be responsible to the Chief Medical Director for the operation of their respective Services.

(8) Such directors of hospitals, domiciliary facilities, medical centers, and outpatient facilities as may be appointed by the Administrator upon the recommendation of the Chief Medical Director.

(9) Such other personnel as may be authorized by this chapter.

84103A. Office of Medical Inspector General

(a) There is established in the Office of the Chief Medical Director an Office of Medical Inspector General.

(b) The Office of the Medical Inspector General shall consist of the following:

(1) The Medical Inspector General who (A) shall be the head of the Office of Medical Inspector General, (B) shall be directly responsible to the Chief Medical Director for such functions as may be assigned to the Medical Inspector General in regulations prescribed by the Chief Medical Director consistent with the provisions of this section, and (C) shall be a qualified doctor of medicine appointed by the Administrator upon recommendation of the Chief Medical Director.

(2) Not less than five Assistant Medical Inspectors General who shall be qualified doctors of medicine, doctors of dental surgery or dental medicine, or registered nurses and who shall be employed on a full-time basis in the Veterans' Administration.

(3) Not less than two registered nurses (including any who are Assistant Medical Inspectors General) who are employed on a full-time basis in the Veterans' Administration.

(4) Not less than one qualified doctor of dental surgery or dental medicine (who may be an Assistant Medical Inspector General) who is employed on a full-time basis in the Veterans' Administration.

(5) Not less than five support personnel, who are employed on a full-time basis in the Veterans' Administration.

(c) The Medical Inspector General shall be appointed for a term of 4 years, with reappointment permissible for successive like periods. The Medical Inspector General shall be subject to removal by the Administrator only for reasonable cause upon the recommendation of the Chief Medical Director.

(d)(1) The Medical Inspector General shall monitor, review, and investigate any adverse incident which is experienced by a patient during the course of the patient's care in a Veterans' Administration health-care facility, including any incident that would not normally be considered a natural consequence of the patient's disease process or illness and any incident that would carry a recognized need for medical intervention.

(2) The Medical Inspector General shall also conduct such reviews and investigations as the Medical Inspector General considers necessary to identify problems in the provision of health care to veterans and, when problems are detected, shall propose to the Chief Medical

Director such corrective measures as the Medical Inspector General considers necessary or appropriate.

(3) The Medical Inspector General shall conduct such other studies, reviews, and investigations relating to the quality of health care provided to veterans as the Administrator or the Chief Medical Director may assign to the Medical Inspector General.

(4) Subject to paragraph (3) of this subsection, the Medical Inspector General shall have sole discretion in determining whether to investigate any incident involving patient care or to study or review any problem in the provision of health care to veterans.

(e) In conducting an investigation of any incident involving the care of a patient or any study or review of any problem in the provision of health care to veterans, the Medical Inspector General shall assign to the investigation, study, or review at least one health-care professional from the Office of the Medical Inspector General.

(f) The Medical Inspector General shall submit to the Administrator, the Chief Medical Director, and the Committees on Veterans' Affairs of the Senate and the House of Representatives a report not later than February 1 of each year, on the activities of the Office of the Medical Inspector General under this section during the preceding fiscal year. The Medical Inspector General shall include in each such report

(1) a description of significant problems, abuses, and deficiencies relating to the administration of programs and operations of the Department of Medicine and Surgery disclosed by such activities during the preceding fiscal year;

(2) a description of (A) the recommendations for corrective action and of any recommendations for disciplinary action made by the Office during the preceding fiscal year with respect to significant problems, abuses, or deficiencies identified pursuant to clause (1) of this subsection, and (B) the action taken as of the end of such fiscal year on each such recommendation, including any such recommendations on which action had not been completed prior to the end of such fiscal year;

(3) a specification of (A) which activities of the Office were carried out pursuant to an assignment by the Administrator or the Chief Medical Director, and (B) which activities of the Office were carried out on the initiative of the Medical Inspector General;

(4) an identification of each significant recommendation for corrective or disciplinary action described in the report or in previous annual reports under this subsection on which action has not been completed;

(5) a summary of any matters referred to prosecutorial authorities and the prosecutions and convictions which have resulted; and

(6) a summary of each incident in which information or assistance requested by the Medical Inspector General from the Department of Medicine and Surgery during the preceding fiscal year has been, in the judgment of the Medical Inspector General, unreasonably refused or not provided.

(g) The Medical Inspector General shall be an ex officio, nonvoting member of all policymaking bodies within the central office of the Department of Medicine and Surgery that are concerned with

the quality of health care provided in Veterans' Administration facilities or that are concerned with quality assurance in the provision of such care. The Medical Inspector General shall not, however, have any direct responsibility for quality assurance activities, including patient risk management and the reporting of patient injuries under quality assurance procedures.

(h)(1) The Administrator shall transfer to the Office of the Medical Inspector General each fiscal year, out of any funds available to the Veterans' Administration for such fiscal year (other than funds available for the operation of the central office of the Department of Medicine and Surgery), such amounts as may be necessary, as determined by the Chief Medical Director, to support five full-time medical doctors and five full-time support personnel in the Office of the Medical Inspector General.

(2) The positions of five full-time medical doctors and five fulltime support personnel in the Office of Medical Inspector General shall be counted against the number of full-time employees authorized by the Office of Management and Budget for the program, function, or activity for which the funds transferred pursuant to paragraph (1) of this subsection would be available except for the transfer of such funds. In the event that the Administrator transfers funds from more than one program, function, or activity, the ten full-time positions shall be counted against the number of such positions authorized by the Office of Management and Budget for each such program, function, or activity in proportion to the amount of funds transferred therefrom.

*

SUBCHAPTER V-QUALITY ASSURANCE

§ 4151. Quality assurance program

(a)

(e)(1)

(2) The Inspector General of the Veterans' Administration shall allocate sufficient resources (including sufficient personnel with the necessary skills and qualifications) to the Assistant Inspector General for Health Care Quality Assurance Review to enable the Inspector General to monitor the quality-assurance program.

(f) The Chief Medical Director shall take such action as may be necessary to ensure that all personnel of the Department of Medicine and Surgery

(1) are given an explanation periodically of their responsibilities for the quality assurance activities of such department; and

(2) are advised that any failure to comply with quality assurance procedures prescribed in regulations or in procedural publications issued by the Department of Medicine and Surgery, in

cluding any failure to report any incident as required under such procedures, will result in appropriate disciplinary action.

VETERANS' HEALTH CARE AMENDMENTS OF 1983

(Public Law 98-160, November 21, 1983)

TITLE I-VETERANS' ADMINISTRATION HEALTH-CARE PROGRAMS

STUDY OF POST-TRAUMATIC STRESS DISORDER AND OTHER POST-WAR PSYCHOLOGICAL PROBLEMS

SEC. 102. (a)(1)

(b) Not later than October 1, [1986,] 1987, the Administrator shall submit to the Committees on Veterans' Affairs of the Senate and House of Representatives a report on the results of the study required by subsection (a). Such report shall contain

(1) a description of the results of the study;

(2) information regarding the capability of the Veterans' Administration to provide treatment to the number of veterans estimated in such study to be suffering from post-war psychological problems;

(3) descriptions of the policies and procedures of the Veterans' Administration with respect to providing disability compensation for post-war psychological problems;

(4) a description of the activities of the Administrator in attempting to coordinate Veterans' Administration health-care and compensation programs with respect to post-traumatic stress disorder; and

(5) such recommendations for administrative and legislative action as the Administrator considers appropriate in light of the results of the study.

MINORITY VIEWS OR MESSRS. MURKOWSKI, SIMPSON, THURMOND, AND STAFFORD ON TITLE III OF S. 1464, THE PROPOSED "VETERANS' ADMINISTRATION BENEFICIARY TRAVEL, QUALITY ASSURANCE, AND READJUSTMENT COUNSELING AMENDMENTS OF 1987"

S. 1464, as reported by the Committee, contains important provisions relating to veterans' travel to and from VA medical facilities and the oversight of VA quality assurance programs. We consider these provisions-which address access to care and quality of care to be inextricably linked to the VA health-care system. These provisions respond to these issues in a thoughtful and responsible manner.

However, we cannot support the provisions contained in title III of S. 1464 relating to the Vet Center Program. Our objections are strong and premised on both procedural and substantive grounds. Although we fully understand the motivation for incorporating these provisions in S. 1464, we do not believe that the legislative process or veterans are well-served by this action.

A program of readjustment conseling for Vietnam-ear veterans— which came to be know as the "Vet Center Program"-was established in 1979. It was established at a time when it was believed that, due to the nature of the Vietnam War, Vietnam veterans were alienated and would be reluctant to seek services through traditional VA health-care facilities. Thus, a program of readjustment counseling-of a limited duration-was established to provide services through community "store-front" counseling centers which sought to minimize the red tape associated with seeking such services. In reaching a determination on an appropriate timetable for this program, the Committee sought the advice of VA psychiatrists and other mental-health professionals. These experts indicated that veterans with problems associated with combat might not avail themselves of counseling for up to two years following that experience. Accordingly, veterans who requested counseling two years after discharge of release from military service were eligible for counseling under this program.

The Vet Center Program was also intended to be temporary because it established new eligibility for certain veterans and nonveterans to receive certain health-care services-provided directly by the VA or by contract, if necessary-on an outpatient basis. As an adjunct to treatment for veterans, eligibility was extended to family members, and referral services were authorized to be provided to those not eligible, such as veterans discharged on other than honorable conditions. Extending eligibility to these categories was believed by some to be important to the total readjustment counseling process. However, the Committee fully recognized that veterans of all wars, including Vietnam, who may have served honorably in combat and been in need for medical treatment were not