Healthcare Inspection – Alleged Magnetic Resonance Imaging Order Deletion and Record Destruction, VA Greater Los Angeles Healthcare System, Los Angeles, CA

OIG conducted an inspection in response to congressional requests to assess the merit of allegations regarding the deletion of magnetic resonance imaging (MRI) exam requests (orders) and the destruction of medical files at the VA Greater Los Angeles Healthcare System (facility), Los Angeles, CA. We did not substantiate that MRI orders were deleted or mass purged or that records were destroyed. We found that orders cannot be deleted or destroyed from the computer system. Each order we reviewed was canceled individually. We did not substantiate the allegation that patients suffered adverse or clinically significant consequences from canceled dated MRI orders in late 2008. We reviewed 1,474 MRI orders and found sufficient evidence to support that cancelations did not impact patient care outcomes. However, we identified quality of care concerns where a delay or inability to schedule MRIs placed patients at risk for more complicated and prolonged management. Incidentally, we identified 170 MRI studies ordered in 2008 that were still pending. We determined the facility had not consistently implemented its process to cancel orders older than 1 year. Additionally, radiology clerical staff did not consistently annotate accurate reasons for canceled orders and appointments. We also found that the facility should strengthen its view alert notification process to ensure ordering providers were notified of canceled orders. We recommended that the Facility Director ensure that the Radiology Department managers confirm that ordered exams are scheduled and completed within the Veterans Health Administration required timeframe, periodically review pending lists of MRI exams to ensure timely scheduling, and implement a consistent procedure for canceling MRI orders. We also recommended that responsible providers are notified of canceled MRI orders and that radiology clerical staff accurately annotate reasons for canceling MRI orders and appointments in the electronic health record.