The Colmery-O’Neil VA Medical Center in Topeka, Kansas hosted a bit of a surprise inspection recently. An anonymous tip suggested the hospital’s faculty were not properly using their clinical privileges. The tip alleged that general practitioners were not asking specialists for follow-up about patients’ health diagnoses as normal.

This lack of consultation, if true, would potentially waste taxpayer money by treating veterans improperly. That could lead to subpar outcomes for those patients, even though specialists are part and parcel of their treatment and already budgeted for.

The tip also alleged that all of Colmery-O’Neil’s inpatient service was under the direction of one Nurse Practitioner (NP) without any other help or supervision. If true, this might be considered a grievously understaffed and neglected area of the hospital’s care. The Office of the Inspector General (OIG) saw fit to investigate.

The OIG found these allegations mostly unsubstantiated. The four patients identified in the tip had received specialist services as needed, and follow-up with 37 other patients found reasonable and timely specialist services provided as well.

The allegations about the NP were also unsubstantiated. The NP had a hospitalist to help them, and a physician who gave telephone consultations to the NP as needed.

That may not seem like much help, but a hospitalist is a specialized type of physician who lends a great deal of support to inpatient procedures. The OIG also found that the NP was amply qualified to direct inpatient service in the first place.

The regulations that deemed this NP fit to run the program are somewhat recent. The VA only introduced them in January 2017. It is understandable that an outside party (in this case, the one who gave the tip) would be unaware of those new regulations.

Now, are these regulations realistic? Is it reasonable to leave an entire hospital’s inpatient procedure to one individual, no matter how qualified? These are separate questions.

In spite of the OIG’s findings that the tip’s allegations were not quite accurate, the Topeka VA came up short in a few other departments. They needed more surgeons after-hours, better pre-operative and pre-anesthesia risk assessment, and higher availability of on-call personnel.

What are your thoughts on the matter? Topeka passed muster against the allegations that kicked things off… but needed immediate remedial attention in other areas. Is that likely to be the case in other facilities? Just how understaffed IS the average VA hospital?

Source: https://www.va.gov/oig/pubs/VAOIG-17-02484-189.pdf

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12 Comments

  1. According to reports, there IS an egregiously amount of healthcare professionals at VA.
    That said, it would be reasonable to state the healthcare provided to veterans is under par.
    I also believe, the OIG is possibly falsifying documents to make the VA look as though it’s providing adequate healthcare to veterans! I believe this due to many OIG Reports NOT being completely honest in the past few years!

    This is my opinion!

    • Correction;
      My statement should read “…lack of healthcare professionals, which is egregiously low at VHA’s…”!

      Damn brain ain’t working this morning!

  2. Not just a VA problem. Since the bankers have taken over financing medical training, psychiatrists have become a dying breed. 10 years of school financed by a loan that can chase you and attach your social security check for life. Bankruptcy out of the question and only $150,000.00 per year expected income. After tax income isn’t enough to pay the interest on the student loan build up after 10 years of borrowing.

    Drs. and Nurses who used to get education via VA scholarships in Land Grant University Medical Schools in return for mandatory years of service with the VA, Military, or HHS just aren’t going to Med school. Cost is too great for the return. So we have too few U S medical staff and who would work for a Medical Facility that doesn’t let you fully treat and record in order to reduce entitlements.

  3. Recently went to ER for what I thought was a problem with my pacemaker, as directed by VA.
    ! doc and 2 nurses for over 30 patients.
    It’s a problem all over but especially in rural AL

  4. Off Topic, but just a half a bubble off. I know a lot of veterans work at the VA. I have met good ones and bad ones, but most of them were good, but they lived and worked in fear, the fear of reprisal, for even agreeing to any thing that was obviously wrong with the vA. Why of late do I hear the word of Jay Gould who said, “I could hire one half of the population to kill off the other half”. I believe there to be two different class systems at vA’s, of course there could be many more, but you have the elite’s and you have the veterans, most of which are not elites. I believe the vA is in a little bit of a class war, a class struggle to be sure.

  5. I put in requests for help on the HealtheVet secure Email to my PCP in the beginning of Feb. I also used the new system to schedule 2 appointments. Both appointments were cancelled within days, and my PCP refused to do anything until my next regularly scheduled visit on 30 Apr 2018. It initially took 3 months to be seen by the PCP for my inguinal hernia, and until 29 Jul 2018 for an appointment for a consult. I was referred to get an MRI by a non-VA neurologist working with me on my SC neuro condition and was told also that I had to wait until my reg. scheduled PCP appointment. I scrubbed the MRI, ended up paying out of pocket for this. 15 Feb noted that it was almost 3 years since anyone spoke to me about liver issues resulting from HCV (which was cleared in 2015) and that the National Institute of Health recommended ultrasound to monitor condition at 6-month intervals, PCP msg told me to wait until next PCP appointment on this also, 2.5 months down the road. When I finally got to the non-VA MRI, they noted that my thyroid had a golf ball sized goiter and referred me to be seen for that. When Notified, the PCP instructed me to wait until my PCP appointment to talk about that (30 Apr 2018).

    Not only does the VA fail to properly follow up on patient conditions that should be monitored, but they 1) missed a large goiter in my neck, which should be checked every time the PCP see’s me for regular checkups, 2) failed to follow up on a liver condition every 6 months to check for cancer IAW national standard recommendations issued by the NIH, a Govt watchdog on care and treatment, 3) refused to set appointments for hernia, which was identified, verified and previously referred to general surgery 3 years earlier after they told that it was causing pain/pinching, 4) PCP ignored the CID (Clinically indicated date) of when I requested service, and entered a new CID over 60 days after PCP, that fails to show that I waited aroudn 5 months for the Hernia consult, 5) failed to identify a large goiter in my neck on my thyroid gland, even though it was visible in MRI’s taken in 2015, and 2017, as well as at each 6 month check up since 2014.

    So, if the question is does the VA give prompt, adequate care that meets standards of care established by nationally recognized authorities, I would think not. I think that when a PCP is squeezed hard enough and forced to care for way too many Vet’s in a years’ time, that they do not have the ability to spend the time to do the job right which effectively presents a danger to the Vet’s that expect care commensurate with modern medicine in one of the most advanced nations in the world. Any time they must lower their standards of care, Vets lose. This is what is happening, and the cause is that the VA is understaffed, and that medical personnel cannot or do not respond to requests for care for whatever reason and postpone it for as long as they can because they don’t have time to see us. This is my experience. I know MD’s that are not VA work 50-70+ hours per week, they put a premium on providing service, so they avert lawsuits. VA Doctors don’t have that pressure, they are not concerned so much about quality as they are about quantity, and they do not have to worry about insurance for a lawsuit because they made a mistake. Maybe this is the answer, stop taxpayers from insuring these guys, make them pay for their own insurance, stand up in court and defend what they do to our bodies and how they screwed up. Make them pay for errors and there will be a higher quality of care.

    • The VA can be astonishingly incompetent, I to believe under staffing is a big problem, and they value quantity over quality. Yet the jobs seem unwanted? I just hope they were not just waiting for you to succumb. I think your solution is viable, make them pay for their errors.

  6. This VA Healthcare is a blessing and a curse. I’ve had bad and good experiences regarding my medical care. With that being said, all of my health issues began as a result of being in the military and as a result of the care I received from the VA. Once the damage was done (the Bad) the VA Healthcare took action to remedy the situation (the Good). Although the action taken is hit and miss, but better than nothing at all.

    This is why I would prefer to have the option to seek care outside the VA if (I) deemed that it is necessary, not the VA. Getting a second opinion might have saved me a lot (my whole adult life) wasted time focusing on my health issues when I could have been focusing on my life the way normal healthy people have the privilege of doing. This thwarted my ability to be professionally competitive and this has an effect on my life in all aspects, financial, physical and emotional, spiritual, and social. Hence a diminished quality of life.

    This is why I get so frustrated and upset when I am treated disrespectfully as if I am “living on the dole”. I would gladly take my old life back before all the damage that was done “to me”, not due to my neglect or mistake. And with all that being said, after all that, I still at times have to fight to get proper care, and many times, to no avail.

    Continue the Good fight my friends.

    Godspeed

  7. The above comment to me. makes so much sense. Unlike a lot of Veterans who have stayed mainly with just one or two “local” VA I have experienced many different VA Hospitals in different states since 1970. To me, they are mostly all the same as above. I am in the Houston area and have been dealing with one of the biggest VA in the country the Michael DeBakey medical center. Almost 0ne billion dollars appropriate funding per year. Saying that I want to include that all VA get reimbursed for a good portion of the healthcare given, by the Veterans private insurance. I started with this VA when I retired from the civil service 2015. At that time I had been on Tramadol for chronic pain for ten years and this medication had been on the “narcotic list” now for a year with me taking drug test and passing them all. The doctor wrote me a script here after me passing yet another drug test for 30 days instead of my usual six month five refills. I am fairly knowledgeable on the federal law concerning narcotics and the VA regulation on Tramadol written up for all the VA healthcare providers. After me writing up my rebuttal to this 30 day refill and drug test in my HealthVet to my doctor I was given a reply and the site to go to on the VA regulation. Obviously the Interns, RN, and doctors yet again do not read what is written up for them to follow. Needless to say it was yet again the Veteran, educating and training these VA employees on what they should already know. Along with this the VA was charging my B/C B/S for the drug tests which are at the PCP requests and are service connected. Having to go a VA finance center, my B/C B/S wouldn’t listen to me, in Tennessee they finally stopped charging my heath insurance. Interesting enough my drug tests were no longer such a priority along the my PCP more willing to write my six months with a drug test once a year and while I was there for an appointment. This drug test, I need to say, is also a farce as they send you out of the lab with no oversight to a restroom that, in this case, had many other individuals in it. Also this PCP and I had never met so one year ago this month I requested a new doctor and this time wanted, my right, to be involved choosing one. With some back and forth I finally ended up with the Patient Relations Assistant who asked me what I needed in my request for a new one. He let me know that it would take “some” time for him to fill that request. Nine months later he gave me a name and looked it up on the internet. He has a private practice and expertise in internal medicine. I am not sure here what the VA civil servants can do on outside work but with the DOD we had to be approved to have an “outside” job to make sure it did not interfere or conflict “ethically” with my DOD position. Anyway my first visit with my new doctor did not go the way of this patient. He immediately told me that he did not write up narcotic prescriptions but would write an anti-inflammatory one and send me to pain management already a set up, my opinion. I asked how he would help me with my withdrawals as after now 13 years being on Tramadol I am of course addicted. He repeated what he had said before and asked if I wanted to see the Patient Relations Assistant (PRA). At this chance I of course jumped at as I wanted to meet the individual who took nine months to get me a new doctor. I did not realize by doing that, my appointment was over and had to reschedule, three months later. The PRA and I had a lengthy conversation. During this time he was obvious about his non-belief of my chronic pain, his trying to set off my PTSD anger so that he could throw me out, a tactic that a lot of VA employees use. Knowing this going in, I was able to get through it. Also out of this conversation he asked me if I wanted my old doctor back, the one I had never met in two years writing my narcotic scripts, I said no will stick with the new one as he also needs some educating on how to be PCP as you do not just stop a patient on any type of meds you moderate them off. The PRA said he would ask my old Doctor to fill my script and she gave me what was usually one months supply, 120 50mg tablets.
    Ok what a VA PCP or the intake RN does or does not write up in their report is never changed. I know as like this time, I have gone and gotten their reports. The new PCP said” he had talked with my previous PCP and she agreed that I should be removed from the narcotic. Then why would she write me another script? He said I went to the PRA to ask for a different doctor not true. At this same VA I went to their mental health clinic earlier. The intake report was in-depth and “pretty” factual unusual, but we sat together for some time till I saw what turned out to be the Director of the mental health clinic, I can only assume that they were short handed for her to attend to my needs. Pulling her report which was written up around seven days after and several requests I can only assume that in amount of time she had forgotten who I was and committed fraud by filling out a very inaccurate report on me. I was told that she has ten days to fill out any of her reports, probably not true either as it does not make sense. I need to mention here that I am in the middle of the NOD (Notice of Disagreement) appeal for my PTSD sent to Washington DC as the Houston VA received “all” my documents, reviewed them, denied them and notified me in one day so I had the DAV send my appeal out the review of Houston. Having inaccurate reports made up on Veterans have a direct impact on their claims. I wrote this back to the VA. I also wrote back to them that I wanted my new PCP to monitor me in my withdrawals till my next appointment. No answer no checking on me at all. I cant help thinking this kind of treatment is due to my standing up to my rights written into law. The PRA asked me to consider going to another clinic. What kind of question is that? I simply told him at that time that no this is my stand as I have been running for years from job to job because of my PTSD and it stops here. I have had about three months to think that statement through and because I need to have a doctor check out my lymph nodes I have decided to use my B/C B/S and go private. Talking with a Vietnam Veteran friend of mine yesterday, he believes the VA is trying to phase out the Vietnam Veterans and I agreed with him. When my Marine Corps buddies finally talked me into filling for my PTSD in 2005 I went to the Santa Barbara Clinic for the process. After going through the intake their suggestion was for me to see their Phycologist. After our fifteen minute meeting she stated” the VA is not focusing on the Vietnam Vets anymore but their focus is on the desert Veterans and she would get back with me. All I can say is wow. Six months later and nothing from her I went to their Patient Advocate got the e-mail of their Director and wrote up a letter. This was replied not even with an apology or another appointment to insure that my claim continued as requested.
    I have gone to lengths here to let you all know that the VA are typically the same. Unfortunately some worse than others. My e-mail is below and if I can help any Veteran out e-mail me in or out of civil service. The veterans in civil service including outside the VA are not getting what has been written up in the CFR (Code of Federal Regulations) for us.

  8. Try going to the Dwight D. Eisenhower VA Medical Center in Leavenworth, KS. You never know ‘who’ will be your Primary Care Provider one day from the next. Want someone to follow up with you about a medical concern? Good luck… I had asked for a follow-up appointment and was told I would have to wait for 6-12 mos!!! Want a Dental appointment at the O’Neil VA? You’ll wait for at least 2-3 mos. VA staff become overly defensive when you question VA practices. I get ill just listening to the ‘Thank you for your service.’ The Govm’t nor the VA gives a shit about Vets; maybe a few there do, but when I’m told I need to be early for a morning appointment and the VA staff slowly filters 20-30mins late… Where’s the accountability? There is NONE!

  9. OMG yes the VA is greatly understaffed and that is the tip of a very big iceberg. Most of us have worked for the US government so my question is with that in mind would you want to work for the VA? I could but I won’t. Hospitalists are fairly new to all medicine but of course the VA is very late to use them. They are great on the medical (disease) side of things but that is where they belong not on the surgical side. FP doctors within the VA have been reluctant way to much to send patients to the specialists they need and this is 100% widespread. The real question is why? I bet if we look hard and maybe i will somewhere there is a memo to all the FP docs not to use the Choice program and to treat themselves at all costs. What is the cost? HUGE vets suffer and really no money is saved because when specialist intervention is needed the cost for service is much higher than early intervention. Idiots!

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