The Veterans Affairs Department has a big real estate footprint. So it has a big environmental impact. Since 2022, it’s also had a Sustainability Plan, something the White House ordered all agencies to have. A review by the Inspector General finds, Veterans Affairs still has some work to do. To discuss more, Jennifer Baptiste, deputy assistant inspector general for healthcare inspections, joined  the Federal Drive with Tom Temin.

Interview transcript: 

Tom Temin Ms. Baptiste, good to have you with us.

Jennifer Baptiste Thank you very much.

Tom Temin And what were you exactly looking for in this examination? Because I can imagine the Veterans Affairs environmental kind of strategy has a lot of legs to it.

Jennifer Baptiste You’re correct. And as you pointed out, the VA is a large health care system. Health care in the United States apparently contributes to about 10% of greenhouse gases. And health care facilities generate a lot of trash and also other substances that may contribute to greenhouse gases. And so we wanted to take a look at how VA is doing in implementing their sustainability plan and see what progress they’ve made and what progress they need to make in the future.

Tom Temin What are the major elements of their plan and how did you find them working against them?

Jennifer Baptiste Yeah. So VA issued this sustainability plan in 2022 and we focused on VHA, Veterans Health Administration’s, implementation of these priority actions. And the plan includes a number of priorities, including carbon pollution free electricity, a zero emission vehicle fleet, achieving net zero emissions buildings to reduce waste and pollution and pursue sustainable procurement, and furthermore, to educate their workforce to be climate and sustainability focused. And lastly, to incorporate environmental justice and accelerate progress through partnerships.

Tom Temin Yeah, some of those things are pretty concrete, some of them a little bit vague. But I guess I’d like to concentrate on some of the concrete things, especially the medical waste. And we all know how much trash is generated in the course of ordinary health care. Was that part of the plan is to try to see if they could reduce that?

Jennifer Baptiste Yeah. So part of our review looked at how VA is doing with medical waste. VA uses, as do other health care systems, a lot of single use medical devices. And while VA does track their waste and is making efforts to reduce and reuse and recycle, we found that there is some improvement they could make in potentially reusing or reducing the use of single use devices.

Tom Temin Right. So I guess they won’t go back to syringes that you put in an autoclave. Remember, they used to change the needle and use the syringe over again, but maybe some larger devices and some things that could be cleaned and reused. I mean, those still exist.

Jennifer Baptiste Correct. And, you know, there are a number of devices that VA already does reuse. And those devices have to be, of course, cleaned and sterilized appropriately, according to manufacturer’s guidance and FDA approved processes. We did find that there are other health care systems in the United States that reuse or repurpose items that manufacturers might designate as single use, but really these might be items that could be safely reused. And the most something VA will have to look at and certainly prioritize patient safety along the way.

Tom Temin Yeah, I always rinse out my cups from 7-Eleven. They’re so heavy you can use them for a few cups of coffee even after work. I hate throwing them out. And something in particular was, and this is really peculiar to a health care system, and that is the use of inhalable anesthetics. And that sounds like there’s emissions related to those. Talk about that issue and what they’re doing.

Jennifer Baptiste Yeah, this is a really interesting area that our team looked at. So inhalational anesthetics contribute to about 5% of a hospital’s greenhouse gas emissions. And there are different types of inhalational anesthetics. Two of these, the inhalational anesthetic gas fluorine and the compressed gas nitric oxide have the most adverse greenhouse gas effects. And there are other safe options for anesthesia. So one doesn’t have to use these two. These other options are just as effective and don’t impact the safety of patients. So this is an area that not just VA, but health care in general in the United States can target as a way to reduce greenhouse gas emissions.

Tom Temin We’re speaking with Jennifer Baptiste. She is deputy assistant inspector general for health care inspections at the VA. And the other consumable type of thing that is peculiar to hospitals, I guess, in health care settings is the use of ethylene oxide for sterilizing things.

Jennifer Baptiste Correct. So, you know, reusable medical. Equipment. Think of items that are used during surgery need to be sterilized, and ethylene oxide has been used for this sterile processing procedure. But it’s carcinogenic, it’s hazardous to reproductive health and can impact a number of our body’s systems. And so reducing the use of ethylene oxide and using safer options is a priority. And we learned that as of January 2024, VA reportedly eliminated the use of ethylene oxide in their health care operations.

Tom Temin Yes. So they are making progress with respect to reuse and reducing some of these inhalants and I guess volatile substances, you could call them. And just briefly about the facilities, tens of thousands of windows, thousands of HVAC systems, doorways, is VA able to make progress on tightening all that up? And I mean, there’s 100 and what, 45 major medical centers and all these other places. What’s going on there?

Jennifer Baptiste Yeah, that’s a great question. And you know, our review focused on the health care delivery aspects of the VA sustainability plan. You point out an area that maybe something we could look at in the future in terms of how VA is doing to improve those facilities. Interestingly, you know, the VA, OIG, we have different groups. Our health care inspections group looks at one aspect of VA oversight. But we we also have auditors and and other groups who might look at that area.

Tom Temin So you’re not the air conditioning lady, you might say, when it comes to sustainability. Got it.

Jennifer Baptiste Well, actually, no.

Tom Temin But you did have a number of recommendations. Maybe just run through those briefly. And one was to the office of the secretary itself.

Jennifer Baptiste Correct. So we made five recommendations. One was directed to the secretary of the VA and the other four were to the undersecretary for health. And the recommendation to the secretary was to incorporate environmental stewardship values into the goals of their climate and sustainability focused federal workforce training. And what that means is, you know, we found that VA had made progress and was working to educate and engage their workforce in climate and environmental sustainability actions, but had not incorporated the environmental stewardship values. That really means educating staff on their local impact, their individual impact to the environment. And so VA concurred with that recommendation and plans to incorporate some of that.

Tom Temin And the other recommendations were to the VA itself there. And we’ve talked about the some of the inhalants and some of the the volatile substances and single use. Anything else that you recommended that should be brought to their attention?

Jennifer Baptiste Sure. So we found that VA has the GEMA program. It stands for Green Environmental Management System. And at every level of VA, they have program managers. This was established before the VA sustainability program, but those individuals may not have the time to really pursue those VA sustainable sustainability actions. And so we found that VA should look at the responsibilities of those program managers and further define those responsibilities and figure out how they might have time to address the concerns in the VA sustainability plan.

Tom Temin And it sounds like the VA and VA leadership. VHA leadership mostly accepted the they’re still all open, but they didn’t object to any of them.

Jennifer Baptiste Correct. VA concurred with all of our recommendations, and they all of the recommendations are still open. That’s pretty typical at the time our reports are published. And we do have a follow up process where there’s some communication back and forth so we can see what type of progress they’ve made and the action plans that they’ve developed.

Tom Temin And by the way, you are a physician yourself. So when you are auditing medical care procedures and practices, you kind of know what you’re looking at.

Jennifer Baptiste Yes, I am a physician and we have a number of physicians on our staff as well as others with other clinical expertise. And I think that really lends to the integrity of our work and allows us to conduct effective oversight of VA.

Tom Temin Dr. Jennifer Baptiste is deputy assistant inspector general for health care inspections at Veterans Affairs. Thanks so much for joining me.

Jennifer Baptiste Thank you very much.

Tom Temin And we’ll post this interview along with a link to her report at federalnewsnetwork.com/federaldrive. Subscribe to the Federal Drive wherever you get your podcasts.

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