Healthcare Inspection – Alleged Violations of Nurse Practitioner Requirements, Carl Vinson VA Medical Center, Dublin, Georgia

OIG conducted a healthcare inspection at the request of Senator Johnny Isakson, Chair of the Senate Committee on Veterans’ Affairs, to assess allegations that nurse practitioners (NPs) lacked appropriate oversight and were operating beyond their scopes of practice in violation of Georgia Board of Nursing (GBON) licensure requirements at the Carl Vinson VA Medical Center (facility) in Dublin, GA. We substantiated that prior to our visit in 2015, the facility was not in compliance with GBON and Georgia Composite Medical Board (GCMB) requirements for NPs. However, at the time of our visit, all NPs were licensed through the GBON. We substantiated that facility leadership made a concentrated effort to get protocol agreements in place for 12 NPs; however, we determined these actions were appropriate. We did not substantiate that facility leadership misled the GBON into believing that the requested protocol agreements were for newly hired NPs, because the application forms did not inquire as to NPs’ length of service at the facility. We substantiated that a certified Family Medicine NP assigned to the MH Clinic was treating MH patients and prescribing psychotropic medications in collaboration with a MH physician. Because the American Academy of Nurse Practitioners permitted this practice and the NP was in the position prior to the requirement that NPs be certified in their fields of practice, this was acceptable. We did not substantiate that an NP was acting in the role of a physician and prescribing medications outside his/her scope of practice. We found that the NP’s scope of practice reflected expected practices and he/she fully complied with prescribing requirements for medications and abided by all limitations on his/her prescription authority. We did not substantiate that the facility Chief of Staff knew that NPs were prescribing medications and failed to report it to GCMB. We made no recommendations.