Delay in Care and Care Coordination at Cheyenne VA Medical Center, Wyoming, and Iowa City VA Health Care System, Iowa

The VA Office of Inspector General (OIG) conducted a healthcare inspection addressing confidential allegations of a patient’s delays in renal cancer care and lack of care coordination at the Cheyenne VA Medical Center (Cheyenne), Wyoming, and the Iowa City VA Health Care System (Iowa City), Iowa. The OIG substantiated that Cheyenne clinicians failed to provide timely and proper surveillance (follow-up) for the patient’s renal cell carcinoma and left nephrectomy (kidney) surgery. Contributing factors included a lack of clear communication among providers through electronic health record documentation, inaccurate diagnostic coding on the patient’s problem list, and limited patient evaluations. Additionally, an institutional disclosure and peer reviews were not initiated. The OIG did not substantiate that Iowa City providers failed to provide care and were unaware of the patient’s cancer history. Although Iowa City providers documented the patient’s history of a left nephrectomy, an e-consult to Urology Service for further evaluation was not addressed timely and resulted in a delay in care. Additionally, the OIG found issues with the providers’ problem list documentation and peer reviews were not initiated for the patient’s care. The OIG reviewed additional Iowa City patients’ electronic health records to determine if those urology consults were timely and found that clinical care was provided and patients were not negatively impacted. However, Urology Clinic providers did not always complete e-consult documentation as required by Veterans Health Administration policy. The OIG made five recommendations to the Cheyenne Director related to timely surveillance for cancer patients, care coordination and communication between Cheyenne providers and non-VA providers for cancer patients, problem lists documentation, and initiation of institutional disclosure and peer reviews for the patient’s care. The OIG made two recommendations to the Iowa City Director related to documentation of patients’ problem lists and initiation of peer reviews for the patient’s care.