Healthcare Inspection - Delay in Treatment, Louis Stokes VA Medical Center, Cleveland, OH

The VA Office of Inspector General Office of Healthcare Inspections conducted an inspection to determine the validity of allegations regarding a patient’s care at the Louis Stokes VA Medical Center (the facility). A complainant alleged that biopsy technique and delay in treatment contributed to enlargement of a cutaneous squamous cell carcinoma (CSCC) lesion, affecting the patient’s prognosis and necessitating extensive surgical treatment and follow-up. We did not substantiate that the biopsy technique used to obtain a tissue sample for diagnosis contributed to a CSCC lesion enlargement. We substantiated that a delay in scheduling the patient’s Dermatology Clinic appointment occurred but did not substantiate that the delay affected the patient’s prognosis. We found that the following facility policies and procedures did not ensure adherence to Veterans Health Administration (VHA) requirements: (1) outlining procedures for contacting patients to schedule an appointment, (2) scheduling consults within the timeframe established by VHA, and (3) defining timeliness of response from Dermatology Service regarding consult requests. We recommended that the Facility Director strengthen local policies to include all VHA required elements regarding procedures for contacting patients to schedule appointments. Additionally, we recommended that the Facility Director strengthen processes for clinic scheduling and consult tracking and monitor timeliness of outpatient scheduling for adherence with VHA timeliness requirements.