Collaboration in Civic Spheres

Health care problems for Spokane area veterans, says audit

by October 8th, 2012

Earlier this year, a U.S. report accented major problems with quality of health care at VA hospitals in Puget Sound. Now, a more recent probe has found significant shortcomings at the major facility serving Spokane area military veterans. Primary care physicians at the Spokane Veterans Administration Medical Center too often failed to ensure that referrals of their patients to specialists actually resulted in the requested care being given within a reasonable time frame, resulting in prolonged pain and suffering, according to a recent audit by the Department of Veterans Affairs Office of the Inspector General.

The audit found that requested consultations for injured and ill U.S. military veterans using the Spokane facility were “inappropriately cancelled or discontinued” and “patients consequently had unnecessary delays in the amelioration of symptoms.” OIG recommended the center develop and educate its doctors on “a comprehensive consultation process” to make sure all referrals to specialists were properly made and monitored, with resulting patient data made available to Spokane VA doctors. Investigators also stressed the need to resolve conflicts and communications problems between Center doctors and specialist colleagues there, and at other Northwest VA centers to which referrals were often made.

In February of this year a complainant to the VA OIG’s hotline alleged problems with the specialist referral process was resulting in delayed care to Spokane VA Medical Center patients, and possible harm. The OIG’s office decided to conduct on an site visit in March, conducted interviews, reviewed rules, and examined records for cases cited by the complainant and patient advocates. The yardstick for an inappropriate delay in care by a consulting physician or facility was failure to see or schedule the patient to be seen within 30 days of the referral.

Investigators found that in eight of the 15 cases reviewed, delays in care from consulting specialists occurred and in seven of those eight cases, patient symptoms were extended as a result. Among the cases classified as resulting in an “adverse outcome” were the following.

  • A primary care doctor at the Spokane VA facility sought consultation from a neurologist for a patient with migraine headaches, but an appointment was denied and not until six weeks later did the specialist provided non-visit consultation, on medication.
  • A Spokane VA doctor sought neurosurgery consultation from the Portland VA Medical Center for a patient with degenerative disease of the intervertebral disc of the spine. The patient was not seen by the specialist until eight weeks after the request.
  • Another Spokane VA patient who’d been referred to Portland VA neurosurgery for evaluation of neck pain wasn’t seen for 10 weeks.
  • One more referred there for chronic pain of the head, neck and back waited eight weeks for an appointment and then was put on a wait list for surgery.
  • It was a four-month wait for an appointment and 11 months until treatment began for a Spokane VA patient referred by a primary care provider there to the center’s own Spine Clinic.
  • A primary care doctor sought orthopedic consultation for another Spokane VA patient’s shoulder pain. The consultant first required the patient to get magnetic resonance imaging and a CAT scan and then saw the patient six weeks after the initial request. The patient was then referred to the regional VA of Puget Sound Health System for further evaluation, but that consultation was later cancelled. The patient received actual treatment eight weeks after consultation was first sought.

  • Communication problems were at the root in many of the cases where diagnosis from consulting specialists and treatment were delayed, the audit found. Primary care physicians requesting involvement from specialists were not invested in the outcome, as they often didn’t phone or visit them to underscore the importance of the request. They and consultants both “used consultation notes to express dissatisfaction with the consultation process, and leaders took no action to address persistent staff conflicts,” the audit found. It wasn’t always a case of specialists being difficult, the audit emphasized, as in some cases, review by specialists was sought by primary care providers before they had done a sufficient preliminary evaluation of the patient.

    In an attachment to the audit, officials at the Spokane VA Medical Center affirmed its recommendations and said they would by the end of this year have completed all necessary steps to implement a better consultation process and educate staff.

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