Healthcare Inspection – Alleged Dental Service Scheduling and Other Administrative Issues, VA Palo Alto Health Care System, Palo Alto, CA

OIG conducted an inspection in response to a request from Congresswoman Jackie Speier to evaluate the merit of allegations regarding Dental Service scheduling as well as administrative issues at the VA Palo Alto Health Care System, Palo Alto, CA. A complainant identified five patients with alleged scheduling issues. We substantiated that two of the five patients’ appointments were canceled and rescheduled to later dates. We did not find evidence of long-term impacts on their clinical outcomes. We noted a 5-month delay in scheduling appointment dates for the two patients. We substantiated that the staffing ratio for dental assistants to dentists was slightly below Veterans Health Administration recommendations. We substantiated that dentists and residents assumed dental assistant duties after dental assistants ended their tours of duty, including the cleaning of instruments and disinfection of environmental surfaces. We were informed that in order to assist patients still being seen after dental assistants ended their tours of duty, all dentists and residents were given access to the Omnicells to obtain any necessary supplies. We substantiated that the dental clinic had a long backlog of undelivered prosthetic devices. The system instituted corrective actions, but due to incomplete documentation, we were not able to fully assess progress in reducing “backlogs” of undelivered prostheses. We substantiated that Dental Service had broken and/or insufficient equipment. We determined that additional equipment and a radiograph software program have been purchased. We concluded that the Dental Service presented numerous concerns and challenges and that it would be beneficial for the Veterans Integrated Service Network to review the Service after all corrective actions have been implemented. We made four recommendations.