Healthcare Inspection – Alleged Poor Quality of Care and Refusal to Pay for Lung Transplantation, Iowa City VA Health Care System, Iowa City, Iowa

OIG conducted an inspection at the request of Senator Charles E. Grassley and the VA Secretary to assess the merit of allegations that the Iowa City VA Health Care System (facility), Iowa City, IA provided poor quality of care; failed to comply with the Veterans’ Access, Choice, and Accountability Act of 2014; and refused to pay for a patient’s lung transplant outside of the VA. We did not substantiate the allegation that the patient received poor care during a summer 2014 admission to the facility. We could not substantiate whether or not family members were told the patient had pneumonia but determined that the patient and family members understood that the patient had received antibiotics for “an infection.” We did not substantiate the allegation that the patient received inadequate treatment for her worsening respiratory condition between summer and fall of 2014. Rather, clinicians aggressively pursued testing during this time to determine whether the patient could receive a lung transplant. We substantiated that while an inpatient in fall 2014, physicians did not properly address the patient’s multiple episodes of oxygen desaturation and that the patient sustained an acute kidney injury. We did not conclude the kidney injury resulted from poor quality of care or that it disqualified her from receiving a lung transplant. We did not substantiate the allegation that the facility failed to appropriately address concerns regarding the patient’s care when brought to the attention of the patient advocate and Chief of Staff. We did not substantiate that the facility failed to comply with the Veterans Access, Choice, and Accountability Act or that the facility refused to pay for a lung transplant at a non-VA hospital. We made 2 recommendations. The Interim Under Secretary for Health and the Veterans Integrated Service Network and Facility Directors provided an acceptable action plan.