Healthcare Inspection - Deficient Consult Management, Contractor, and Administrative Practices, Central Alabama VA Health Care System, Montgomery, Alabama

OIG conducted a review in response to allegations of deficient consult management, contractor, and administrative practices at the Central Alabama VA Health Care System (CAVHCS), Montgomery, AL. We substantiated delays securing Non-VA Care Coordination (NVCC) services, lack of follow-up, delays in getting NVCC care authorized, staff not verifying eligibility for NVCC care, some NVCC consults being cancelled, and some community-based outpatient clinic (CBOC) nurses scheduling patients directly with community providers. We also substantiated insufficient NVCC staffing and repeated leadership changes. We could not substantiate that 8,000 consults were reassigned to NVCC, that intra-facility consults went unanswered for months, that patients were not notified when appointments were scheduled, that there were delays in oncology care, or that a patient’s colorectal cancer metastasized due to delays in oncology care. We did not substantiate that the Dothan CBOC primary care contractor improperly billed for physician-led primary care appointments or that contract providers did not notify patients of critical fecal occult blood test results. We substantiated that a contracted private medical group (PMG) completed inadequate initial history and physical exams, that those reports were not always available in the patients’ VA medical records, and some patients with care needs identified by PMG were at risk due to poor or non-existent documentation. We substantiated that CAVHCS had multiple vacancies in important clinical areas; that the Podiatry Service did not follow appointment scheduling guidelines; and that Administrative Boards of Investigation were not consistently chartered, completed, or followed through in response to serious events. We substantiated that CAVHCS leaders were aware of many of the issues identified in the report and determined that a fractured organizational culture contributed to the development and perpetuation of these issues. We were unable to fully evaluate eight additional allegations due to insufficient information and/or details. We made seven recommendations.