Breadcrumb

Healthcare Inspection – Alleged Improper Management of Dermatology Requests, Fayetteville VA Medical Center, Fayetteville, North Carolina

Report Information

Issue Date
Report Number
14-02890-286
VISN
State
North Carolina
District
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Healthcare Inspections
Report Type
Hotline Healthcare Inspection
Recommendations
2
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
OIG reviewed allegations that dermatology appointments and consults were improperly cancelled or discontinued in 2011–2012 at the direction of the Director and Chief of Staff at the Fayetteville VA Medical Center (facility), Fayetteville, NC. We substantiated that 1,993 dermatology clinic appointments were cancelled and that 3,272 dermatology consults were cancelled or discontinued between January 2011 and December 2012. We reviewed 344 randomly selected patient electronic health records and found that 86 percent of patients with cancelled appointments, who still required dermatology care, received care; however, 30 percent waited more than 3 months, and some waited more than 1 year. We found no evidence that 45 patients received dermatologic care after their appointments were cancelled. We reviewed 299 randomly selected patient electronic health records and found that while 65 percent of patients with cancelled or discontinued consults, who still required dermatology care, received care, the average wait time was about 13 months. We found no evidence that 89 patients received dermatologic evaluation or care after the consults were cancelled or discontinued. A look-back of patients with diagnosed skin malignancies did not disclose cases where cancelled or discontinued dermatology consults in 2011–2012 negatively impacted patients’ subsequent diagnoses or treatment. We could not substantiate that facility leadership improperly instructed employees to cancel dermatology appointments. Staff we interviewed did not report instances when they were instructed to cancel dermatology appointments without consideration for patients’ needs. For the cases reviewed, we did not identify instances where patients experienced clinically significant delays in diagnosis or treatment. A shortage of dermatologists at the facility in 2011–2012 contributed to the appointment scheduling and consult completion delays. The facility has since hired additional dermatology providers in its Wilmington location and continues to use teledermatology and Non-VA Care Coordination to meet demand. We made two recommendations.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the facility Director follow up on the 143 patients referenced in this report who did not receive dermatology care after their appointments or consults were cancelled, and take appropriate action.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the facility Director follow up on all the patients with cancelled dermatology appointments and consultations in 2011–2012 who were not subsequently seen by a dermatology provider to determine whether the requested evaluation and/or care is still needed.