Came across this article and thought y’all might be interested…
This article reprinted with permission
December 8, 2014 Oliver B. Mitchell III
As a result of Marine Veteran Mitchell’s complaint about radiology issues and the recent VA Scandal of 2014 we decided to look into the world of VA Radiology Clinics to see what we’d discover. Our series begins with the Bay Pines VA Medical Center.
On March 24, 2009, Marine Veteran Oliver Mitchell filed a complaint with the VA OIG alleging the destruction of documents to include radiology backlogs that consisted of significant wait times, productivity issues, wait list and wait times for outpatient care and services.
During our cursory investigation we discovered that “fraud is rampant in VA Radiology clinics around the country.”
On June 12, 2006 the VA OIG issued a report titled “Healthcare Inspection; Follow up evaluation of clinical and administrative issues Bay Pines Healthcare System.”
The purpose of the inspection was to “assess the overall quality of care…” Additionally, the OIG had received “new allegations of alleged mismanagement, alleged corruption and incompetence of Bay Pines management, and an alleged budget deficit.” At the request of Senator Bill Nelson the OIG had conducted this investigation as a follow up inspection.
The OIG had visited the healthcare center 3 times during the month of March ’06. They noted that “management had implemented corrective actions that fully resolved or had improved a majority of the deficiencies” from a prior OIG report from 2004. The OIG continued saying “despite significant progress and achievements they found that actions taken in some areas were not completely effective in resolving the conditions or that further action was needed.”
In usual double talk, the OIG initially claimed “the facility had improved since 2004, but despite significant progress they found that further action was needed.”
Therefore, one must ask, did the Bay Pines facility improve or digress in their actions?
The OIG continued their report saying “we found no evidence of mismanagement resulting in inadequate patient care, nor did we identify any examples of mismanagement corruption or incompetence.”
Despite the fact that they noted:
- Mammograms were not interpreted in a timely manner.
- Immediate and urgent radiological examinations continue to be ordered inappropriately.
- Managers did not adequately monitor radiology productivity.
Again, the OIG uses double talk. Their report highlights untimeliness and inappropriate ordering of exams, yet, there’s no impact towards patient care.
Earlier we noted that this report was a follow up inspection from a prior OIG report in 2004. In both February and March of 2004 at the request of the Secretary and multiple members of Congress the OIG had visited Bay Pines to evaluate their effect on patient care.
Among other issues, their evaluation identified:
- The effectiveness of management and leadership.
- Radiology backlogs.
- Wait times and productivity.
- Waiting List.
- Wait times for outpatient care and services.
In that 2004 report the OIG had “confirmed many of the allegations and made recommendations.”
From the issues the OIG had found, the following deficiencies had existed:
- Inadequate management that resulted in a dysfunctional Clinical and Administrative operation.
- Medical Care in selected clinical services was not adequate.
- VA’s management did not protect the interests of the government.
- The medical facility wasn’t adequately prepared.
- Security weaknesses placed programs and data at risk.
- Senior leadership failed to respond.
Out of the 6 issues the OIG noted:
- Turnover in key leadership positions was excessive.
- A lack of trust in senior management led to low physician and employee morale.
- A culture of safety and accountability was not present.
- Out of fear of reprisals, patient safety was not discussed.
- Audiology appointments were manipulated by management to meet performance goals.
- Waiting lists were understated by more than 1,000 veterans.
- Service connected veterans were not receiving appointments within the 30 day requirement.
- Non-service connected veterans had their appointments cancelled with some waiting in excess of 800 days.
- The Radiology Service was not able to schedule or interpret x-ray images within acceptable time frames.
- On February 24, 2004, there were 1,099 unread x-rays, over 750 of which were Computerized Tomography scans and Magnetic Resonance Imaging (MRI) films. The delays contributed to delays in diagnosing patients with lung cancer.
- The delay in a MRI interpretation and the diagnosis of a tumor, contributed to a veteran’s spinal cord injury.
- Pulmonary Service patients incurred unexplained appointment cancellations.
- Medicine Service did not have a peer review process to monitor patient care.
Despite the alarming and overwhelming issues identified, the OIG concluded its 2006 report saying “We found no evidence of mismanagement resulting in inadequate patient care, nor did we identify any examples of management corruption or incompetence. Overall, it is our opinion that conditions have substantially improved at BPHCS since March 2004.”
The Radiology/ Imaging department consist of two divisions; Nuclear Medicine and Radiology. Imaging Service offers nuclear medicine, general x-rays, computerized tomography (CT) scanning, magnetic resonance imaging (MRI), ultrasonography, angiography, interventional radiological procedures, and screening mammography.
According to the report “Urgent requests require the examination and interpretation within 2 hours. Routine requests require the examination within 30 days and image interpretation within 48 hours of exam completion.”
Mitchell says “he wasn’t surprised” to learn that the Bay Pines Radiology department “wasn’t scheduling exams or interpreting and verifying images in a timely manner.”
Mitchell continued saying “we had the same [exact] issues as Bay Pines. After having read that report it brought back an eerie feeling. It was like being back at work again. I can’t believe that another Radiology clinic clear across the country faced the same operational challenges and employee morale issues as we did at the Los Angeles VA.”
The OIG report cited the Bay Pines Radiology clinic saying “Radiology has made substantial improvements in access and timeliness and has also improved capacity by adding new equipment and increasing operational hours and coverage. However, we were told of some morale problems within the division, primarily related to salary and benefits. We also noted that one of the radiologists has been functioning as the Acting Chief for more than 2 years because the facility has been unable to recruit a full time Chief of Radiology.”
Mitchell told us “had the OIG conducted a real and full investigation, instead of alerting Donna Beiter to his allegations; we possibly could have improved our services and care. It’s absolutely mind boggling as to why they wouldn’t investigate, knowing there’s a pattern of misconduct within the radiology clinics across the country.”
Mitchell says he noticed one striking comment within the report. The OIG had stated “Stability within Radiology is critical to efficient operations.” Mitchell says “every provider will at some point order a test or exam from radiology. These exams are used to detect a patient’s illness. If radiology is behind the 8 ball, then healthcare in general will lag and the patient will suffer.”
This has been another post from “A Veteran Whistleblower: Exposing Corruption.”
Copyright. Oliver B. Mitchell III, 2014. All rights reserved. This article cannot be copied, re-posted, published or edited without the express permission of the author. You may link and/or embed a link to this article.
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