Deficiencies in Privileging a Urologist to Practice and Medication Management Processes at the VA Central Iowa Health Care System in Des Moines

The VA Office of Inspector General (OIG) conducted a healthcare inspection at the VA Central Iowa Health Care System (facility) in Des Moines in response to an OIG Office of Investigations referral regarding a facility report that a urologist practiced, was privileged, and ordered controlled substances without a Drug Enforcement Administration (DEA) registration. The OIG confirmed the facility’s report regarding the urologist and assessed facility medical staff management processes. The OIG found that the urologist was able to practice and was privileged without DEA credentials because facility leaders did not timely implement a Veterans Health Administration (VHA) directive requiring providers who ordered controlled substances to possess an individual DEA registration. Upon recognizing that the urologist verbally ordered controlled substances in the operating room without a DEA registration, facility leaders took action by notifying the OIG Office of Investigations of the urologist’s unauthorized ordering, suspending the urologist’s privileges for one month, and implementing a process to ensure all controlled substance ordering providers, including the urologist, hold an active DEA registration. The failure of the urologist to timely obtain a DEA registration was not related to clinical competency. The OIG was concerned, however, that the facility’s operating room practice permitted surgeons to issue verbal orders for nonurgent medications without subsequently entering the medication orders in the computer. The practice bypassed quality controls and prevented pharmacists and controlled substance inspectors from reviewing medication orders. The OIG made five recommendations to the Facility Director related to monitoring compliance with VHA and facility policies to maintain DEA registrations and management of medications in the operating room.