Breadcrumb

Deficiencies in Privileging a Urologist to Practice and Medication Management Processes at the VA Central Iowa Health Care System in Des Moines

Report Information

Issue Date
Report Number
20-02359-52
VISN
23
State
Iowa
District
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Healthcare Inspections
Report Type
Hotline Healthcare Inspection
Report Topic
Medical Staff Privileging Credentialing
Major Management Challenges
Healthcare Services
Leadership and Governance
Recommendations
5
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
The VA Office of Inspector General (OIG) conducted a healthcare inspection at the VA Central Iowa Health Care System (facility) in Des Moines in response to an OIG Office of Investigations referral regarding a facility report that a urologist practiced, was privileged, and ordered controlled substances without a Drug Enforcement Administration (DEA) registration. The OIG confirmed the facility’s report regarding the urologist and assessed facility medical staff management processes. The OIG found that the urologist was able to practice and was privileged without DEA credentials because facility leaders did not timely implement a Veterans Health Administration (VHA) directive requiring providers who ordered controlled substances to possess an individual DEA registration. Upon recognizing that the urologist verbally ordered controlled substances in the operating room without a DEA registration, facility leaders took action by notifying the OIG Office of Investigations of the urologist’s unauthorized ordering, suspending the urologist’s privileges for one month, and implementing a process to ensure all controlled substance ordering providers, including the urologist, hold an active DEA registration. The failure of the urologist to timely obtain a DEA registration was not related to clinical competency. The OIG was concerned, however, that the facility’s operating room practice permitted surgeons to issue verbal orders for nonurgent medications without subsequently entering the medication orders in the computer. The practice bypassed quality controls and prevented pharmacists and controlled substance inspectors from reviewing medication orders. The OIG made five recommendations to the Facility Director related to monitoring compliance with VHA and facility policies to maintain DEA registrations and management of medications in the operating room.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The VA Central Iowa Health Care System Director ensures sustained compliance of providers who order controlled substances maintaining an individual Drug Enforcement Administration registration.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The VA Central Iowa Health Care System Director ensures verbal medication orders given in the operating room comply with Veterans Health Administration and VA Central Iowa Health Care System policies to permit verbal orders in emergent situations.
No. 3
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The VA Central Iowa Health Care System Director ensures operating room verbal medication orders are entered in the Computerized Patient Record System pharmacy package in accordance with Veterans Health Administration and VA Central Iowa Health Care System policies.
No. 4
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The VA Central Iowa Health Care System Director ensures that verbal medication orders given in the operating room are reviewed by a pharmacist in accordance with VA Central Iowa Health Care System policy.
No. 5
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The VA Central Iowa Health Care System Director ensures that controlled substance inspections include verification of medication orders for controlled substances removed from the operating room automated dispensing cabinet.