Provider Assignment and Dermatology Consult Scheduling Delays at the Joint Ambulatory Care Center, Pensacola, Florida

The VA Office of Inspector General (OIG) conducted an inspection to determine the validity of allegations that when a patient’s primary care provider left, the patient did not have another primary care provider assigned for over a year. The patient also allegedly experienced delays in scheduling dermatology care at the Joint Ambulatory Care Center (JACC) in Pensacola, Florida—a community based outpatient clinic of the Gulf Coast Veterans Health Care System in Biloxi, Mississippi. The OIG determined that a new primary care provider was assigned to the patient approximately nine months after the previous provider left the system. During the interim period, the patient remained assigned to a provider who was no longer employed at JACC. The patient experienced a scheduling delay of approximately three months for a dermatology consult. The delay occurred because the dermatologist had not followed Veterans Health Administration (VHA) requirements and had changed the appointment date beyond the date requested by the primary care provider. Although the patient received treatment and did not experience an adverse clinical outcome, the risk increased because of the delay. The OIG reviewed other JACC dermatology consults and found scheduling delays in 46 percent initiated during fiscal year 2017. The patients with delays did not experience adverse clinical outcomes, although the risk was increased for one patient. System staff reported insufficient scheduling personnel as one reason for delays. The OIG also determined that documented electronic health record communications between two providers did not meet VHA requirements and contained critical and derogatory comments. Four recommendations related to primary care provider assignment, scheduling dermatology appointments, reviewing staffing levels, and improper electronic health record documentation were made.