of issues of concern to the centers, some legislators, and
other vocal critics of the agency:
4 PointClickCare is care management software popular in the long-term care and nursing home industry. Its modules
range from medical and patient records to financial recordkeeping, and its implementation at ODVA is discussed
further beginning on page 57.
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In a later response to this email, the deputy director informed one

administrator that, “FYI, no one answered any question below in the
affirmative.” However, many of these issues were brought up as concerns
during our interviews and employee surveys. It is concerning not only
that agency management does not already know the answers to some of
these significant questions, but that the deputy director claimed no one
had answered “yes” to any of them, suggesting that either he or the
administrators were not being truthful.
More recently, we were provided with a copy of an email sent to
administrators and other staff by the now-director that included the
following language 5:
Sent: Thursday, March 29, 2018 3:45 PM
Subject: Incentive pay/Retirement
Team,
I expect the audit to come out soon, possibly tomorrow and if I'm not
fired due to findings of mismanagement, toxic environment, improper
purchases or whatever other allegations I have heard of in the rumor
mill we will be moving forward with the incentive/excellence pay after
the dust settles from those allegations. We have been working
on average numbers and achievable goals for certain metrics and
patient care events.
5 As we received a photograph of the email on a computer screen, it has been retyped here for legibility.
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Again, it is clear that central leadership is aware of the control

environment issues affecting the agency. The inclusion of a promise of
incentive pay if the director remains employed, and despite repeated
claims of budget difficulties, is also of interest.
Some respondents offered the perspective that management is making
helpful changes and the rest of the agency is resisting change. Most who
conceded that some of the changes being made might be worthwhile still
argued that the way the changes were implemented caused unwarranted
stress and confusion. One central office employee who remarked
positively on their experience at the central office offered that “if the
director had gone to each of the facilities to give a speech regarding his
mission and goals . . . hearing it directly from the horse’s mouth would
have prevented a communication breakdown.”
This breakdown appears to have played a particularly crucial role in
aggravating employee and public concerns regarding the Talihina center.
While events specific to Talihina are discussed in their own section of this
report, it must be noted here that many of the staff’s concerns and
theories related to the closure of the center’s special needs unit and
legislative efforts to relocate the center clearly derive from a lack of viable
information. The lack of clarity in management’s statements as to why
they wanted to close the special needs unit, or decertify its beds, or
relocate the center altogether – from mold problems, to staffing issues, to
declining demand from potential residents – is often interpreted as
management not having a clear motivation or having an ulterior motive
for these changes. It’s likely that to some degree this is in fact due to
management lacking the ability or willingness to clearly communicate its
plans and reasoning to staff and the public. This type of transparency is
expected of ODVA as a state agency, and its absence obviously causes
suspicion, which is then compounded by the air of fear and intimidation
present at the agency.
Other Control Additional issues related to the overall agency environment at ODVA
Environment came to our attention during our work and as a result of our employee
Concerns surveys. Overall, this degraded control environment increases the risk of
misappropriations, errors, and declining quality of care for the veterans
the agency is designed to serve.
Snap Decisions
Staff at all levels relayed concerns and examples of central office
management attempting to operate on generalizations, assumptions, and
numbers, without acknowledging the complexities and human factors
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truly involved at the veterans centers. Management has even reportedly

told administrators directly to focus on the numbers, not the people.
Many staff interviewed and surveyed noted that management does not
take advantage of the expertise available from their center administrators,
medical staff, and other experienced employees. They also stressed that
management is known for making immediate decisions without time for
research and analysis, often leading to their directives later being
reversed. Examples included the following issues, also discussed
elsewhere in this report:
• Replacement of nursing policies agency-wide with no warning or
training, leaving centers with unfamiliar policies that didn’t even
apply in some cases
• Removal of EKG machine access at the centers
• Center business managers being terminated or moved before
policies and procedures were updated and new responsibilities
were made clear
In another example, the clinical compliance director reportedly indicated
routine physician orders would no longer be permitted in the centers, and
then, a few days later, asked administrators to send lists of their routine
orders to the central office so management could decide which orders
would be followed. Medical staff was concerned not only about the
inconvenience and impact to care, but that the clinical compliance
director was not in a position to override physicians’ orders or clinical
judgment.
One survey respondent described the phenomenon as follows: “They
abolish jobs without even seeing what these jobs do for the facilities. Then
these job functions are given to other staff that do not have the
knowledge or time to adequately do them. They send out emails with
changes that are not based on current policies or rules or regulations.
They may send another one a few days later, changing it again. They
have the departments in total chaos by their emails.”
Consolidations
During our audit procedures, central management initiated a
consolidation of business office staff at the centers, including terminating
via a Reduction in Force (RIF), the business managers at five centers, and
absorbing the other two business managers (from Ardmore and Norman)
into central office finance staff. Some of these business managers and
other staff contacted us with concerns about the way they were informed
of the consolidation, the terms of their departures, potential
noncompliance with state merit rules, as well as the demoralizing lack of
a “thank you” or “goodbye” after years and even decades of service.
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Center administrators must now rely on central office personnel who are
new to their positions and in some cases unknown to the administrators,
to conduct the financial activities and control the budgets of their centers.
Center staff have relayed that it now takes weeks to make a purchase,
instructions for the remaining financial duties at the center are unclear or
non-existent, there are no clear provisions for emergency purchases, the
accounting technicians remaining at the centers are overwhelmed, and
back-ups for these positions may not be available.
GAO standards for internal controls state that management should
establish an organizational structure designed to achieve the entity’s
objectives. This entails assigning responsibility and delegating authority
to key roles throughout the entity. By withdrawing more and more
control to the central office, executive management is doing the opposite,
thereby decreasing the presence of expertise at the centers and further
hindering agency-wide communication, as there are fewer individuals
entrusted with authority and information at each location.
Another troubling aspect of this removal of financial oversight from the
centers is that it removes control from the administrators, not only
hindering their ability to efficiently and effectively run each center, but
potentially threatening their long-term care licenses. The Administrator
Code of Ethics outlined in the Oklahoma State Board of Examiners for
Long Term Care Administrators (OSBELTCA) administrative code
(490:10-13-1) includes the following expectations and admonishments:
• Individuals shall strive, in all matters relating to their professional
functions, to maintain a professional posture that places
paramount the interests of the facility and its residents.
• The Health Care Administrators shall not: Defend, support, or
ignore unethical conduct perpetrated by colleagues, peers, or
students.
• Administrators have a fiduciary duty to the facility.
Further, 490:10-13-2 outlines that: “It is the responsibility of the long-term
care administrator, as the managing officer of the facility to plan,
organize, direct, and control the day-to-day functions of a facility and to
maintain the facility’s compliance with applicable laws, rules, and
regulations. The administrator shall be vested with adequate authority to
comply with the laws, rules, and regulations relating to the management
of the facility.”
It is clear from these guidelines that the administrator is expected to be in
effective financial and operational control of his or her facility. As the
administrator’s control diminishes, and their fear of termination or
central office retribution rises as has been described by all levels of center
staff, their ability to stand up to unethical directives or activities
impacting their facilities and residents surely diminishes as well. Without
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licensed and capable administrators to run its centers, ODVA could not
legally serve its many resident veterans.
As discussed earlier, the removal of center business managers also
negatively impacted our ability to gather detailed, reliable, independent
financial information from the centers. Agency employees also expressed
numerous concerns about this consolidation in our surveys, including
• The centralization of purchasing food and medical supplies,
which has led to delays in ordering and receiving these essential
products
• Bills not being paid on time since the consolidation occurred
• The loss of institutional knowledge and expertise at the centers
regarding policies, rules, and regulations related to purchasing
and financial activities
• The breakdown of key financial internal controls previously in
place at the centers
• Administrators losing their ability to control their spending and
budgets and to expediently meet the needs of the facility
• Feeling like the central office had “pulled the rug out from under”
center staff and failed to communicate about terminations and
process changes
• Negatively impacting processes underway at the centers such as
debt collection
• Potentially unqualified individuals being left in charge of the
center business offices
• The feeling that no cost savings actually resulted from this and
other terminations, while the quality of life of residents and
remaining staff have suffered
We received a specific report of an accounting technician in the business
office of the Norman center who had previously misappropriated funds
at that center, allegedly from the veterans’ trust fund, had repaid the
money, and is still employed there – now without business manager
oversight. Additional records, including related legal records, will be
provided to the Attorney General’s office for follow-up on this matter.
One employee commented that central office had stated its centralization
of the business offices was based on a recommendation by the auditor’s
office, which they “know is a lie.” We were made aware several times
during our procedures that personnel actions and process changes were
being explained by central management as “auditor recommendations.”
We contacted the agency to let them know these changes were not
recommended in any past report, and clarified the only consolidation-
related report contents we had provided in the past, including specific
support of decentralized maintenance. We noted in this correspondence
that we did not endorse the ongoing changes and found it unusual for
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such sweeping changes to take place during an investigation or audit.

Their reply to us deflected that statement and the changes continued.
Survey responses included concerns about the recent Fire & Safety and
Maintenance department consolidations at centers as well. This change
resulted in pay cuts to Fire & Safety supervisors, no security presence
during the day shift, which is now covered by a Maintenance employee,
and a newly combined staff whose members may be unqualified to
perform the duties of either department. Employees expressed concerns
that such a change indicates resident and staff safety are not a priority for
central management. Changes such as this have broader implications as
well: the effectiveness of center emergency plans may be decreased as
trained staff is no longer available during the same hours, and job
classifications may be inaccurate as employees are performing duties
from various departments.
The Government Accountability Office report Streamlining Government:
Questions to Consider When Evaluating Proposals to Consolidate Physical
Infrastructure and Management Functions (GAO 12-542) contains some
helpful best practices regarding consolidations:
• The key to any consolidation initiative is the identification of and
agreement on specific goals, with the goals being evaluated
against a realistic expectation of how they can be achieved.
• The initiative needs to be based on clearly presented business-case
or cost-benefit analysis and grounded in accurate, reliable data.
• As stakeholders often view consolidation as working against their
own interests, it is critical that agencies identify who the relevant
stakeholders are and develop a two-way communication strategy
that both addresses their concerns and conveys the rationale for
and overarching benefits associated with the consolidation.
• Agencies should have an implementation plan for the
consolidation that includes active, engaged leadership of
executives at the highest possible levels; a dedicated
implementation team that can be held accountable for change; and
a strategy for capturing best practices, measuring progress toward
the established goals of the consolidation, retaining key talent, and
assessing and mitigating risk.
In summary, employee buy-in, clear support data, two-way
communication, and a strong implementation strategy are essential for a
successful consolidation. It is clear from our interviews and survey
responses that employee buy-in and two-way communication were not
present in ODVA’s consolidations discussed above. Any planning or
strategizing that may have taken place prior to these changes appear to
have been inadequate and obscure.
While the GAO’s report focuses on consolidations, these general
implementation steps could be very effective in the case of some other
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changes underway at the agency, such as outsourcing services. Regarding

the agency’s recent move to outsource laboratory services, a study
including factors such as cost effectiveness is still underway, although the
outsourcing is already implemented. Survey comments and interviews
suggested the agency is likely to outsource physical therapy, x-rays, or
maintenance services next; following project implementation best
practices in such a situation could help central management to ensure
these moves are financially and operationally sound and to gain
employee buy-in through communication.
Management has often presented its reasoning for changes such as
outsourcing services and eliminating or consolidating staff positions –
both to the public and to internal staff – as the need to conserve funds due
to cuts in state appropriations. As reflected in our discussions of budget
and revenues later in this report, the agency does not in fact appear to
have experienced significant budget problems. While state appropriations
have declined at ODVA as they have statewide, the agency’s overall
revenues in fact increased during the audit period.
In its response to a legislative inquiry in April 2017, ODVA explained its
temporary removal of EKG capabilities from the centers as a regulatory
and liability issue. They then shifted gears to claim the agency was
seeking efficiencies due to budget cuts: “Should ODVA's budget be
restored with the $10 million that it has lost in the last seven years it
could easily restore all the services that were once present, hire additional
doctors, operate 24-hour lab services and many other luxuries that are
currently not feasible.” Management’s ongoing moves to outsource
services and centralize financial control do not appear easily reversible in
the case of a financial upswing at the state level, nor do its actual revenue
trends appear to justify these “efficiency” measures. Management’s
activity during and since the audit period gives no indication that they
intend to add “other luxuries” at the centers. Employees are aware of this
contradiction, and this perceived false excuse for internal changes has
impacted staff morale, eroded trust in central management, and may
damage the agency’s public reputation.
Favoritism, Bias, and Other Issues with Central Office Staff

It should be emphasized again that tone at the top and throughout the
agency is fundamental to an effectively functioning internal control
system. Without strong ethical leadership, awareness of risk can be
diminished, responses to risk may be inappropriate, control activities
may be ill-defined or not followed, information and communication may
falter, and feedback from monitoring activities may not be heard or acted
upon. Therefore, tone can be either a driver or a barrier to internal
control, influencing the control consciousness of all employees. GAO
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standards also emphasize that “management should demonstrate a

commitment to recruit, develop, and retain competent individuals.”
Even as this report was being written, we were receiving calls and other
forms of communications from various parties concerned about
management’s actions and their impact on the veterans and staff. Despite
the proliferation of comments and concerns we have received, we
continue to hear that there are others who are still afraid to share their
experiences and worries with us. As described earlier, staff is fearful of
management retribution. They also alleged in survey comments that
within the central office, inner circle members receive preferential
treatment and may lack the necessary qualifications to run the agency
and oversee veterans centers.
We received multiple reports of incentives, such as training
opportunities, being preferentially offered to some individuals and not to
others in the same position. Similarly, we were made aware of instances
where rules were circumvented in favor of certain employees. The
overlooked parties alleged that it was “all about who you know.” It is the
perception of some current staff that only male veterans (primarily
having served in the National Guard) are being promoted, treated
appropriately, or in line to be administrators of centers. Others alleged
favoritism for specific friends of management. For example, one
individual was terminated by a center, then immediately given a job at
the central office, and is now the deputy director of a different center.
One survey respondent pointed out that this favoritism is discouraging
for newer employees seeking long-term employment with the agency.
There is also a widespread understanding that new hires at the central
office are generally former National Guard, and have no experience in
long term care or health care.
Numerous staff expressed concerns that center funds are being redirected
to the central office, causing a cut to the level of veteran care in order to
increase the staff size and comfort of the central office. Many center staff
reported central office employees getting large raises, special treatment,
and excessive travel opportunities, while long-time employees are
demoted or terminated to make room for central management’s
“cronies.” While we did not complete detailed staffing analysis
procedures, for reasons discussed on page one, we did note that a total of
46 pay raises were granted to staff designated as central office in
statewide accounting system HR records, between July 1, 2014 and mid-
May 2018. Of those raises, 22 were $5,000 or greater per year, and 10 were
$10,000 or greater per year. In addition, over half of those raises occurred
in fiscal year 2018. 6 This is accounted for to some degree by central office
6For reference, the central office currently employs approximately 34 individuals, not including IT staff, as of June
2018. It should also be noted that some individuals who received raises while working as central office employees
may have been subsequently transferred to other departments or terminated.
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expansion and centralization of certain functions, but also explains why

the volume of raises has piqued employee interest.
It is integral to note that while some of these allegations could be an issue
of perception, the effect of that perception on morale and the overall
control environment at the agency is very real.
The majority of comments regarding central office centered around the
actions and attitudes of the audit period deputy director (who became
ODVA’s director February 1, 2018) and the clinical compliance director.
In addition to the issues discussed throughout this report, staff
commented that
• The deputy director screams and yells when angry, and both
individuals dictate orders, threaten staff, curse, and speak
unprofessionally in front of staff and third parties.
• The deputy director has poor knowledge of federal regulations,
and the clinical compliance director focuses on private care
regulations when federal rules are more applicable.
• Both individuals encourage staff not to circumvent the chain of
command and call them directly.
• They display a vengeful, “gotcha” attitude.
• They have an agenda to close the Talihina Veterans Center and
other centers.
• They and other central management ignore the employees and the
resident veterans. Several individuals commented that central
management, including the audit period director, refused to eat
with the veterans at the centers, for reasons ranging from not
liking the food to not wanting to eat with enlisted men.
• “The two people making all the decisions in this agency have
never worked a day in a State Veterans Home.”
• If you challenge them, you will be fired.
We encountered a number of additional concerns specific to the clinical
compliance director throughout our procedures:
• Administrators were not told she would be overseeing them until
she showed up unannounced to give them performance
evaluations. On a separate occasion, she handed evaluations out
publicly at an administrators’ meeting.
• Many rumors are circulating in the agency that she was
terminated from past long-term care and health care positions,
which impacts the staff’s respect for her.
• Her instructions and new policies are presented in an inconsistent,
incomplete, or informal manner. Center personnel reported that
she has granted them informal permission to deviate from
particular instructions or policies, but always verbally, and
sometimes with warnings such as, “we never had this
conversation.” This includes allowing deviations from the
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standardized menu (substituting items), and allowing lab techs to

read EKG results.
In 2017 ODVA hired an LPN to serve as a central office programs
administrator position working with the clinical compliance director. This
new hire had recently been arrested for attempting to obtain a controlled
substance using a forged prescription. Many survey respondents
commented that this history would prevent him from being hired at a
center by the agency’s own policies, and requires him to have additional
supervision. They suggested his employment by the very director
responsible for compliance, as well as the fact that they believe he is paid
more than an LPN working at a center, has outraged employees.
While the audit period director was not mentioned specifically in as
many cases, some surveys and interviewees brought up concerns that his
serving as director of the agency and Secretary of Veterans Affairs
simultaneously seemed like a conflict of interests. We did not perform
detailed procedures related to this concern, as the two positions were
joined at the governor’s request, but it does appear to remove one layer of
independent oversight, and of potential influence on the tone at the top.
We were also made aware of concerns about the fact that after the
appointment of the audit period director/secretary in February 2015, the
following month the agency hired the former secretary of veterans affairs
as “administrative assistant to the director.” She was paid $100,000 per
year until her retirement in February 2017, and employees reported rarely
seeing her at work.
Commission
As discussed earlier, GAO standards emphasize the key role the
governing board, in this case the Commission, plays in the agency’s
overall environment and tone at the top. It is also essential that the
Commission gather appropriate information to properly maintain
oversight of the agency and deal with any issues that may arise:
The oversight body should receive quality information that flows
up the reporting lines from management and personnel.
Information relating to internal control communicated to the
oversight body should include significant matters about
adherence to, changes in, or issues arising from the internal
control system. This upward communication is necessary for the
effective oversight of internal control.
Personnel should use separate reporting lines to go around
upward reporting lines when these lines are compromised.
As discussed in our communication section, ODVA staff generally
reported not having access to or contact with the Commission, which
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would clearly hinder the flow of information to the commissioners

whether through normal reporting channels or through separate lines. It
would also be difficult for a commission that is removed from the agency
to set an appropriate ethical tone for its employees; indeed, it appears a
questionable tone is being set in the Commission’s effective absence.
Our prior performance audit report 7 recommended the Commission
expand its financial oversight, approve agency SOPs, and enhance its
monitoring activities. Prior to our current audit period, additional
finance-related committees had been created and various financial and
general performance reports were being provided to the Commission. We
reviewed the meeting minutes available on the ODVA website, which
covered calendar year 2017, and noted that general reports were still
being provided during this audit period and info presented by the CFO
during meetings. Meeting packets and agendas from February and May
2018 made available online include a variety of top-level financial and
statistical reports as well as detailed information about pending
legislation and capital projects.
72 O.S. § 63.3 states that it is the power and duty of the Commission to
appoint the director of the Department of Veterans Affairs and provide
for the employment of all such other personnel as may be necessary to
carry out the provisions of that title, and any other duties prescribed by
law. The salary and tenure of the Director of the Department are
determined by the Commission. Our prior report also recommended the
Commission adopt a formal policy and consistent process for evaluation
of the executive director. In their response, the agency stated: “The
Commission will standardize and formalize the evaluation process to
insure a proper annual evaluation of the executive director is conducted.
It should be noted that the executive director is under evaluation at all
times by the Commission, and is not limited to an annual evaluation.” If
the Commission indeed takes this level of responsibility for the director’s
performance, it is accountable for the environment currently being
created by the director and his staff.
7 Oklahoma Department of Veterans Affairs performance audit, for the period of July 1, 2011 through June 30, 2012,
available online at https://www.sai.ok.gov/Search%20Reports/database/ODVAWebFinal.pdf.
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LEVEL OF CARE
Disfunction in the ODVA control environment is clearly damaging staff

morale, and that employee experience is no doubt intertwined with the
morale of veterans center residents and the quality of care they receive. It
stands to reason that the agency must provide an effective work
environment for veterans center staff in order for that staff to provide
adequate care to the veterans. Many survey comments related concerns
that ODVA management is not concerned with the wellbeing of staff or
residents, and while many staff members fear for their jobs, as one survey
respondent put it, “Veterans are also extremely scared that they will lose
their home.”
In developing our objectives for this investigation, we were asked to
determine whether ODVA is actively decreasing the level of care
provided to residents of its veterans centers. Our employee surveys and
interviews echoed this question with frequent statements of worry that
the level of care provided to veterans is declining.
The consensus appears to be that the major advantages of an Oklahoma
state veterans center over a typical long-term care facility have always
been the on-site medical care, the pharmacy and laboratory services, and
the adequate number of caring staff. One survey respondent described
the “old” ODVA centers as follows: “The resources the ODVA Centers
had at one time was amazing. Lab, XRAY, Medical Providers in house 5
days a week (and more often), on call 24/7, Pharmacy . . . all in house. A
patient on sick call would be seen by a provider that day. Their
medication could be available to them in minutes if needed. Hospital
visits could be avoided because almost anything a hospital could do was
available in the Center. We had an amazing working relationship with
our counterparts in the Federal VA and they provided medications to the
Center at Fed VA contract pricing. Waste was minimal.”
Many changes have occurred at the centers in the past several years that
impact the care provided to resident veterans. Some of these are
discussed to an extent in other areas of this report.
• Laboratory Services: Most laboratory services have been
contracted to an outside firm; see further discussion beginning on
page 63. Center personnel indicated that now that in-house lab
services are limited, veterans are sent out to the hospital more
frequently, although providers feel they could give quicker
medical attention with in-house testing, especially for infectious
diseases. The agency’s laboratory and radiology programs
administrator further indicated that “after outsourcing, lab testing
results are not available for 24 to 36 hours. On weekends results
can take up to 4 days. Critical lab results are called to the on call
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medical provider 10 to 24 hours after the specimen is obtained.

The inability to provide lab results in the facility can result in the
veteran being sent to the local ER for evaluation and treatment.
Veterans that are less than 70% service connected 8 receive bills for
all ER and ambulance services that are not covered by insurance
or Medicare.” The agency’s contract with DLO, the firm to which
lab services are now outsourced, outlines that DLO may bill the
residents’ insurance or the residents/their families for services not
covered by ODVA or the United States Department of Veterans
Affairs (USDVA). Several interviewees expressed concerns that a
veteran’s inability to pay newly enforced fees may result in them
opting out of needed testing.
• Diets: As discussed on page 61, management has decreased the
use of specialty diets at the centers, a move that aligns with trends
in private long-term care but limits options for residents with
certain medical conditions. They have also standardized menus
across the seven centers, resulting in some complaints about the
items offered and decreased choices.
• EKG machines: As discussed on page 62, EKG machine use was
temporarily prohibited but is now allowed, officially for physician
use only, at the centers.
• Other outsourcing: Many employees responding to our
anonymous survey expressed concerns that physical therapy, x-
ray, and pharmacy services will soon be outsourced. While this
does not appear to have yet occurred, the belief has exacerbated
fears about further declines in the level of care provided at the
veterans centers.
• Medical care: During our visits to centers, we were informed that
medical providers (including doctors, physician’s assistants, and
nurse practitioners) have been directed by management to not
take sick calls; veterans are now directed to go to the nurse
instead. Some staff suggested that doctors are there primarily to
meet regulatory requirements and not to provide care.
• Additional factors: The level of care provided to veterans may be
impacted in various ways by other issues discussed throughout
this report: seeking Centers for Medicare and Medicaid Services
(CMS) certification, with the attendant requirements; prolonging
or cancelling capital projects such as the roof replacement in
Lawton or the boiler replacement in Talihina; policy changes
causing confusion, requiring review and training, and removing
8
See discussion of service-connected compensation on page 53.
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center-specific procedures; and of course the overall impact of

poor employee morale.
During our interviews and procedures, various individuals related that
central management rarely visits the centers, and when they do, they go
directly to speak to an administrator or other individual, usually for
disciplinary reasons, and do not walk the halls, speak to veterans, or greet
staff. Several center employees shared anecdotes about central
management refusing to eat with the veterans because they did not like
the food served at the centers, or because they would not eat with lower
ranking veterans. They also related that the Commissioners, who used to
visit the centers both for commission meetings and voluntarily on other
occasions, rarely visit now and have been effectively cut off from center
management and staff. Communication is apparently severed to such an
extent that some staff members worry whether the Commission has any
idea of the true goings-on at the centers, and others blame the
Commission – and even the governor – for problems at the agency.
In relating their concerns about the declining level of care, many survey
respondents provided commentary along the following lines:
• Multiple comments opining that central office doesn’t care about
resident care, or that they don’t understand the effect of their
decisions on veteran care – and on veterans’ families, and staff.
• Frequent comments that removal of in-house lab services keeps
elderly residents from getting timely care they need.
• Related concerns that laboratory outsourcing is costing the
residents money, and about how resident’s finances will be
impacted by Medicare and Medicaid revenues being sought.
• Statements that removing the business managers and to some
extent shutting down the business offices has slowed down
purchasing and receiving of supplies, which directly impacts the
veterans.
• Comments that the veterans complain about the food. One
respondent noted that the poor choices of food are inappropriate
given the amount of money the agency receives for veterans’ care,
while another noted food was the only thing residents previously
had control over and they’re no longer happy with the menu.
• Concerns about other changes, such as removing phones from
individual residents’ rooms at a center, or having to fight for
certain day trips.
In several cases, employees even expressed the perception that the
number of resident deaths has increased due to level of care changes, as
well as the removal of veterans after the closure of the special needs unit
at Talihina. One respondent stated: “The number of deaths has increased
substantially over recent months due to changes in how we are to treat
residents, cuts to medical staff, and directives to medical staff regarding
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how they can practice medicine. The transition to the new computer
system has been over a year and is still not complete. This also has a
significant impact on the ability to provide quality care to our residents.”
Multiple letters we received alleged that individual residents removed
from the Talihina SNU may have passed away prematurely due to
complications resulting from their removal from the center. No matter its
level of certainty, this perception impacts morale.
Overall the survey respondents repeatedly worried that the centers are
being turned into nursing homes. Respondents seemed particularly
distressed because they truly care about, respect, and admire the resident
veterans, and feel that central office does not share this care and respect,
despite the military background of some central executives.
While the results of our discussions and procedures showed that the level
of care provided within the centers does appear to be declining, we
determined it was important to also ask whether this change ultimately
contradicts any significant laws, regulations, or other guidelines that
apply to the agency.
According to GAO standards, the oversight body and management
reinforce the commitment to doing what is right, not just maintaining a
minimum level of performance necessary to comply with applicable laws
and regulations, so that these priorities are understood by all
stakeholders, such as regulators, employees, and the public. The
following is a survey response, echoing a sentiment expressed in multiple
surveys: “The philosophy of this Agency has changed to ‘meeting
regulatory requirements.’ That is far from the best we are capable of.”
While current management is making changes to the historical level of in-
house care provided at the centers, and this has caused internal concerns
and brought forward some vocal critics among stakeholders outside the
agency, the situation is complicated by the fact that the changes do not
appear to violate any applicable laws or regulations. Veterans centers are
licensed as long-term care facilities, and are therefore liable to the
standards of such a facility, including Oklahoma State Department of
Health regulations for nursing facilities and VA regulations. The care and
services provided above that standard could be considered “extra,” and
while staff repeatedly expressed the feeling that the veterans deserved
this excellent care as a result of their patriotic service, the requirements
are more minimal.
We again noted that the centrally directed changes impacting residential
care may be impacting authority of the center administrators. Under the
terms of the Administrator Code of Ethics outlined in the OSBELTCA
administrative code (490:10-13-1):
• Individuals shall hold paramount the welfare of persons for
whom care is provided.
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• Individuals shall strive, in all matters relating to their professional

functions, to maintain a professional posture that places
paramount the interests of the facility and its residents.
• Individuals shall honor their responsibilities to the public, their
profession, and their relationships with colleagues and members
of related professions.
Given our earlier discussions of the agency-wide environment and
broken communications at ODVA, if an administrator believed a change
such as outsourcing services negatively impacted residents’ welfare or
interests, or otherwise conflicted with their professional responsibilities,
they would likely not be in a position to question or prevent the change.
Administrators stripped of their authority and seeing the provisions of
their own Code of Ethics ignored are in a precarious position: Should
they leave a position – often a long-term career – caring for patients for
whom they respect and feel a deep responsibility for, to protect their own
licenses, integrity, and self-worth? It is our understanding, as a result of
our discussions and surveys, that several administrators, as well as other
personnel within the centers, feel that they are in this state of quandary,
subject to management’s instructions but questioning the impact on the
veterans, center staff, and their own mental and professional wellbeing.
External laws and regulations are not the only principles guiding the
agency. As discussed earlier, GAO standards state that the oversight
body and management are to lead by an example that demonstrates the
organization’s values, philosophy, and operating style. One way
management expresses its values and philosophy are within the agency’s
mission statement.
The mission of ODVA has changed over time, and as presented on the
agency’s website, is currently clear and succinct:
Provide to Oklahoma Veterans and their families residing in the
State of Oklahoma the highest quality services and care available
anywhere in the Nation.
The agency’s mission and vision are presented in greater detail 9:
Mission: In partnership with the Secretary of Veterans Affairs, the

Oklahoma Department of Veterans Affairs, state and local agencies,
and Veterans Services Organizations, the state of Oklahoma will
facilitate in providing to the Veterans residing in the state of Oklahoma
the highest quality support and care available anywhere in the Nation.
Additional characteristics of ODVA style and services driven by the

mission include:
• Each center’s atmosphere is comfortable and relaxed
9 Full text from ODVA website, “About ODVA” page, last accessed May 8, 2018.
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• All employees are sensitive to residents and their families

• Employees communicate well and enjoy coming to work
• Employees’ knowledge, skill and experience are recognized and
leveraged
• Facilities are maintained in good repair
• Eligible veterans are assisted with claims
• Benefits include both VA and others
Vision: The state of Oklahoma is a state known for the best Veterans
care and services in the nation, where Veterans are provided tools that
are readily accessible, while facilitating their needs and requirements to
continue a quality life among the community in exchange for their
service to the nation, which has been paid in advance.
Explanation: It is the vision of the Oklahoma Department of Veterans

Affairs that all programs administered by this agency to Oklahoma
veterans will always be first in the nation in:
• Services
• Benefits
• Care
• Facilities
• Employees
• Relationships
An alternate vision is presented in a document provided to us by the

central office:
An agency known for providing model services and state of the
art facilities which honors the extreme sacrifices and superb
achievements of our veterans and their families.
We did not perform detailed procedures analyzing the agency’s
compliance with its own mission and vision. However, it seems clear that
ODVA has farther to go to reach their vision. The issues already
discussed in this report present a stark contrast to goals such as
• Providing the “highest quality support and care available
anywhere in the Nation”
• Employees who communicate well and enjoy coming to work
• Employees’ knowledge, skills, and experience being recognized
and leveraged
• Providing “state of the art facilities” and being first in services,
benefits, care, facilities, employees, and relationships
A letter from Governor Fallin in January 2015 asked the Oklahoma
Veterans Commission to join her in a “new and expanded vision to serve
all of Oklahoma’s veterans and their families,” asserting that as a state we
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offer services to far too few veterans and must expand our reach.
Management has shown clear intentions and movement toward
expanding its services to veterans outside the seven residential centers.
This is commendable, and no doubt necessary, as Oklahoma has a
population of veterans outside the centers far larger than the population
receiving long-term care from the agency. A high-level mission and
planning document provided to us by the central office documented
ODVA’s progress and further plans in place to increase the agency’s
outreach to veterans in need of services other than residential care and
claims and benefits assistance – including education, employment, and
mental health aid. Central office efforts include increased social media
presence and other visibility tactics, community and government
partnerships, events, and legislative initiatives.
Employees believe the central office is defunding the veterans centers in
order to support these other services. Whether or not this is the case, this
situation highlights the breakdown in communication within the agency.
Employees are left to wonder whether and how their leaders are choosing
to serve the veterans, and they cannot assist in meeting the mission and
vision of the agency without being educated about them. If management
indeed believes it is necessary and appropriate to alter the level of agency
involvement in residential care in order to adequately attend to the state’s
other veterans, transparency and communication with both internal staff
and the public would be crucial to securing buy-in and support.
Several other factors remain unclear: Are the commission or the
legislature aware of the decline in service level provided at the veterans
centers? Is it their intention to decrease in-house services provided to
veterans? Could the decrease in medical care provided at the centers, as
survey respondents worried, affect the volume of federal reimbursements
the centers are eligible to receive?
The agency’s handing of the Talihina center also conflicts with its mission
to provide the “highest quality” care. A detailed discussion of events at
the Talihina center begins on page 32. While the agency has sought
legislative authority to move the Talihina center to a different location, it
has also reported that it will take at least five years to do so.
Management’s avoidance of maintenance responsibilities at the center in
the recent past, and its consistently negative public statements about the
center, do not place the administration there in a position to provide
excellent care in the interim.
The following responses from our surveys illustrate two employees’
feelings related to the ODVA mission:
• It seems our efforts are lost in the process of what's really
important for our vets or maybe I don't understand the mission.
Do we just provide healthcare, food, and shelter? Are families
important and part of their health care plan? Do volunteers
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matter? . . . Our vets know the difference between lip service and
action and what we do is more than just another job.
• It sure doesn't look good when the resident's worry if they are
going to have a place to live and people to take care of them in the
right way when they gave their lives for this country.
As it stands, the veterans centers are by far the most visible and highest
cost division of the agency, and are relatedly the focus of most of the
concerns we were asked to address. The same mission and planning
document we received that outlines the expansion in veterans services
also details the agency’s “values,” which reflect those of the various
military services: loyalty, duty, respect, honor, integrity, and selfless
service, among other laudable characteristics. Unfortunately, the majority
of ODVA’s staff does not see these values reflected in management’s tone
or actions, and the fear and confusion they are experiencing is impacting
their morale and the care they are providing.
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TALIHINA VETERANS CENTER
In response to the volume of questions and concerns brought forward

during this engagement specific to the Talihina Veterans Center, we have
endeavored to present some information about occurrences in Talihina
under the current administration. As our procedures and access to
reliable documentation have been limited as discussed beginning on page
one, we were unable to provide a lengthy and detailed timeline of events.
However, some additional information on events at the Talihina center
has been made available publicly by news publications.
Background and Events in Talihina

The Talihina Veterans Center was originally constructed as the Eastern
Oklahoma Tuberculosis Sanatorium in 1921. In 1975, the Sanatorium was
transferred to the control of the War Veterans Commission to provide
nursing care to Oklahoma veterans. The center is located approximately
two miles northwest of Talihina and is situated on 600 acres at the
western edge of the mountainous Ouachita National Forest.
In recent years, the Talihina center has been the focal point of a battle
between ODVA central management and the staff at the center,
legislators, concerned citizens, and the City of Talihina. Various
allegations and actions, which include the looming effects of the center
potentially relocating, have caused many concerns among these parties.
Concerns related to the center mentioned throughout our interviews, in
surveys, and described in the media vary widely and include the age of
the center, water quality concerns within the town of Talihina, questions
about staffing levels related to the remote location of the center, the
closing of the center’s special needs unit (SNU), explained variously by
central management as being due to mold, inadequate staffing, or low
demand.
Several events have impacted the Talihina center in the past few years.
After being asked to replace the HVAC system in the SNU, management
had the unit tested and mold was detected, leading to complications in
cleaning or replacing the duct system. This situation is discussed in
further detail later in this section. Controversy surrounded the center in
October 2016 and again in January 2017, as a result of resident deaths.
Details regarding these unfortunate deaths have been made available in
various publications, and the circumstances surrounding them were
complex. They led to the resignations and terminations of various
employees, including a physician’s assistant and three nurses. They also
led to a lengthy process through which central management eventually
succeeded in having a nurse practitioner’s license revoked.
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These events were reported in the press and comingled with claims of
other problems at the center by central management. These included low
staffing and high turnover levels, a limited pool of qualified applicants in
the rural Talihina area, and a comparably small wait list for the center
when compared with other centers. Where these claims were made in the
press, they did not appear to be accompanied by evidence.
In a December 2016 a local news station interviewed Senator Frank, who
explained that he had listened to complaints from Claremore, Norman,
and other facilities over the past five years, and he was part of the move
to overhaul the administration of the state agency. He expressed the
belief that relocating the Talihina facility to a more easily accessible area
would be the best long-term solution for both recruiting and retaining
qualified staff members in the future. The Senator was also quoted in the
same article saying, “I know there are concerns about the economic
impact it would have on the community, and those are serious concerns
that we’ve got to take a look at, but my primary concern is to make sure
we can provide the quality care that our veterans need.”
Senator Simpson authored SB 544 during the 2017 Legislative session, to
relocate the Talihina veterans center. The bill read in part:
The Oklahoma Department of Veterans Affairs is

authorized and directed to relocate the Oklahoma
Veterans Center at Talihina, Oklahoma, to a new
location eligible for approval or recognition by the
United States Department of Veterans Affairs as a
State Veterans' Home.
The Oklahoma Department of Veterans Affairs is

further authorized and directed to proceed with the
development of a new facility to assume the
operations of the Oklahoma Veterans Center presently
located in Talihina, Oklahoma, subject only to such
geographical constraints as may be imposed by the
United States Department of Veterans Affairs.
The bill failed to pass in the Appropriations and Budget Health

Subcommittee. During this same time period, a group of individuals met
with the Attorney General’s office regarding concerns related to the
ODVA. Many of those concerns were directly related to the potential
relocation of the Talihina center and views of the current administration.
In March of 2017, the Talihina administrator received an email from the
ODVA deputy director instructing her to inform the families of residents
residing in the SNU that due to the need for repairs and lack of staff, they
would need to find an alternate location to receive care. The deputy
director also stated that his intent was not to lose the beds but to
remediate the rooms that have mold or preferably locate to a new facility.
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The following is the entire body of the email, dated March 28, 2017, with
the header removed 10:
Following the receipt of the above email, the administrator wrote a letter
to the Federal Veterans Affairs Medical Center dated March 28, 2017,
informing them of the planned closure of 48 beds in the SNU.
The administrator then called a meeting with the department heads

notifying them of the instructions she had received from the deputy
director to close the SNU by June 1, 2017. She also stated that no
employees would lose their job and that they would assist the families of
the SNU residents in finding an alternate facility for them to live. The
administrator also stated in the meeting that it was the intent of the
director to reopen the unit once construction is complete.
She further explained that the reasons given for closing the unit were the
HVAC system and lack of staffing.
After the closure of the SNU, and continued loss of employees, and the
loss of residents in October of 2016 and January of 2017, the Federal VA
Medical Center informed the administrator that until the issues could be
addressed, a 90 day hold was being placed on all referrals. The following
10 Correspondence has been limited to the body of each document, with significant parties and dates noted in the
report text, both to save space and to eliminate the inclusion of any unnecessary identifying information.
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is the body of the April 14, 2017 email from the assistant chief of social
works service at the Muskogee USDVA office:
This email was subsequently released to the press, which prompted

complaints from the USDVA assistant chief who had written it. The
deputy director replied to that individual as follows on April 17:
On June 9, 2017, the deputy director sent the following to the Talihina
administrator:
The administrator responded with the following on June 12:
It has been represented by management at certain times that low staffing

levels at the Talihina center were one of the main reasons for closing the
SNU and for relocating the center. In their December 2017 response to
allegations, management indicated that the Talihina turnover rate for
certified nursing assistants (CNA) was 100 percent. They went on to claim
that turnover is approximately 50 percent at all of the other centers, even
in metro areas where more competition exists.
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We summarized the hires and terminations at the agency by location for

fiscal years 2015, 2016, and 2017. While the terminations were significant
at the Talihina center, they did not appear to differ greatly from or exceed
the other centers when accounting for their size and terminations likely
related to the SNU closure. (Veteran counts by center are included in the
table on page 53.)
Clare - Central
Termi na ti ons Ardmore Clinton Norman Sulphur Talihina Lawton Others Total
more Office
FY 15 225 83 91 304 99 153 196 5 7 1163
FY 16 322 97 97 271 102 161 199 2 13 1264
FY 17 248 84 101 284 70 190 168 6 13 1164
Source: Statewide accounting system HR records
In reviewing the hires for the same time period, it appears all seven
centers trended toward hiring fewer individuals than were terminated,
and this was the case for all centers in FY 2017, and for Talihina in each
fiscal year.
Clare- Central
Hires more
Ardmore Clinton Norman Sulphur Talihina Lawton
Office
Others Total
FY 15 261 104 116 306 96 133 193 3 8 1220

FY 16 326 98 103 268 85 154 203 7 16 1260
FY 17 188 69 72 275 42 120 120 3 21 910
Source: Statewide accounting system HR records
Throughout our interviews, administrators and staff at every facility

noted that turnover in the Patient Care Assistant (PCA; this is another
name for the CNA position mentioned earlier) position is a huge concern.
It is also significant that the agency now hires PCA/CNA employees with
assistance from the Galt Foundation who, in exchange for an
administrative fee, recruits staff and arranges interviews. It appears
employees were not regularly hired through Galt until FY17, although
they were used for temporary services, such as moving and assembling
furniture, during FY15 and FY16. According to statewide accounting
system records, ODVA paid over $2 million to Galt in FY 2017. The
marked drop in hires in FY 17, coupled with the situation discussed on
page 9 in which Galt employees have lost their previously promised
opportunity to become state employees after one year, suggests they are
not included in the statewide accounting system and therefore not
represented here. This presents a complicating factor in interpreting
turnover figures, including those presented publicly by management.
Many legislators continue to be at odds over relocating the Talihina
center, but during the 2018 Legislative session, HB 3042 passed, creating
the Oklahoma Veterans Facility Investment Act of 2018. The bill reads in
part:
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A. The Oklahoma Department of Veterans Affairs is

authorized to plan, develop and construct a long-term
care facility for the purpose of assuming the
operations of the Oklahoma Veterans Center
established in Talihina pursuant to Section 229 of
Title 72 of the Oklahoma Statutes. The Department may
construct new facilities or refurbish any existing
facilities on property currently owned by the State
of Oklahoma or on property purchased or donated from
other sources, including but not limited to private
owners or other governmental or municipal entities.
B. The location of the facilities shall be subject only
to such geographical constraints as are imposed by
the United States Department of Veterans Affairs to
preserve and continue recognition and certification
of the facility as a State Veterans Home.
C. The location and site of the facility shall be
determined by the Oklahoma Veterans Commission. The
Oklahoma Veterans Commission may consider any and all
criteria which, in its sole discretion, further the
interests of Oklahoma veterans.
D. Operations of the Oklahoma Veterans Center
established in Talihina pursuant to Section 229 of
Title 72 of the Oklahoma Statutes shall continue
until such time as its operations are transferred to
the location identified pursuant to the authority.
As one of the authors of the relocation bill, Representative Chris

Kannady, R-Oklahoma City stated in the Tulsa World, “The way we
improve it is to move it. If it remains the same, that facility will close.
Whatever (the new facility) is in five years, it will be significantly better
than (Talihina) is now.”
The move of the center was bitterly opposed by Rep. Brian Renegar, D-
McAlester, in whose district the center is located, but was backed by
several veterans in the House who say the aging Talihina center is not
viable in the long term. It is unclear whether the legislators performed
independent research to support this stance or based their opinions on
statements from ODVA management. It should also be noted that this bill
gives the authority to determine the location and site of the new facility to
the Commission, which, as discussed on pages 22 and 23, may not be
fully in touch with operations at the center level.
Following a 2017 interim study regarding the center that he spearheaded,
Representative Renegar released a statement that included the following
refutations of some of management’s concerns:
An ODVA spokesman told a Fort Smith, Ark., television station in
February that maintenance of the 100-year-old Talihina center is
expensive. He also said it’s difficult to recruit doctors to the facility. The
town has had some issues with its water system, as well, the ODVA
contends.
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“We have spent approximately $5 million to upgrade our water facility in

Talihina,” said Mayor Don Faulkner, who attended Renegar’s interim
legislative study last month.
He also said the Talihina center is constantly being renovated and has
been up-to-date since 2004. “Talihina is actually one of the better centers
and the facility with the lowest turnover rate in nurses and employees,”
he told KFSM-TV.
Roy Griffith, who was the administrator of the Talihina Veterans Center
for 25 years, said it’s a great place to live and work. He, too, disagreed
with the ODVA’s findings. “I just don’t know where this is coming from,”
said Griffith, who also attended Renegar’s study.
The press release also noted that no one from ODVA attended the interim
study, and only four of the nine members of the House Committee on
Veterans and Military Affairs were in attendance.
Additional Information Related to Capital Project Cancellations
HVAC Replacement and Mold Issue

According to Talihina Center staff, in March 2015, the Talihina
administrator informed central management that the SNU needed a new
HVAC system, and budgeted the project for fiscal year 2016.
Documentation provided to the ODVA construction programs
administrator in early April 2016 suggests a professional engineer had
developed a proposal for HVAC system replacement at the center, and
outlines a detailed plan designed to minimize disruption within the SNU
and to maximize efficiency, with considerations tailored to residents’
needs based on the engineer’s experience with a previous duct
replacement project at the Sulphur center. This plan included replacing
air handling units, fan coils and attached heating and chilled water
piping serving them (all of which the engineer states need to be removed
from service), and the duct system, which the engineer states is only sized
to handle the outside air portion of the system, about 20% of the total
volume of circulated air. The following is an excerpt from the letter
outlining the plan, dated April 6, 2016:
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Management chose to have the building tested for mold, and Terracon
Consultants, Inc. conducted. The scope of the project included collecting
surface samples within the air duct system of the building and collecting
air samples for culturable and non-culturable mold spores from within
the site building. The inspection results, conclusions, and
recommendation are as follows:
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Source: Terracon Consultants, Inc. Report on project No. 04167092
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After the mold was identified, the administrator indicated that an

estimate of $50,000 was received from Office of Management Enterprise
Services (OMES) to clean the ventilation system. However, central
management elected to close the SNU. In December 2017, management
explained that the Terracon mold report failed to mention that the duct
has an internal liner for which cleaning is costlier than replacing (and, per
the previous engineer’s letter, potentially a health hazard). Management
also indicated that OMES concurred in the ODVA’s assessment that
cleaning of the duct was not a feasible option, although we were not
provided evidence of this.
Interestingly, none of these mold discussions appear to address the
aspects of the initial HVAC replacement plan that call for new air
handling units and the retirement of fan-coils and related heating and
chilled water piping. Mold abatement and duct replacement would not
address the need for HVAC improvements to the equipment handling the
other 80% of airflow.
Eventually the SNU was closed and patients were removed from that
affected area. However, according to staff members at the Talihina center,
the same ventilation system feeds into various other sections of the
building that are still being used today. These areas still in use by both
staff and veterans include the physical therapy room, exam rooms, and
stock rooms.
Nurse Call System

We received documentation of a purchase request for an upgrade to the
Nurse Call Responder 4 project at the Talihina Veterans Center that was
approved by the CFO and director on June 12, 2017. The center
administrator had been informed by the distributors that this nurse call
system had reached its “end of life” and that replacement parts and
repairs were no longer available.
On July 31, 2017, Governor Mary Fallin gave the ODVA director the
directive that “no funds be expended on the infected wing of the Talihina
Veteran Center until we thoughtfully and thoroughly consider the best
options for moving forward and providing the level of care that our
veterans deserve.” See the full letter:
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On August 1, 2017, the deputy director emailed a copy of this letter to the
Talihina administrator with the message, “Please see the attached
decision by the Governor concerning future capital improvement at
Talihina.” When the center’s administrator argued that not updating the
call system was a life safety concern as there were remaining veterans
residing at the center that were not in the infected area, the matter was
forwarded to the central office clinical compliance nurse, who asked the
administrator essentially to prove that not updating the Nurse Call
System was a life safety concern. The administrator provided detailed
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information from discussions with the system manufacturer and

distributor and related documentation, including the approved purchase
request (which lists the reason for replacement as “old system no longer
able to be repaired”) and a letter from manufacturer Rauland-Borg
Corporation stating, “In order to ensure the continuity of your life safety
nurse call system, please contact your local Systems Integrator to create a
strategic plan to upgrade to Responder 5.” It also states that they will
honor the Responder IV’s warranty as long as they can continue to
procure required components, suggesting that this may become difficult.
The deputy director and clinical compliance nurse responded with
further questions about parts availability, then asked the central office
construction programs administrator to verify the information provided.
Her response was as follows 11:
“I've known that the Responder IV system is nearing functional
obsolescence meaning Rauland is no longer manufacturing parts for that
version of the system. I have a call in to my contact but from what I
understand parts can be shipped to them for repair but at some point in
the future they cease to provide that type of support. I don't know when
that will be (could be 6 mos., 1 yr., or 2-3 yrs.). So yes the system can be
repaired for right now.”
Based on this opinion, the clinical compliance nurse informed the
Talihina administrator that “Based on the information provided by [the
construction programs administrator] we will not be replacing the system
at this time. That isn’t to say we won’t in the near future but it doesn’t
seem to be as big of an emergency as reported earlier.” Although the
construction programs administrator’s email clearly stated that she had
“a call in” to her contact, and had therefore not actually yet verified the
Talihina administrator’s statements, these instructions that “we will not
be replacing the system at this time” were emailed only six minutes later.
Once again, the administrator reinforced not updating the Nurse Call
Responder system was a life safety concern and should not be dismissed,
the administrator also provided the contact information for the
representative for Rauland Borg and stated the representative would be
willing to speak with anyone about the matter. The clinical compliance
nurse then sent the construction programs administrator instructions that
“should the system go down they would be replacing quickly and to put
together a POC should we be required to repair in an emergency
situation.”
The decision to avoid preventive maintenance of the nurse call system
could easily be interpreted by the average citizen as management not
prioritizing the veterans’ wellbeing. The Governor did give the directive
to not expend funds on the infected wing, due to the reported mold
11
Minor typographical errors have been fixed for ease of reading.
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Special Audit
issues; however, there was no such language that would have given
central office permission to not update crucial lifesaving medical
equipment; her letter specifically says “life-critical situations excepted.”
The Nurse Call System plays an integral role in basic veteran care,
allowing the veteran to push a button and notify medical staff of a
possible medical emergency. In the instance a veteran is bed ridden or
there is a medical reason that prevents a veteran from verbally being able
to ask for help, the Nurse Call System provides an immediate notification
to medical staff. Medical staff cannot properly and efficiently do their jobs
without having reliable medical equipment.
Management’s dismissal of an administrator’s concern that there is a risk
that could adversely affect a veteran in their care is illustrative of the tone
at the top of ODVA’s administration discussion earlier in this report.
Additionally, reluctance to update lifesaving equipment until it has failed
does not appear to support the ODVA mission to “provide to Oklahoma
Veterans and their families residing in the State of Oklahoma the highest
quality services and care available anywhere in the Nation.”
According to the central office, the centers in Norman, Clinton,
Claremore, and Lawton use Responder 5. The Sulphur center has
Responder IV on Units 1,2,3,6 & 7, while units 4 & 5 have Responder V
system. Clinton has the Rauland Responder IV/4000 Nurse Call System.
It appears the agency has seen fit to outfit some centers with the more
recent version of the Responder nurse call system. The other centers or
units are potentially at the same risk for failure without possible
replacement or repair as is the Talihina center.
Boiler System
The records of audit period ODVA Projects we reviewed also included a
steam boiler replacement project in the amount of $310,498.81 that had
been cancelled at the Talihina Veterans Center. During our interviews we
had been told that a steam boiler project at the center was approved and
subsequently canceled, which led to the center incurring a multitude of
emergency repair costs. We obtained a copy of a purchase order for this
steam boiler replacement signed by the CFO and director in June 2016,
but did not encounter documentation as to why it was later canceled.
According to center management, many boiler system repair costs have
been incurred since that time.
Employee Perspective
Staff are clearly uncertain of the direction management has chosen for the
Talihina center, and particularly the motivation or reasoning for that
direction. There are no clear lines of communication about the future or
how and when the changes will occur. The comments gathered through
our employee surveys are a true reflection of how individuals feel and
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Special Audit
what they believe the situation to be, and often frankly express the
conviction that central office is sabotaging the Talihina Center in order to
close it by firing employees, removing medical equipment, closing the
SNU for unclear reasons, not allowing input from veterans, and allowing
holds to be put on admissions. The following is a sample of comments
received, in the survey respondents’ own words:
• Central Office is leading the charge to have our facility relocated,
at any cost. Our SNU has been closed and I have heard 3 different
excuses for this closure: 1. mold in the air system which staff and
residents are still being submitted to each day as it supplies air to
other areas of our building, 2. Staffing – our direct care staffing
numbers do not indicate staffing is an issue, 3. Admissions – the
most recent excuse that our director stated during the hearing for
the Nurse Practitioner. I’m not sure Central Office know why they
directed the SNU to be closed.
• In normal circumstances a new building for veterans is a good
thing, but it’s my understanding that the new building model
would not meet the needs of a large majority of our current
resident population, leaving families with the burden of taking
care of our veterans.
• The center at Talihina has been portrayed in a terrible light in the
media and rather than fix things wrong in the building central
office personnel are seeking to abandon it and move it to another
town so it will be a "feather in their cap". I have been told that the
mold in the Alzheimer's unit is very fixable and the whole
building does not need to come down.
• Central office has refused to fix life safety issues at Talihina while
fixing them at the other centers. One is the nurse call system
which is in the infirmary part of the facility. Without it we would
have to close rooms and not admit residents. This system is
needed to install another type of wander management system for
dementia residents. Without it we cannot keep residents that
show dementia signs. They have to be discharged or not admitted
at all at Talihina.
• [The audit period deputy director] loves to send E-mails with a
double meaning. He said his main agenda is to close Talihina.
Now how stressful would you say that would be for someone
with kids . . . . And there are very little to no jobs in our area.
Please help these state employees.
• I would like to know why they have chosen to attack Talihina in
the papers? If Central Office wanted to close the Talihina center –
why did they choose to lie, tell ½ truths + slander one of their own
centers? Why not just close it?
• It appears Central Office is trying to divide the staff at Talihina –
encouraging an atmosphere of distrust – manipulating the
administrative + upper level nursing till you can’t trust anymore.
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Special Audit
Two survey comments addressed fears of additional centers being closed,

alleging that the deputy director
• “has said in a public meeting he was going to bulldoze Ardmore,
Sulphur, Clinton, and Talihina centers because they were not
good enough for America’s heroes. Sulphur has had renovations
and new buildings over the past several years.”
• “told administration at the Sulphur center that he plans to shut
down 5 of the 7 state veterans centers. This is a direct
contradiction to what he has been telling legislators and news
media about closing only the Talihina center. Another lie.”
Once again, we must note that no matter the level of veracity of
employees’ beliefs, central management does not appear to be doing
anything to refute them, and those beliefs damage morale and increase
risk.
Whether or not a different facility eventually replaces the Talihina center,

one key fact is clear: there are residents living in that center today, and
employees working there, and by all appearances that will continue to be
the case until a new facility can be made ready. Estimates for that time
period have typically been in the range of five years. Providing care for
these residents in the interim necessitates that the agency maintains the
center at an acceptable level, staffs the facility adequately, and supports
that staff in providing care and operating the center.
Management’s negative statements about the Talihina center in the press
might give the impression that they are not responsible for the condition
of the center, even as they centralize various functions, removing facets of
the center’s autonomy one by one. Based upon our surveys and
interviews, Talihina center staff is clearly convinced that central
management has a vendetta against the center, and fears for their jobs
and residents’ wellbeing. As previously discussed throughout this report,
the toxic environment at the agency and breakdown in communication
that are impacting all veterans centers have no doubt exacerbated the
situation, and must be rectified if the center is to regain the internal
support needed to care for its residents today, no matter where they may
be relocated in the future.
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Special Audit
RESULTS OF PROCEDURES
AND EMPLOYEE SURVEYS
As discussed beginning on page one, after feeling that our access to

reliable, independent information related to center operations had been
compromised, we ceased detailed procedures and moved forward to
report on the current environment at ODVA. The following information
comprises the results of our procedures as they then stood, as well as
related information from our survey of ODVA employees. These topics
may also be discussed in terms of the agency environment and level of
care in previous report sections.
Sources of The agency’s main sources of revenue are federal funding, state
Revenue appropriations, and institutional care charges.
Federal reimbursements include
• Per diem payments from the USDVA based on the veteran’s
eligibility, calculated based on the daily rate and the number of
days that a Veteran has been a resident. (Over 95% of federal
reimbursements are per diem payments.)
• Funding for ODVA construction projects that have been placed on
the federally approved construction priority list; the USDVA pays
65% of the cost of construction while ODVA pays a 35% match.
(Just under 4% of federal reimbursements)
• Funding for approving veterans for on-the-job training and
apprenticeship programs, managed by the State Accrediting
Agency. (Less than 1% of federal reimbursements)
State dollars are appropriated by the Oklahoma legislature. During our
interviews and review of press articles, we noted that management often
references this decrease when discussing the need for changes within the
agency and cost-cutting measures. While ODVA’s state appropriations
decreased by nearly 13% during the audit period, this resulted in their
overall revenues decreasing less than 3%, and it appears federal revenues
increased nearly 9%. See table below for details. Overall, the agency’s
revenues fluctuated but did not actually decrease between FY 2015 and
FY 2017.
Institutional care comprises care and maintenance charges collected from
the residents who are not eligible for federal per diem reimbursements
(i.e. not 70% or greater service-connected disability). These charges
amount to 85% of the resident’s income, or 50% for residents contributing
to the support of legal dependents, with a current cap of $3,925/month
(with additional specifications outlined in 72 O.S. § 63.5). The agency
noted that this funding is used for the general operations, state match for
construction projects and financial assistance.
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Special Audit
Revenue sources bringing in less than $150,000 over the three fiscal years
(and totaling less than a tenth of a percent of the agency’s income
altogether) are grouped as “Other Revenues” in the table. These minor
revenue streams are derived from various sources and include sales and
auctions of assets, court awarded judgments, other sales and services, and
commissary and concession income.
FY 2015 FY 2016 FY 2017 TOTAL % of total
Federal Reimbursements 88,285,119 96,643,990 96,159,462 281,088,571 60.96%
Net appropriations 34,396,712 31,005,211 30,011,916 95,413,838 20.69%
Institutional Care 28,889,625 26,520,378 26,592,967 82,002,970 17.78%
Other Grants, Refunds, & Reimbursements 858,995 51,151 - 910,146 0.20%
Food & Beverage Sales 256,510 260,834 237,777 755,122 0.16%
Refunded Money Prev. Disb - Gds & Svc 342,896 109,232 157,055 609,183 0.13%
Other Revenues 89,893 156,035 94,756 340,684 0.07%
$ 153,119,750 $ 154,746,831 $ 153,253,933 $ 461,120,514
Source: Combining Trial Balance reports from Statewide Accounting System
Budgeting of Carryover budgeting is handled by central office accounting staff as part

Carryover Funds of the overall budgeting process, which is overseen by the Office of
Management and Enterprise Services (OMES). According to the CFO, the
centers’ three funding sources are handled as follows:
• The general appropriations budget is typically fully expended on
payroll and operations, or any carryover is re-budgeted in the
next fiscal year for the same purposes.
• Revolving funds are budgeted for center operations and capital
projects, and carryover is pooled for budget preparation and split
between operating and capital budgets as needed.
• Federal funds are budgeted for operations and capital projects,
and carryover is used to offset reductions to appropriations, for
major maintenance and repairs, and for grant projects.
Our initial interviews suggested center administrators and business
managers submit annual budget drafts to management and otherwise
have little control over how funds are transferred between locations. Staff
at some centers suggested the budget is volatile, with regular changes
made by central office without explanation. However, they generally
believed their budgets were adequate and in fact expressed that they did
not understand some “cost-saving” measures effected by the central
office when there were funds remaining in their budgets. See discussions
regarding MDS coordinators, general staffing concerns, and other
potentially cost-cutting measures throughout this report section.
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Special Audit
Annual Budgets Using data from the statewide accounting system and approved budget
by Location reports, including revisions, provided by the Office of Management and
Enterprise Services (OMES), we compiled the annual budgets for fiscal
years 2015 through 2017. The table below provides the centers’ annual
budgets in terms of average number of veteran residents. Also presented
are annual budgets for Central Office and “Other,” which consists of
Information Technology, Claims and Benefits, Capital Lease, Veterans
Services, and Financial Aid.
Budget Comparison Analysis
Fiscal Year 2015 2016 2017
Avg. Budget Avg. Budget Avg. Budget
Center Annual Budget Number of Breakdown Annual Budget Number of Breakdown Annual Budget Number of Breakdown
Veterans Per Veteran Veterans Per Veteran Veterans Per Veteran
Claremore $ 26,318,037.00 289 $ 91,065.87 $ 26,640,537.00 287 $ 92,824.17 $ 26,706,385.00 284 $ 94,036.57
Ardmore 17,924,277.00 168 106,692.13 18,470,594.00 169 109,293.46 18,107,273.00 167 108,426.78
Clinton 16,091,071.00 145 110,972.90 16,829,101.00 143 117,686.02 16,009,570.00 145 110,410.83
Norman 26,419,023.00 297 88,952.94 27,038,930.00 299 90,431.20 26,766,461.00 296 90,427.23
Sulphur 14,239,098.00 109 130,633.93 14,635,214.00 115 127,262.73 13,953,467.00 117 119,260.40
Talihina 18,202,224.00 175 104,012.71 18,165,181.00 174 104,397.59 18,141,131.00 153 118,569.48
Lawton 20,395,099.00 195 104,590.25 21,043,435.00 196 107,364.46 20,475,943.00 196 104,469.10
Central Office 3,636,408.00 - - 4,333,467.00 - - 3,537,016.00 - -
Other 6,582,332.00 - - 6,662,491.00 - - 7,439,025.00 - -
The noticeable drop in Talihina’s average resident count in FY 17 is due

to the closure of the center’s Special Needs Unit; see further discussion
beginning on page 32. Note that central office figures in this table do not
include central IT costs (included in Other).
FY 2018 Budget When compared with the data in the previous section, the agency’s
budget for FY 2018 presented higher expenditures for most locations,
with a significant drop in Talihina and smaller drop at the Lawton center.
Budget Comparison Analysis
2018 as of
Fiscal Year 2015 2016 2017
February 2018
Center/
Annual Budget Annual Budget Annual Budget Annual Budget
Location
Claremore $ 26,318,037 $ 26,640,537 $ 26,706,385 $ 27,182,189
Ardmore 17,924,277 18,470,594 18,107,273 18,532,912
Clinton 16,091,071 16,829,101 16,009,570 16,034,039
Norman 26,419,023 27,038,930 26,766,461 26,914,257
Sulphur 14,239,098 14,635,214 13,953,467 14,048,223
Talihina 18,202,224 18,165,181 18,141,131 14,967,984
Lawton 20,395,099 21,043,435 20,475,943 19,958,912
Central Office 3,636,408 4,333,467 3,537,016 4,254,910
Other 6,582,332 6,662,491 7,439,025 8,836,963
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Special Audit
A comparison of the budget reports for fiscal years 2017 and 2018 also
showed the following increases in central budgets, all of which are
included in the “Other” category above and are therefore separate from
the general increase in Central Office budget illustrated in the table:
• Central Administration IT (dept 8807011) increased 18%, from
$2,378,787 to $2,815,672
• Veterans Services (dept 2000002) increased 38%, from $498,363 to
$688,228
• Central Office IT (dept 8807001) increased 39%, from $38,800 to
$54,000
• ODVA Commission (dept 1100002) increased 100%, from $5,500 to
$11,000
Policies and Over the past several years, central management has worked to centralize
Procedures the agency’s policies. Centers are permitted to develop procedures
unique to themselves as long as they do not contradict or interfere with
centrally approved policies. This is reportedly to ensure regulatory
compliance and standardization prior to implementing policies, and
center-unique procedures are required to be approved by the central
office. However, some administrators expressed that they had center-
specific procedures that had not been submitted to the central office for
review. It stands to reason that, because each center is unique, individual
procedures could be justified at the separate centers. Management may
need to better communicate or enforce the requirement for central review
of such procedures after discussion with the administrators.
ODVA policies are generally updated on a schedule, for regulatory and
internal process changes and to ensure consistency, though not
necessarily due to specific events. In the past, updates were distributed to
the centers by the central office, but the agency now has an electronic
system in place for handling policies and requiring staff
acknowledgement of changes.
According to several interviewees and records obtained from the agency,
in late 2016, all centers’ nursing policies and procedures were removed
from the agency intranet and replaced with one standard template set of
policies. Reportedly, these policies were not provided to center
administrators or medical staff for review prior to implementation, and
initially lacked an index. This sudden change in policies and procedures
created concerns within the centers that the removal of specific guidance
previously put in place in response to inspections and peer reviews
would leave them open to poor inspection results in the future. Center
management also noted that without adequate time to review and
provide training on over 1,000 pages of new policies, it is difficult to
conform to, or to hold employees accountable to, those policies.
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Special Audit
We received further concerned comments regarding the changing of

policies and procedures (particularly these nursing policies) during our
electronic surveys. These comments stressed that the centers’
individualized, functioning policies were removed without warning and
replaced with a set of unfamiliar, standardized policies, some of which
did not apply to their operations. This left supervisors without time to
review the policies or provide relevant training, and unable to enforce the
policies with staff. Several survey respondents and staff members
interviewed also brought up the implementation of reportedly unlicensed
policies and subsequent legal threats from the company who owned them
and payment to that company, claiming it was an embarrassment, an
unwarranted expense when budget cuts were so frequently discussed,
and an example of the level of ethics and competency at the central office.
It was also brought to our attention by several individuals that the
standardized nursing policies may have been unlicensed, resulting in
legal threats from the owner of those policies and subsequent payment to
that owner. Our procedures led us to limited evidence of what central
finance staff reported was a payment for such licensing; however, the size
and timing of that payment did not line up with the allegations, and
detailed documentation was not provided. We will recommend potential
follow-up under Further Procedures at the end of this report.
Of 138 survey respondents with an opinion, 43.5% noted that they believe
central office management “Seldom” or “Never” strives to comply with
laws, rules, or regulations affecting the organization. Multiple comments
referred to policy changes directed by central management occurring “on
a whim,” sometimes being quickly retracted, and creating chaos and
confusion.
Cost per Bed We were asked to provide the cost per bed at ODVA facilities. This was
determined by verifying ODVA data on the applicable direct and indirect
costs incurred, then recalculating the cost per bed using quarterly costs
divided by quarterly patient days. The table below summarizes each
center’s average number of veterans per year and the corresponding cost
per bed for state fiscal years 2015 through 2017 (July 1, 2014 through June
30, 2017). Also presented are total average veterans across the agency
each year and the agency-wide average cost per bed, weighted by
number of veterans at each center. Note that the significant drop in
number of veterans at the Talihina center in 2017 is due to the closure of
its special needs unit.
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Special Audit
Fiscal Year 2015 2016 2017

Avg. Number Avg. Number Avg. Number
Center Cost Per Bed Cost Per Bed Cost Per Bed
of Veterans of Veterans of Veterans
Ardmore 168 $288.28 169 $310.57 167 $289.98
Claremore 289 $246.63 287 $264.62 284 $256.27
Clinton 145 $306.89 143 $330.42 145 $302.80
Lawton 195 $295.02 196 $304.16 196 $275.95
Norman 297 $255.47 299 $258.92 296 $250.61
Sulphur 109 $354.09 115 350.19 117 $316.40
Talihina 175 $277.44 174 $292.60 153 $303.99
Total Avg. Weighted Avg. Total Avg. Weighted Avg. Total Avg. Weighted Avg.
Veterans Cost per Bed Veterans Cost per Bed Veterans Cost per Bed
1,378 $279.21 1,383 $292.05 1,358 $277.55
Service- We were initially asked to investigate the impact to the agency of the
Connected change in USDVA compensation for wartime veterans. However, this
Compensation change took place well before the beginning of our audit period and
before audit period management was in place. While eligibility and
priority for admission to Oklahoma veterans homes are outlined in
statute and in ODVA’s administrative code, USDVA regulations (38 CFR
51.41) outline service connected compensation rules as follows:
Service Connected Compensation is payment for a disability that started or
was aggravated while the veteran was on active duty. The amount
payable depends on the degree of disability and the number of
dependents. The veteran's income and assets have no effect on the
amount of compensation.
Non-Service Connected Compensation is a non-service connected pension
payable to any veteran who is permanently and totally disabled and who
meets certain income and asset limits set by congress. The veteran must
have served a minimum of 90 days active duty of which at least one day
is during a wartime period. Income, unreimbursed medical expenses, and
the number of dependents could affect eligibility and the amount of the
pension.
The USDVA regulations state that the USDVA and State homes may enter
into both contracts and provider agreements, through which the USDVA
pays for each eligible veteran's care. Eligible veterans are those who
(1) Are in need of nursing home care for a USDVA adjudicated
service-connected disability, or
(2) Have a singular or combined rating of 70 percent or more based
on one or more service-connected disabilities or a rating of total
disability based on individual unemployability and are in need of
nursing home care.
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Special Audit
In general, ODVA bears a much higher financial burden for non-service

connected veterans housed at the centers. Changes described in other
parts of this report, such as outsourcing of laboratory services and
seeking to accept Medicare/Medicaid funding, may impact the costs to
both the agency and veterans.
Central Office In response to concerns about central management travel expenditures,

Travel we reviewed travel reimbursements to central office staff and
Expenditures commissioners, as well as direct payments and purchase card payments
coded as travel in the statewide accounting system. Overall, the agency
appears to have shifted from a high level of travel by commissioners in
FY 15 to more agency employee travel activity and less commissioner
activity in FY 16 and 17. Certain staff and commissioners attend one to
two conferences per year; while these conferences involve out of state
travel and airfare, they are hosted by national organizations and offer
relevant training opportunities, and in our experience, this volume of
travel is not unusual for an agency this size. Overall travel cost fell
markedly during the audit period.
FY 2015 FY 2016 FY 2017

$ 71,402 $ 39,447 $ 31,185
Total expenditures in departments 1100001 and 1100002 (Central Office and

Commission), account codes beginning with 521 and 522 (travel)
Source: Statewide Accounting System expenditure records
It should be noted that ODVA does have vehicles, and agency vehicle use
would not be reflected in the above figures. They are also based on
department and account code classifications assigned by central finance
staff; controls over the accuracy of these classifications were not
examined as part of our procedures. Training costs are included in
account codes beginning with 522 and often incorporated with travel
claims.
Statutory We received questions as to whether the agency had AG permission or an

Exemption exemption from statutory requirements in order to hire its own attorneys.
Allows ODVA 74 O.S. § 18c exempts ODVA from the statutory prohibition against
to Hire Attorney agencies hiring or appointing attorneys. This exemption became effective
April 11, 2016 and is currently in place through January 1, 2022. ODVA
hired an attorney on May 16, 2016, as permitted by this statute.
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Special Audit
Contracts with We were made aware of concerns related to contracts between the agency
Arts Council and and the Oklahoma Arts Council for an art education pilot project, as well
Related Issues as the motivation behind these contracts and the methods of payment
used. ODVA has signed two contracts for services from the Arts Council
in recent years: one at the Norman Center in 2015 for $9,400, and one at
the Lawton center in 2017 for $10,000. The Norman payment was made
from the Veterans’ Benefit Fund, a portion of resident trust funds and
donations designated for expenditures that benefit the residents, as
justified by the art classes provided under the contract being for the
residents. The Lawton center, however, made arguments against this
funding source and payment was made using appropriated dollars from
their operating budget, as directed by the central office.
While we had heard allegations that a member of the Arts Council was
somehow connected to a member of ODVA management at the time of
these agreements, the director of the Arts Council stated that she
personally contacted ODVA of her own volition and presented the pilot
project. Both the Lawton and Norman Arts Council agreements were
signed by the ODVA director. The center administrators reportedly had
no prior knowledge or input into the agreements, and did not necessarily
approve of the projects.
We noted some irregularities with the Lawton payment: the contract was
signed and the original invoice received before any authorizing
paperwork (such as the Departmental Purchase Request required in
advance for all purchases by ODVA SOP 330.2) was prepared. The
business manager had concerns with this timeline as well as other aspects
of the project; these concerns were provided to us in memo form and
documented in emails to the central office and administrator at the time
of the payment. However, in the business manager’s understanding she
was instructed by central office personnel to pay the invoice in spite of
her concerns about noncompliance with purchasing rules. These emails
also documented concerns by the administrator that the Arts Council’s
services could be provided by volunteers and that she was unsure what
the center was paying for. We reviewed documentation showing that the
original invoice was dated April 28, 2017, a requisition signed by the
administrator on May 17, 2017, and the same invoice then revised with a
date of May 18, 2017.
Both contracts also included a requirement that full payment be received
within 30 days of the agreement being signed. The Norman Agreement
was signed on December 29, 2015, and payment was made on March 1,
2016. The Lawton Agreement was signed March 24, 2017, and was paid
May 18, 2017. Both payments exceeded the 30-day deadline.
We considered whether these contracts were reasonable given the
agency’s mission to provide “the Veterans residing in the state of
Oklahoma the highest quality support and care available anywhere in the
Nation.” The written agreements do appear to outline services that could
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Special Audit
be beneficial to the veterans in terms of learning and engagement

opportunities in creative writing, visual arts, and music. Multiple staff
members with firsthand knowledge of what services were provided to
the veterans expressed the view that the cost was not reasonable and the
services could have been provided by volunteers free of cost. In addition,
the Lawton agreement included the results of a resident survey that had
been conducted. We noted that veterans did not express a high level of
interest in the Arts Council Program. There were 75 veterans that
responded to the survey and 46 of those expressed an interest in arts
instruction. With an average of 196 residents at the center in 2017, this is
less than a quarter of residents. Even fewer expressed interest in the
classes that were eventually offered. No similar survey data was included
in the Norman contract.
We reviewed ODVA expenditures in the state-wide accounting system
for payments or transfers to other state agencies and did not note
anything of concern. However, records of payments from the veterans’
trust funds and benefit funds often do not record the specific vendor or
payment recipient, instead listing general vendor names “Oklahoma
Department of Veterans of Affairs” or “Refund Vendor,” making analysis
of such records extremely difficult. The risk related to these funds is
compounded by the fact that the centers write their own vouchers and
make cash disbursements from the funds, and by the recent removal of
business managers from the veterans’ centers, resulting in reduced
accounting staff size, and likely impacts of such a change on the
segregation of financial duties in these locations. We have therefore
included a recommendation at the end of this report that further
examination of these funds occur in the future.
ODVA We were asked to research employee bonus programs in place at ODVA.

Employee Bonus Several bonus programs have been in place at ODVA over varying
Programs timelines:
• Prior to the audit period, the agency began the Peer Review
Performance Recognition Program, which paid $500 annually to
primary peer review team members and $250 annually to
secondary members. Peer reviews are no longer performed and
according to management, this program ended in January 2015.
• Under a pay for performance program corresponding with state
merit rules (Merit Rule 530:10-7-27) and approved by OMES
Human Capital Management, ODVA paid bonuses through a Pay
for Performance Program in May 2013 and April 2014. The plan
was to provide a performance-based adjustment not to exceed 5%
for “Meets Standards” and not to exceed 10% for “Exceeds
Standards” performance. Per central office staff, funding was
available for this program as the result of a payroll lapse in the
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Special Audit
benefits budget, attributable to high volume turnover and the

related replacement of some staff with temporary employees.
• In February 2017, in accordance with state merit rule 260:25-7-24,
Skill-based pay adjustments, ODVA developed a Registered Nurse
Clinical/Leadership skill-based pay incentive program. According
to central office personnel, this is a 30.5 hour continuing education
program offered through the agency’s educational department
and Healthcare Academy, focusing on teamwork, communication,
leadership, and geriatric clinical skills. Each year the units change
and the lump sum payment can progress by $500 as the employee
maintains certification and continues with the approved courses,
with an accumulative maximum of $3,000 annually.
• In March 2017, ODVA developed a Certified Medication Aide
skill-based pay incentive program, again in accordance with
related merit rules and with 74 OS 840-2.17 governing raises. Per
central office personnel, this program provides Certified
Medication Aides (Patient Care Assistants III) with a differential
above the employee’s base pay of 3.5% for enrollment into the
Advanced Certified Medication Aide (ACMA) certification
program and a 6.5% increase upon completion of the ACMA
program, full-time on medication cart, 5.5 hours in the
Clinical/Leadership Program, and certification in CPR.
Medicare/ We were initially asked to consider the requirements and potential

Medicaid benefits or downsides of upgrading the ODVA receipting system to
Funding: accept Medicaid and Medicare funds. ODVA is already in the process of
Software and implementing a new software system across the veterans centers, called
Other Issues PointClickCare. According to our interviews with staff with private
industry experience, this is a common software option for long term care.
Opinions of PointClickCare’s functionality and ease of use were mixed
among the staff we spoke with and there were concerns about its
implementation and compatibility; see earlier discussion page 12.
ODVA does not currently have the authority to accept Medicaid or
Medicare as revenue, but is seeking legislative authority to obtain dual
Medicare and Medicaid certification. According to management,
“Members of the Veterans and Military Affairs Committee have
requested information and have been briefed regarding the additional
resources and services that would be made available to the State Veterans
Home (SVH) residents and the Veterans Centers operations through
Medicare and Medicaid funded programs.” Legislation granting this
authority is actively being considered as of the writing of this report.
In general, accepting these funding sources would require the centers to
provide an increased level of skilled nursing care, subject them to various
rules and inspections in order to maintain certification with the Centers
57
Special Audit
for Medicare and Medicaid Services (CMS), increase their bureaucratic

workload, and expose them to related fines.
A 2016 article from the State of Michigan 12 detailed the steps that state
was taking in order to pursue federal CMS certification by FY 2018.
Michigan’s governor suggested the move was critical to the long-term
financial stability of the state’s veterans’ homes and would align its
quality of care with best practices in the veteran health care field. The
article states that to those ends, the governor’s 2017 budget included $8
million to fund the certification process, including a supplemental to the
state’s 2016 budget of $1.9 million, to create a Medicaid pilot program.
The program included a Medicaid consultant to provide guidance to the
homes on the certification process, and additional nursing staff to
accommodate CMS specifications. The other $6.1 million was for
construction and infrastructure improvements also mentioned as
necessary for the goal of CMS certification at both centers in FY 2018. The
state had also already made some improvements toward this end,
including implementation of electronic medical records, construction of
family rooms and living rooms for visitors at the centers, and surveillance
and security improvements.
This information suggests that seeking CMS certification is likely a
lengthy and expensive process. While Michigan has only two veterans’
homes to bring into compliance with CMS requirements, Oklahoma has
seven, several of which are in aged buildings that are, as suggested by
other procedures in this audit and the agency’s statements in the media,
in need of varying degrees of maintenance and repair. It appears
Michigan prepared and budgeted far in advance of its goal year for
achieving certification. While ODVA is still in the process of seeking
legislative authorization, it would benefit the agency to do as much
financial analysis and advance preparation as possible now, to help
accommodate this lengthy process. This analysis should include
consideration of necessary infrastructure improvements as well as
staffing – not only to meet care requirements, but administrative
requirements. While ODVA recently decreased the salaries of MDS
coordinators (see discussion on the next page) and reduced fire and safety
staff across the centers, the volume and importance of each of their duties
may now increase.
It should be noted that during our procedures, ODVA management
issued a response to public allegations that included a discussion of
Medicare/Medicaid funding. It shows their understanding of the
complicated issues at play:
12
Michigan Veterans Affairs Agency, “State veterans homes pursuing Medicare, Medicaid certification,” February
10, 2016. https://www.michiganveterans.com/a/State-veterans-homes-pursuing-Medicare-Medicaid-certification
58
Special Audit
MDS MDS 13 coordinators are responsible for continuously monitoring,

Coordinators evaluating, and managing care given to residents. The coordinators are
responsible for assessing and evaluating the quality of emotional, mental,
and physical care being given to long-term care residents and develop
care plans with long-term and short-term goals for improvement. They
coordinate with specialists, caretakers and families. As one center
administrator put it, MDS coordinators “are an intricate piece of the
puzzle when it comes to the veteran’s plan of care and vitally important
during an inspection process.”
It appears the centers are able to meet their MDS requirements with the
current staffing level, but this level is considered minimal by most center
administrators. HR records from the statewide accounting system reflect
that during the audit period, each center had one MDS coordinator
employed, and Board of Nursing data available online confirms that each
of these individuals is an actively licensed RN. However, some
administrators noted that it would be acceptable to function with only
LPNs as MDS staff, with an RN signing off on care plans and transmitting
MDS batches to the USDVA as required by regulations. The Claremore
center administrator reported functioning effectively in this manner.
Several administrators emphasized that MDS duties are vital to resident
care and the nursing staff experiences frustration with the current staffing
levels, for example when the only RN assigned to MDS duties is out on
leave. Most MDS coordinators received a salary decrease of over $5,000
13
Minimum Data Set (MDS) is a tool for assessing the residents’ capabilities in certified nursing facilities. MDS
coordinators, or nurse assessment coordinators, use these results in creating resident’s individual care plans, and are
responsible for transmitting MDS data. The federal regulations regarding resident assessment are set forth in 42 CFR
483.20.
59
Special Audit
annually in summer 2016. This resulted in some MDS coordinators

quitting, or taking on additional duties in order to avoid the cut. This pay
cut was directed by central office and resulted in this position now
earning approximately $53,000 per year.
According to information regarding the MDS coordinator profession on
PayScale.com, MDS coordinators earned $45,257 - $82,041 annually as of
January 2016, with a median salary around $61,000. We found examples
of MDS nurse job opportunities in Oklahoma showing salary estimates of
$45,000 to $65,000 and $48,000 to $78,000. It appears ODVA is
compensating its MDS coordinators at a below-average level nationally
and statewide. However, they do not appear to be at the bottom of the
pay range, and do receive a State of Oklahoma benefits package. Multiple
administrators also expressed that this salary cut resulted in the loss of
quality employees and they believe the salary should be increased again.
Our discussions with administrators with experience in private nursing
homes where Medicare or Medicaid was accepted suggested that MDS
coordinators’ work would increase with the introduction of these revenue
streams. This is supported by our research, which suggests that the
additional requirements and inspections inherent in CMS certification
would be accompanied by additional administrative responsibilities and
that data collection and care planning would fall to MDS personnel.
As MDS staffing is already at a minimal level according to the
administrators, staffing in this area will most likely need to be increased
when additional Medicare/Medicaid requirements are introduced, and
may need to be increased as the agency goes through the process of
seeking CMS certification. This may require the agency to restore the
MDS coordinators’ salary level or face difficulties hiring and retaining
qualified nurses to handle these responsibilities.
Administrative We received inquiries about the level of administrative overhead

Overhead spending at ODVA. To efficiently isolate central administrative costs for
these procedures, we consulted budget reports from the statewide
accounting system and included the following departments: Central
administration; Central administration IT; Central office IT (added in
fiscal year 2017); ODVA commission (added in fiscal year 2017). As a
result, the data is totaled by budget year associated with the
expenditures, which does not necessarily reflect actual spending within
each fiscal year.
FY 2015 FY 2016 FY 2017
$ 5,816,508.30 $ 6,141,548.88 $ 5,960,562.19
Total central administrative expenditures by budget year,
per statewide accounting records.
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Special Audit
Headquarters In late 2017, ODVA relocated its central headquarters from an aged
Move and New building west of the capitol to a newly renovated building a few miles
Building away, near the Military Department and several other state agencies.
Renovation While it was reported in the press that the headquarters move and
renovation costs exceeded $3 million, the approximate $3 million
renovation cost in the news reports was the value of the project on the
state’s Capital Improvement Plan, and was paid by OMES, not by ODVA.
ODVA has paid for other costs associated with the move, such as rent,
office furniture, moving fees, and supplemental construction costs. These
have primarily been paid using state appropriations, although a portion
of office furniture costs were paid from the ODVA revolving fund.
Construction costs included supplemental needs for the facility, such as a
flag pole and OMES IT services. According to ODVA, there was $700,000
budgeted for these purposes in FY17 and the majority of that has been
rolled into FY18, as some expenditures related to the move, for which
ODVA is responsible, are still being made.
The following table details actual ODVA expenditures for the central
office move, through December 31, 2017. Management reported
additional, pending construction expenses of $33,071 and audio-visual
costs of $107,171. Monthly rent payments of $13,028 are ongoing.
OMES- Office Moving and Commercial Total

Funding Source Rent Construction Furniture Storage Movers Expenditures
Appropriations $47,510.18 $23,361.00 $249,244.35 $1,843.44 $326.00 $322,284.97
Revolving Fund $0.00 $0.00 $95,167.04 $0.00 $0.00 $95,167.04
Grand Total $417,452.01
Specialty Diets Specialty diets (diets that limit residents regarding ingredients, calories,
and Menu solid food, or otherwise for medical reasons) have been limited at the
Standardization veterans’ centers. According to central management, this is to ensure
regulatory compliance as well as resident satisfaction. Administrators did
not report any health issues arising from the removal of specialty diets as
of our discussions in August 2017. While various diets may be prescribed
for veterans, they generally have access to alternative foods and have the
right to eat what they desire. Several administrators mentioned, and our
research supports, that it is the industry standard in long-term care to
liberalize diets, easing restrictions and allowing residents more flexibility
in choosing their foods. While our veterans centers are not typical long-
term care facilities, standards supported by CMS show that liberalized
diets can be beneficial in various realms of medical care because patients
have access to familiar foods and can increase their intake as needed,
thereby decreasing their risk of malnutrition, honoring their personal
preferences and dietary needs, and potentially improving their overall
quality of life.
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Special Audit
Management has also standardized the center menu agency-wide,

although they stated that this change was not related to the elimination of
specialty diets. If the agency’s focus in providing a more liberalized diet
is on improving the quality of life and overall nutritional intake of
residents, those factors should also be kept in mind in handling the
standardized menu. We did receive reports of resident complaints about
some of the items on the new menu, the decreased number of options,
and the fact that regional preferences had been disregarded.
Accessibility of We were asked to investigate management having allegedly instructed

EKG Machines that EKG machines 14 and crash carts be removed from the floor at the
and Crash Carts veterans’ centers. During our discussions with center administrators, no
in Centers one confirmed having been instructed to remove crash carts. According
to central management, the only directive given was to remove all drugs
from the cart that were not allowed in regulations, and the Talihina
center, under a new medical director, was the only one to voluntarily
remove the crash cart from the floor.
During our meetings with center staff, we were told that center
administrators had been instructed to remove EKG machines at their
respective centers. Center personnel reported that this was due to central
management concerns related to liability and the medical qualifications of
individuals using the EKG results. When contacted for clarification,
central management stated that the EKGs required a server update and
were potentially going to be outsourced. However, management claims
the directive to lock up the EKGs was never given; “one administrator
made a decision to lock up the EKG in Talihina while other
administrators asked for clarification and were given authorization to
continue EKGs for diagnostic purposes.”
Central management stated that after consulting with the Board of
Nursing, they concluded registered nurses are not trained to read EKG
results, and the decision was made to have only medical providers
perform the EKGs. According to center administrators, management
revoked the instruction that EKGs would no longer be available without
giving a formal reason or explanation of who would be allowed to read
the EKG results going forward.
We were provided a copy of an email sent to administrators by the
director of clinical compliance, and while it did not include a directive to
“lock up” the EKG machines, its language could lead readers to conclude
EKG machines would no longer be used:
“EKG’s will not be available as of March 1, 2017 due to being
removed from server they will not be transmitted. If EKG is
14 Electrocardiography machines, used to record the electrical activity of the heart, commonly used to record patterns
in heart activity and detect cardiac problems.
62
Special Audit
required the resident probably needs to be in a different setting

(acute).”
Further confusing matters, at least one center reported having been
granted informal permission for lab techs to read the EKG results. These
informal exceptions to written policies and requirements were reported in
several areas during our procedures, as discussed on pages 21 and 51. In
such an environment, it’s possible that administrators were individually
given varying instructions.
As of January 2018, EKG machines and crash carts are present at the
centers. The agency recently stated the following: “ODVA will provide
our physicians access to EKG equipment for the physician to personally
conduct an EKG within his/her discretion but not as a criteria for
admission.”
Outsourcing of Since late fiscal year 2016, ODVA has discontinued on-call laboratory
Laboratory services and terminated all clinical laboratory scientists at the veterans
Services centers. There are one to two laboratory technicians remaining at each
center, available Monday through Friday. Lab techs draw blood and
perform dipstick urinary analyses, rapid flu testing, and x-ray services.
They are responsible for ordering and processing specimens to send to
the reference lab, receiving and charting results, and are completing
training to perform occult blood and gastroccult testing. One lab
administrator, working from the Norman center, is now responsible for
the labs at all centers, including traveling to the centers statewide
regularly for administrative purposes, and is on call 24 hours a day.
The majority of laboratory services are now outsourced to Hospital and
Health System Executive Diagnostic Laboratory of Oklahoma, L.L.C.
(DLO). Throughout our procedures and as discussed earlier in our
discussion of Level of Care, this decrease in on-site services has been
repeatedly cited as a major concern by ODVA staff as well as outside
parties. As stated by ODVA in their response to State representative Mike
Ritze, “Veterans centers are not acute care facilities and the luxuries of a
24-hour lab service is no longer feasible due to budget cuts.” However,
the agency has not completed a cost analysis of this outsourcing decision.
While an analysis was reportedly underway throughout the duration of
our audit procedures, it had not been completed as of March 2018.
According to central office personnel, the analysis covers a variety of
information, including data on residents’ insurance status and review of
test type and frequency across agency and by center, all of which seems
like it would have been pertinent and necessary for analysis before
choosing to outsource laboratory activity. When the analysis is complete,
if it shows minimal or no cost savings, or increased burden to the
residents, management will be in a complicated situation, having already
63
Special Audit
outsourced laboratory services without this data to inform its decision

making. In addition, details of the planned analysis provided by central
office make no mention of incorporating information from medical
professionals at the centers regarding the qualitative effects of this
outsourcing on medical care.
Per federal guidelines (38 CFR, Chapter 1, Part 51, Subpart D § 51.210), if
the facility does not provide its own diagnostic services, it must have an
agreement to obtain these services. The services must meet all applicable
certification standards, statutes, and regulations. Radiologic and other
diagnostic services must be available 24 hours a day, seven days a week.
According to the ODVA Laboratory and Radiology Programs
Administrator, when testing was available in the centers the medical staff
had diagnostic test results, including notification of critical values, within
two to four hours. After outsourcing lab testing to DLO, results are not
available for 24 to 36 hours. On weekends results can take up to four
days. Critical lab results are called to the on-call medical provider 10 to 24
hours after the specimen is obtained. The inability to provide lab results
in the facility can result in the veteran being sent to the local ER for
evaluation and treatment. In this case, the lab administrator stated that
veterans who are less than 70% service connected receive bills for all ER
and ambulance services that are not covered by insurance or Medicare.
Central office personnel claimed this is not the case; however, their
contract with DLO outlines provisions for billing veterans.
We obtained a copy of the agency’s contract with DLO, effective for a
one-year term beginning June 1, 2017, signed 05/22/17 by Director Myles
Deering. In summary, it outlines that DLO will bill the resident for any
services not covered by ODVA, USDVA, or insurance. Under the
contract, it is ODVA’s responsibility to provide adequate information to
facilitate that billing.
64
Special Audit
Details from ODVA-DLO contract effective June 1, 2017

The contract also states that it’s the facility’s responsibility to ensure all
tests ordered, including standing orders, meet federal and state
requirements, are medically necessary, and don’t exceed frequency
limitations.
Several other concerns related to laboratory outsourcing and related
financial issues were brought to our attention:
• According to one administrator, since outsourcing laboratory
services, medical providers have begun simply sending out
veterans to the local hospital, with USDVA approval. They
claimed that while ODVA is no longer bearing the burden of the
lab cost, the federal VA is bearing that burden as centers must
seek approval to send a veteran out for acute services.
• We received the related concern that veterans are being sent to the
hospital for testing because sending urgent lab work directly to
the hospital costs ODVA money.
• We received conflicting information as to whether and how DLO
is billing veterans directly, but the DLO contract clearly provides
for billing veterans.
• There are also concerns that while ODVA plans to cover the cost
of lab work for veterans without Medicare coverage, those
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Special Audit
veterans who have Medicare coverage for 80% of their costs are
being left to cover the other 20% themselves.
Cancelled We received concerns about ODVA capital projects that had been
Capital Projects cancelled despite costs already invested. We were able to compile
information related to the following projects:
Lawton Roofing Project
We determined through discussions with OMES staff and review of
related contracts, correspondence, and other supporting documentation
that this project involving replacement of the Lawton Veterans Center
roof was originally handled via the OMES Roofing Program (RAMP).
ODVA received a roof replacement proposal for a standing seam metal
roof, under the heightened standards and guarantees inherent in this
specific program. The proposal price was $3,229,369.50. After ODVA
accepted the proposal and the contractor had begun work, ODVA
leadership cancelled the project. An email from ODVA’s construction
programs administrator to OMES staff stated, “I was just directed to stop
this project. Our Deputy Director wants to have the project publicly bid.”
The project was now split into two pieces. One included the roof, with
metal roof and shingle roof options, and the other included
waterproofing the exterior walls, replacing doors and some windows,
and making the site more conducive to moving rainwater away from the
building. The winning bid was won by the original contractor, Clayco
Industries.
The roof project bid totaled $2,354,918.00, and the second project bid
totaled $1,345,000, plus OMES CAP fees on each project, for a total newly
bid cost of $3,728,265.73.
Talihina HVAC, Boiler, and Nurse Call Systems
The cancellation of projects at the Talihina center are discussed
previously in this report beginning on page 38.
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Special Audit
RECOMMENDATIONS
The following recommendations stem from our discussions throughout

this report:
1. The Commission should recognize the risks associated with a
negative control environment and work towards evaluating and
addressing the condition to ensure the mission of the agency is
accomplished in the most efficient and positive manner possible.
In addition, they should be cognizant of the risk associated with
ineffective communication within the agency and work to
eliminate any such barriers. The Commission should also
recognize its authority and responsibility in appointing the
director, as outlined in 72 O.S. § 63.3.
2. We further recommend that management establish a system of
clear communication that relays information from the bottom of
the organization to the top and vice versa. The tone at the top
regarding internal controls will greatly impact the success of the
agency’s internal control framework.
3. The Commission should seek an independent evaluation of cost
effectiveness and impacts to services prior to relocating any
veterans center.
4. Management should ensure policies and procedures are
standardized or customized to the extent that best ensures the
agency meets its mission and complies with appropriate
requirements. Relevant procedures should be developed and
reviewed prior to making significant operational changes, and
adequate time should be allowed for affected parties to
reviewnew policies and procedures. Adequate training should be
provided to ensure compliance with such policies and procedures.
5. Management should ensure appropriate cost-benefit analyses are
performed prior to outsourcing key services or making other
significant operational changes.
6. Management should pursue an independent examination of
current financial controls and other significant operational areas,
as outlined in the next section.
We also recommend further study of the following topics in the future:

• Thorough examination of expenditures from and controls related
to Trust Funds. In light of the recordkeeping limitations in the
resident trust funds, and in light of the agency’s recent
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Special Audit
dismantling of center business offices and move to consolidate

financial controls in the central office, we believe a more in-depth
examination of these 700 funds is warranted.
o Relatedly, we received allegations that reconciliations were
off on Norman trust funds and any reconciling items may
be concealed as the center is transitioned from its Billing &
Banking system to the financial module of PointClickCare.
• Reassessment of all significant financial internal controls, at
centers and central office, given complete reorganization of
financial staff and processes. Information that has come to light
during our procedures in this engagement certainly indicates that
controls relied upon during past audits are no longer in place.
• Review of medical staff to resident ratios. This was requested in
the context of follow-up procedures but no such procedures were
included in our past reports. Such an analysis may be informative
but with staffing levels already cut, does not bear the time and
effort involved at this point.
• Review of effectiveness of Galt in hiring medical staff for centers.
This may include examination of the situation discussed on page 9
in which Galt employees were offered an option to convert to state
employees after one year, which was subsequently revoked.
In addition, the Attorney General’s Office may wish to follow up on these

allegations that were repeatedly brought to our attention:
• The standardized nursing policies discussed beginning on page 51
may have been unlicensed, resulting in legal threats from the
owner of those policies and subsequent payment to that owner.
Our procedures led us to limited evidence of what central finance
staff reported was a payment for such licensing; however, the size
and timing of that payment did not line up with the allegations,
and detailed documentation was not provided. One employee
alleged the payment had been “covered up.” Further follow-up
could be performed.
• As discussed briefly on page 15, we heard many concerns about
whether the reduction in force or other forms of
terminations/buy-outs of center business managers were
compliant with applicable laws and regulations. The survey
responses also included general questions about the
appropriateness of the agency’s hiring and firing practices,
especially failure to post available positions before they were
filled.
68
OFFICE OF THE STATE AUDITOR & INSPECTOR
2300 N. LINCOLN BOULEVARD, ROOM 100
OKLAHOMA CITY, OK 73105-4896
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SPECIAL AUDIT

Special Audit Report

For the Period

TO THE HONORABLE MIKE HUNTER, OKLAHOMA ATTORNEY GENERAL

GARY A. JONES, CPA, CFE

Executive Summary .......................................................................................................... i

Background of This Engagement................................................................................... 1

Control Environment & Tone at the Top

Level of Care .................................................................................................................. 24

Talihina Veterans Center

Results of Procedures and Employee Surveys

Oklahoma State Department of Veterans Affairs

This As a result of concerns about the Oklahoma Department of Veterans

For general procedures, we focused on the period of July 1, 2014 through

ODVA The Oklahoma Department of Veterans Affairs was created by the

Commission members as of June 2018 are:

CONTROL ENVIRONMENT & TONE AT THE TOP

The concerns and perspectives expressed most frequently in survey

o “Our central office is a ‘Toxic leadership’ installing fear in

• “Morale and unity suffer as a result of poor leadership and lack of

Staffing, Employees responding to our survey voiced numerous concerns specific

well as the Galt hiring process, and Galt employees’ segregation

opinions and possible misinformation attached, or learn about agency

Internal communications have continued to deteriorate over recent

disagree with the statement, “The interaction between management and

In a later response to this email, the deputy director informed one

Again, it is clear that central leadership is aware of the control

truly involved at the veterans centers. Management has even reportedly

such sweeping changes to take place during an investigation or audit.

changes underway at the agency, such as outsourcing services. Regarding

Favoritism, Bias, and Other Issues with Central Office Staff

standards also emphasize that “management should demonstrate a

expansion and centralization of certain functions, but also explains why

standardized menu (substituting items), and allowing lab techs to

would clearly hinder the flow of information to the commissioners

available online at https://www.sai.ok.gov/Search%20Reports/database/ODVAWebFinal.pdf.

Disfunction in the ODVA control environment is clearly damaging staff

medical provider 10 to 24 hours after the specimen is obtained.

center-specific procedures; and of course the overall impact of

• Individuals shall strive, in all matters relating to their professional

Mission: In partnership with the Secretary of Veterans Affairs, the

Additional characteristics of ODVA style and services driven by the

• All employees are sensitive to residents and their families

Explanation: It is the vision of the Oklahoma Department of Veterans

An alternate vision is presented in a document provided to us by the

TALIHINA VETERANS CENTER

In response to the volume of questions and concerns brought forward

Background and Events in Talihina

The Oklahoma Department of Veterans Affairs is

The Oklahoma Department of Veterans Affairs is

The bill failed to pass in the Appropriations and Budget Health

The administrator then called a meeting with the department heads

This email was subsequently released to the press, which prompted

The administrator responded with the following on June 12:

It has been represented by management at certain times that low staffing

We summarized the hires and terminations at the agency by location for

FY 15 261 104 116 306 96 133 193 3 8 1220

Throughout our interviews, administrators and staff at every facility

A. The Oklahoma Department of Veterans Affairs is