Healthcare Inspection – Mismanagement of Mental Health Consults and Other Access to Care Concerns, VA Maine Healthcare System, Augusta, ME

Report Information

Issue Date
Report Number
14-05158-377
VISN
State
Maine
District
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Healthcare Inspections
Report Type
Hotline Healthcare Inspection
Recommendations
8
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
OIG conducted an inspection at the request of former Ranking Member of the House Committee on Veterans’ Affairs, Michael Michaud, regarding allegations of mismanagement of mental health (MH) consults and other access to care concerns at the VA Maine Healthcare System (facility). We substantiated allegations that staff were directed to discontinue using the consult package for MH services referrals in certain circumstances and language in the consult package directed providers not to request MH consults if the patient was not willing to be seen within 14 days. We also found that referral processes within the MH services made it difficult to track whether patients’ requests for services were met. We did not substantiate the allegation that staff were directed to restrict who could submit MH consults. Although we did not substantiate the allegation that staff were directed to close consults before services were rendered, we found that this practice occurred. We did not substantiate the allegation that facility leadership directed staff to utilize workshops to meet VHA’s benchmark for timely MH assessments and follow-up. We found that there were concerns about the clinical appropriateness of certain group workshops, patients’ attendance in workshops did not “count” towards meeting VHA performance measures, and some of the MH Chief’s correspondence with staff emphasized meeting performance measures. We did not substantiate the allegation that, in order to meet VHA’s benchmark for same day access, staff were directed to use drop-in clinics instead of scheduling appointments or that staff were directed to omit certain information from clinical notes to limit the number of veterans seeking MH services. We did not substantiate the allegation that licensed independent providers were directed to see patients for medication management. We substantiated the allegation that some of the alleged practices have persisted, despite other reviews. We made eight recommendations.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Facility Director remove the language in the Computerized Patient Record System outpatient psychological testing consult that may be interpreted as instructing providers not to enter a consult.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Facility Director reevaluate and make the appropriate changes to the methods for referring patients for mental health care, including the extent to which the consult package is being used appropriately.
No. 3
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Facility Director ensure that mental health consults are reviewed and closed in accordance with Veterans Health Administration policy.
No. 4
Not Implemented Recommendation Image, X character'
to Veterans Health Administration (VHA)
We recommended the Facility Director ensure that Veterans Health Administration appointment scheduling guidance is followed and that schedulers utilize the electronic waiting list and give priority to service connected veterans, as appropriate.
No. 5
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Facility Director review all existing mental health wait lists to identify patients who may be at risk because of a delay in the delivery of mental health care and provide the appropriate care.
No. 6
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Facility Director expand access to mental health services, particularly required evidence-based psychotherapy and intensive case management services.
No. 7
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Facility Director ensure that mental health staff is available in the Emergency Department as required by Veteran Health Administration and local policy to avoid potential delays in admission to the inpatient psychiatry unit.
No. 8
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended the Facility Director review guidance provided to staff about meeting performance measures and confer with the Office of Human Resources and the Office of General Counsel to determine the appropriate administrative action to take, if any.