by Matt Rosenberg 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.
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.