Healthcare Inspection – Delays in the Evaluation and Care of a Patient with Lung Cancer, VA Southern Nevada Health Care System, Las Vegas, NV

OIG conducted a healthcare inspection to assess the merit of allegations regarding delays in the evaluation and care of a patient with lung cancer at the VA Southern Nevada Healthcare System (system), Las Vegas, NV, in 2014. We substantiated a delay of approximately 6 months occurred in the evaluation of the patient’s pleural effusion, and delays occurred in the diagnosis and treatment of the patient’s lung cancer. In conjunction with the delay in evaluation, the patient was not timely notified of test results. We identified several contributing factors, including lack of follow-up related to a non-VA provider’s lung biopsy recommendation. We did not substantiate a PCP failed to perform a physical examination during an appointment. We substantiated delays in obtaining NVCC authorizations. We identified several contributing factors to the delays: NVCC staff inconsistently applied the requirement for system providers to see the patient for services offered at the system before an NVCC consult was approved; NVCC staff failed to process the request according to the requesting provider’s urgency; Emergency Department (ED) providers failed to follow the NVCC consult request process; NVCC staff did not appear to be knowledgeable of covered services. We substantiated inadequate medication management due to delays in filling medications ordered by non-VA care providers and problems with delivery of medications. We did not substantiate a lack of continuity of care due to changes in the patient’s PCP and did not find disruptions in the patient’s care due to the changes. We found inconsistencies with the system’s peer review process. We recommended the System Director ensure that: (1) providers address and communicate test results to patients within the required timeframe; (2) providers timely follow up on non-VA care providers’ recommendations; (3) the NVCC requirement for patients to be seen by system physicians first for services offered at the system before an NVCC request is authorized does not delay care; (4) NVCC staff process requests according to the urgency noted by the requesting provider; (5) ED providers follow NVCC consult request processes; (6) NVCC staff are knowledgeable of specific services that are authorized when NVCC consults are approved; (7) the peer review process is conducted according to current Veterans Health Administration guidance; (8) a review of existing practices for filling non-formulary/restricted medications is performed to ensure that medications are ordered, reviewed, and processed timely; and (9) an evaluation of patients’ experience is completed regarding contracted companies’ processes for delivery of medications.