Healthcare Inspection – Alleged Quality of Care Concerns, Gene Taylor Community Based Outpatient Clinic, Mount Vernon, Missouri

OIG conducted an inspection to assess the merit of allegations regarding the quality of care provided to a patient at the Gene Taylor Community Based Outpatient Clinic (CBOC), Mount Vernon, MO. We substantiated that CBOC staff did not appropriately evaluate the patient’s gastroesophageal reflux disease symptoms but concluded that it is unlikely that this influenced his outcome. A non-VA specialist diagnosed the patient with esophageal cancer within 3 months of his first complaints of increased heartburn. Veterans Health Administration (VHA) policy requires VA providers to manage conditions for which they prescribe medications, even if the patient is also seeing a non-VA provider for that condition (dual care). The patient’s electronic health record did not list which medical records the VA provider had available when increasing the patient’s medication. We cannot determine whether the CBOC provider’s summarized notes accurately reflected the patient’s non-VA care or whether the CBOC provider needed to take additional action. We did not substantiate that CBOC providers inappropriately denied a request for Nexium®. VHA’s drug formulary lists preferred medications based on competitive pricing, safety, and efficacy. VHA requires facilities to have a process for reviewing non-formulary medication requests which may be approved if certain criteria are satisfied. In this case, the CBOC provider offered to prescribe Nexium® if the patient tried other medications first, as required under VHA policy. The patient was in the process of trying other medications when he was diagnosed with cancer; he then requested that further medication management be done by his non-VA physicians. We made one recommendation to the Interim Under Secretary for Health and one recommendation to the Veterans Health Care System of the Ozarks Director. The Interim Under Secretary for Health and Veterans Integrated Service Network and Facility Directors agreed with our findings and recommendations and provided acceptable improvement plans.