Report Summary

Title: Comprehensive Healthcare Inspection of the VA Loma Linda Healthcare System in California
Report Number: 22-00048-120 Download
Issue Date: 5/24/2023
City/State: Loma Linda, CA
Blythe, CA
Blythe, CA
Corona, CA
Redlands, CA
Murrieta, CA
Palm Desert, CA
Rancho Cucamonga, CA
Victorville, CA
VA Office: Veterans Health Administration (VHA)
Report Author: Office of Healthcare Inspections
Report Type: CHIP
Release Type: Unrestricted

This Office of Inspector General Comprehensive Healthcare Inspection Program report describes the results of a focused evaluation of the inpatient and outpatient care provided at the VA Loma Linda Healthcare System, which includes the Jerry L. Pettis Memorial Veterans’ Hospital and multiple outpatient clinics in California. This evaluation focused on five key operational areas:

• Leadership and organizational risks

• Quality, safety, and value

• Medical staff privileging

• Environment of care

• Mental health (emergency department and urgent care center suicide prevention initiatives)

The OIG issued five recommendations for improvement in three areas:

1. Leadership and organizational risks

• Sentinel events and institutional disclosures

2. Quality, safety, and value

• Adverse events

3. Medical staff privileging

• Focused Professional Practice Evaluation processes

• Reprivileging reviews

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