Noncompliance with Community Care Referrals for Substance Abuse Residential Treatment at the VA North Texas Health Care System

The VA Office of Inspector General (OIG) evaluated allegations that VA North Texas Health Care System (VA North Texas) domiciliary substance use disorder treatment program (DOM SUD) staff placed patients on waitlists and failed to offer non-VA community residential care (community residential care) referrals, as required by the Veterans Health Administration (VHA). Domiciliary care is aligned under mental health residential rehabilitation treatment programs (MH RRTPs), which provide 24-hour treatment and rehabilitative services. VA North Texas includes a DOM SUD at the Dallas VA Medical Center (Dallas DOM SUD) and a DOM SUD at the Sam Rayburn Memorial Veterans Center in Bonham (Bonham DOM SUD). The OIG reviewed 15 VA North Texas DOM SUD consults placed for 10 patients and substantiated that staff placed patients on waitlists and failed to offer community residential care referrals. Failure to discuss alternative treatment options, including community residential care, may have contributed to patients’ increased risk of negative outcomes due to delayed access to DOM SUD services. The OIG also determined that the Veterans Integrated Service Network (VISN) 17 Chief Mental Health Officer lacked authority to ensure national MH RRTP policy adherence. Effective oversight is critical to ensuring efficiency of DOM SUD operations and patients’ access to care. The OIG found that the Bonham MH RRTP standard operating procedure was inconsistent with VHA’s scheduling requirements. Further, VA North Texas policy did not include the requirement for staff to ensure a Mental Health Treatment Coordinator (MHTC) assignment for patients awaiting MH RRTP admission. The OIG made two recommendations to the Under Secretary for Health related to VISN MH RRTP oversight and MHTC assignment procedures and three recommendations to the VA North Texas Director related to alternative treatment options when DOM SUD admission wait times exceed 30 days, management of community residential care referrals, and scheduling procedures.