Healthcare Inspection – Alleged Provision of Care, Nursing Supervision, and Scheduling Issues at Community Based Outpatient Clinics at the Amarillo VA Health Care System, Amarillo, Texas

OIG conducted a healthcare inspection at the July 2014 request of Congressman Mac Thornberry to assess allegations at the Amarillo VA Health Care System (facility), Amarillo, TX, concerning provision of care at the Childress, TX, and Clovis, NM, community based outpatient clinics (CBOC); nursing supervision at the Childress, TX, CBOC; and scheduling issues at the Lubbock, TX, CBOC. We substantiated that from November 2012 through November 2014, the Clovis and Childress CBOCs had more than 100 patients who had not been seen for more than one year. However, we did not find a requirement that patients be seen yearly. We did not substantiate that in March 2016, the Childress CBOC had (1) inadequate space to provide care and ensure privacy, or (2) did not provide comprehensive care or the same level primary care that was provided at the facility. Services not available on-site were offered via other mechanisms. We substantiated that in January 2015, Registered Nurses (RN) and Licensed Vocational Nurses (LVN) performed clerical duties because the facility did not assign clerical staff to CBOCs. However, this was not a violation of Veterans Health Administration policy. We did not substantiate that in January 2015, nurses at the Childress CBOC lacked supervisory nursing oversight. Nursing staff were supervised and able to contact supervisors by phone and email. We substantiated that LVNs may have exceeded their scope of practice. After our 2015 visit, facility staff instituted a new process to provide patients access to an RN and/or a provider by phone when an RN or provider was not available on-site. We did not substantiate that in August 2014, Lubbock CBOC staff lacked training in scheduling patient appointments and/or destroyed documents and kept paper wait lists. We made two recommendations.