At the request of Senators Tim Johnson and John Thune and Representative Kristi Noem, OIG performed an inspection at the VA Black Hills Health Care System, Hot Springs, SD to determine the validity of allegations they received regarding staffing, quality of care, and safety concerns. The complainants expressed concerns that only temporary staff were hired for critical clinical positions and that staffing issues may lead to quality of care issues and patient/staff safety concerns. While onsite, we also received allegations that the pharmacy and an inpatient unit (1E) were understaffed and 1E nursing staff were working excessive amounts of mandatory overtime. We did not substantiate that only temporary staff were hired for critical clinical positions, hiring temporary staff led to quality of care or safety issues, or 1E was understaffed with nursing staff working excessive amounts of mandatory overtime. We did not review pharmacy staffing due to unavailability of workload data. We recommended that the Health Care System Director reevaluate Hot Springs division 1E staffing and overtime and obtain a VA Pharmacy external review of the pharmacy workload and staffing needs.