Chief of Staff Dorn VA Medical Center Jan 2012 – Do Not “…send out anymore non-VA care GI requests for endoscopy until further notice.”
According to VA IG Report No. 12-04631-313 “Healthcare Inspection: Gastroenterology Consult Delays William Jennings Bryan Dorn VA Medical Center Columbia, South Carolina”, Former Chief of Staff Barbara Temeck, M.D, sent an email to the Business Office “not to “…send out anymore non-VA care GI requests for endoscopy until further notice.”” According to the IG Report the email stated ““…attempting to internalize as many of these 700 cases as possible.”. During January 1–March 29, 2012 only 100 Veterans were seen outside the VA for Colonoscopies while the In-house Colonoscopies declined during the same time period.
Why the Chief of Staff made this decision is unclear. The IG Report report substantiated claims of a lack of priority by HR and Nursing Admin to staff open positions in the GI Clinic.
We substantiated that GI staffing was not optimal and that critical nursing positions went unfilled for months. It was difficult to determine specifically when some critical positions were vacant, primarily because interviewees recalled dates and events differently or documentation was sparse. However, most GI managers and clinicians we interviewed relayed similar accounts of staffing deficiencies, positions not being backfilled, and difficulty getting approval for new hires. During the AIB, the former CoS testified that the GI Service lacked nurses and clerks, and that the problem was “fairly long standing.”
The Chief of Medicine requested funds in 2011 from VISN 7 to address the growing backlog in the GI CLinic. The Request was approved and the facility received $1.02M but only appropriated $275,000 for Non-VA Care Colonoscopies.
We substantiated that VISN 7 gave the facility $1.02M in early September 2011 to use to address the GI backlog but that only approximately $275,000 was actually used for this purpose through August 2012. The Business Office was not aware that the additional monies were “earmarked” to address the GI backlog and obligated the funds as usual. The VISN 7 CFO told us that although the facility was given $1.02M expressly to address the GI backlog, they did not have to report back to the VISN on how the funds were used. The CFO reported that facilities may use their discretion to determine how to best meet the needs of their patients; however, fee care was specifically identified as a mechanism to reduce the backlog.
Clearly the funds were available to refer Veterans to Non-VA Facilities but the CoS chose not to. Why would the CoS make this decision when clearly the Facility did not have the capacity due to staffing issues. Veterans DIED. People need to be held accountable.