Healthcare Inspection – Alleged Delay in Gastroenterology Care, Durham VA Medical Center, Durham, NC

OIG conducted an inspection to determine whether a patient, who is now deceased, received appropriate and timely diagnostic testing for colorectal cancer (CRC) at the Durham VA Medical Center in Durham, NC. We confirmed that almost 8 months elapsed between the patient’s initial gastrointestinal-related complaints in January 2011 until his colonoscopy in August. We did not find that this 8-month timeframe represented a clinically significant delay in care. The patient’s clinical presentation was unusual for a patient with CRC for both the early age of onset, as well as the short time period from initial symptoms to the discovery of advanced cancer. None of the providers were suspicious for CRC given the patient’s age at presentation and no known family history, and they reasonably considered inflammatory bowel disease as the more likely diagnosis. We could not say with certainty that the patient’s outcome would have been different had he received the diagnostic colonoscopy sooner. The colonoscopy and subsequent computerized tomography scan revealed the patient had a large mass and advanced CRC with metastasis to the liver. As CRC is typically a slow-growing cancer, the patient likely had advanced CRC at the time of his initial presentation with symptoms. We made no recommendations.