Medication Delivery Delays Prior to and During the COVID-19 Pandemic at the Manila Outpatient Clinic in Pasay City, Philippines

The VA Office of Inspector General (OIG) conducted an inspection to assess allegations related to delayed medication delivery from the VA Manila Outpatient Clinic (clinic) pharmacy in Pasay City, Philippines, prior to and during the COVID-19 pandemic. The OIG substantiated a patient experienced medication delivery delays and did not timely receive morphine from the clinic pharmacy in October and November 2019. While the patient requested a renewal in a timely manner, pharmacists could not fill the medication because there was no available stock from the Veterans Health Administration’s (VHA) prime vendor, McKesson Corporation (McKesson). The OIG did not substantiate a second patient experienced medication delivery delays for five new orders, a medication renewal, and a glucometer in November 2019. The OIG was unable to substantiate if this patient experienced delivery delays of three medication refills because the OIG could not determine when the patient requested the refills. Clinic leaders identified a pharmacy processing time of 10.09 days (eight days over VHA and clinic policy requirements) in October 2019. In November 2019, the Chief of Pharmacy Services initiated an action plan. The average pharmacy processing time decreased to 1.63 days in December 2019. The Philippine President declared a COVID-19 public health emergency on March 8, 2020, and implemented a quarantine on March 16, 2020, that imposed travel limitations. Four patients experienced medication delivery delays in March and April 2020 due to limited or nonexistent courier transport. The OIG substantiated pharmacists could not dispense insulin to a patient as the clinic pharmacy had no stock after April 2020. McKesson canceled orders for perishable items due to unavailability of flights to the Philippines. The OIG determined that none of these delays resulted in adverse clinical outcomes and made two recommendations related to pharmacy stock shortages and processing delays.