Review of an Alleged Radiology Exam Backlog at VHA’s W.G. (Bill) Hefner VAMC in Salisbury, NC

The VA Secretary forwarded to the Office of Inspector General (OIG) allegations received from the Office of Special Counsel (OSC) regarding access to care at the W.G. (Bill) Hefner VA Medical Center, Salisbury, NC (Salisbury VAMC). The complainant made six allegations related to the existence of a large backlog of radiology exams at the Salisbury VAMC. These allegations are in addition to the allegations investigated and published October 4, 2016 in the Administrative Summary of Investigation in Response to Allegations Regarding Patient Wait Times–VA Medical Center in Salisbury, North Carolina by the VA OIG’s Office of Investigations. We substantiated the allegation that the Salisbury VAMC had a backlog of about 3,300 pending orders for radiology exams, but did not substantiate the other five allegations. We confirmed the existence of a backlog of over 3,000 pending orders for radiology exams at a specific point in time in 2014 near the date identified by the complainant. However, Salisbury VAMC Imaging Service decreased the over 3,000 pending exams and the number of pending orders. The facility averaged 1,358 pending orders from January 1, 2014 through March 31, 2016, but was unable to eliminate the backlog. Furthermore, our review found the Imaging Service was not effectively managing its pending radiology exam workload to ensure patients received timely exams. Some patients experienced significant delays in the completion of ordered exams. We reviewed the records of 15 patients who died before the completion of a total of 16 ordered exams, but did not determine that any of the deaths or adverse clinical outcomes resulted from the delays. We recommended the Salisbury VAMC Director require staff review all unscheduled radiology exam orders that are 30 days past the clinically indicated date and either cancel the orders if the exams are not needed or ensure the exams are scheduled. We also recommended the Director make unscheduled urgent and STAT orders a priority in the staff’s review of unscheduled radiology orders and identify whether potential harm has occurred to patients due to delays in care. Finally, we recommended the VA Mid-Atlantic Health Care Network Director ensure the Salisbury VAMC develops a plan to address existing demand for radiology exams and ensure future patients receive access to exams in accordance with Veterans Health Administration (VHA) policy. The VA Mid-Atlantic Health Care Network Director and the VAMC Salisbury Director concurred with our findings and recommendations and provided an appropriate corrective action plan.