Alleged Deficiencies in a Hospitalist’s Interactions with a Patient at the Veterans Health Care System of the Ozarks Fayetteville, Arkansas

The VA Office of Inspector General (OIG) conducted a healthcare inspection to determine the validity of allegations regarding a hospitalist’s interactions with a patient and family when obtaining consent for do-not-resuscitate (DNR) status and determining discharge plans at the facility. The OIG was unable to determine whether the patient had decision-making capacity to consent to a DNR status when the hospitalist discussed life-sustaining treatment. The hospitalist followed policy when determining the patient’s decision-making capacity. The OIG did not substantiate that the facility failed to evaluate, plan, and coordinate the patient’s discharge. The discharge plan addressed the patient’s medications, nutrition needs, and aspiration precautions. The patient’s shortened hospital stay did not afford the Palliative Care Consult Team the opportunity to educate the patient and family about home-hospice services. After discharge, the family requested, and the patient received, home-hospice services and a nasogastric tube. The OIG was unable to determine whether the hospitalist demonstrated inappropriate and unprofessional behavior with the patient and family due to differing recollections of the interaction. While on-site, the OIG learned of three other patients for whom facility staff expressed concerns with the way the hospitalist presented prognoses and end-of-life treatment options to patients and families. The OIG team evaluated the three additional patient cases focusing on the hospitalist’s determination of patients’ DNR status. The hospitalist’s interactions lacked evidence of discussions of patients’ preferences and quality of life, which likely led to the patients’ and families’ requests to reverse DNR orders. The OIG determined that the facility had processes to provide oversight of physician behavior. The OIG made no recommendations.