Review of VHA’s Alleged Mishandling of Ophthalmology Consults at the Oklahoma City VAMC

We substantiated an anonymous allegation that Oklahoma City VA Medical Center (VAMC) ophthalmology staff, teleretinal imaging staff, and referring providers acted inappropriately on discontinued consults. VAMC ophthalmology staff discontinued about 31 percent more consults than the national average in FY 2014, and about 42 percent more in FY 2015 (as of March 10, 2015). Ophthalmology staff discontinued consults without adequate justification and often because they could not provide eye exams to the patients within 30 days. In addition, ophthalmology staff and referring providers did not take the necessary steps to refer the patients to non-VA care staff to obtain their medical care outside of the VA. Referring providers did not ensure that discontinued teleretinal imaging consults received the appropriate ophthalmology clinic follow-up. As a result of our inquiries about inappropriate consult actions, Oklahoma City VAMC leadership initiated a follow-up review of ophthalmology consults discontinued from January 1, 2014, through March 3, 2015, and identified issues with 439 of 1,937 discontinued consults (about 23 percent). Ophthalmology leadership did not provide sufficient oversight for processing consults and the VAMC did not have well-defined guidance to ensure staff took appropriate actions when processing consults. We recommended the Interim Director of the Oklahoma City VAMC take appropriate action on patients affected by ophthalmology and teleretinal imaging consults, as well as formalize guidance and train staff on initiating and processing consults.