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DepeRrueNT oF VereRnrus ArrruRs
Office of lnspector General
P.O. Box 50410
Washington DC 20091-0410

FINAL REQUEST
ln Reply Refer To: 53E/86/2009*11475

Ser;ctember 4, 2009

Mr tCliver Mitchell, lll


P.O. Box 1912
Lorrg Beach, CA 90801

Dear Mr. Mitchell.

Th s concerns your correspondence dated March 27, 2009, subject: quality of care
issres, to the VA's Office of lnspector General (OlG) Hotline.

Based on the information you provided, we would like to ask the Department (Veterans
Benefits Administration, Veterans Health Administration, National Cemetery
Administration, or other VA entity) to conduct an inquiry into your allegations.

Altrough VA OIG makes every effort to protect the identity of complainants, it may
be,)ome apparent in conducting this review who made the allegations. lf your issue
cot'lrlerns you individually and requires a review of your individual records, we will need
yottr signed release before proceeding. Therefore, in order for us to initiate an inquiry,
we need you to permit us to release your identity to the Department. lf you agree or
disagree to the release of your identity, please complete the attached Permission to
Dis;close ldentity form along with the name of the employee who was allowed to attend
class during her tour of duty, more specific information in regard to the cancellation of
MFll appointment, improper storage of patient date and return it to us by fax to
202.565.7936, or mail. A self-addressed envelope is provided for your convenience.

lf 1,ou have not responded to this request by October 5. 2009, we will assume you clo
nol wish to pursue this matter with OIG and consider this matter closed or take other
ac':irln as we deem appropriate.

Sirrcerely,

rytu
Cl'ristina A. Lavine
Dir erctor, Hotline Division

Enclosures
Attention: Representative 86/2009-1 1475

PERMISSION TO DISGLOSE TDENTITY

PLEASE PLACE YOUR INITIALS NEXT TO YOUR SELECTION, SIGN, PRINT YOUR
FULL NAME, AND DATE

TO: lnspector General


Department of Veterans Affairs

fi-f!- I (Oliver Mitchell) give permission to use my name and employment


sittttttion in connection with the complaint I filed with the lG Hotline on March 27. 2009,
cottt;erning draft request for analytics waiver. I understand this authorization applies
only to the specific lG Hotline complaint identified above and will renrain in efiect unless
witlr,Jrawn by me in writing.

OF:

I (Oliver Mitchell) do not consent to the release of my name in connection


witit the complaint I filed with the lG Hotline on March 27. 2009, concerning draft
recuest for analytics waiver. I understand that my failure to consent to the release of
my name will result in VA ol9 able to address my issue.
f'gbeing
I \t

SIGI\ATURE

FULL NAME (PRINTED) ftuwl-ub. lwTauEL


DA]'E q.
lq .0q

* ?us*se Noru *
TH rf Is dor I ?,ew*se Tunr (,gW&ss * Luitay
0r ,uy ltu Dtrr DIAL LeelLDs . THts tut*lrel DlEs NoT
C,Ot.tCg&Nl N€ lNOV,ooHLy .
PERMISSION TO DISCLOSE IDENTITY

TO: lnspector General


Department of Veterans Affairs

{n , n,u" permission to use my name and employment situation in connection with the
complaint I filed with the lG Hofline on 3 j ? , 2OO?. I understand this
authorization applies only to the specific lG Hotline complaint identified above and will
remain in effect unless withdrawn by me in writing.

OR

I I have already initiated a grievance, appeal, or EEO complaint regarding the matters I
raised, and do not wish to have my name and situation used as an example in the
systemic review.

OR

E t Oo not wish to pursue my concerns any means.

SIGNATURE (FULL NAME):

FULL NAME (PRINTED) :

DATE:

ArrN: REP EOiDS (2009-1 5275i CONSENT FORM