Alleged Mismanagement of Inpatient Care at the Colmery-O’Neil VA Medical Center within the VA Eastern Kansas Health Care System, Topeka, Kansas

The Office of Inspector General (OIG) conducted a healthcare inspection at the Colmery-O’Neil VA Medical Center (Facility) in Topeka, Kansas, regarding an anonymous complainant’s allegations that physicians were practicing beyond their clinical privileges and expertise; physicians failed to seek assistance from specialists, thus placing patients at risk; and a nurse practitioner did not have physicians’ help or supervision for the inpatient medical service. The OIG did not substantiate that physicians were practicing beyond their clinical privileges and expertise. However, two providers were granted clinical privileges that exceeded the Facility’s operative and Intensive Care Unit complexity levels. Although the OIG did not substantiate that physicians failed to seek assistance from specialists, specialty care clinics had only one provider to cover each area. The OIG determined that specialty services’ consults were ordered when medically necessary, patient transfers were timely and clinically indicated, and inpatients were transferred if specialists were unavailable. The OIG did not substantiate that a nurse practitioner covered the entire inpatient medical service without help or supervision. Additionally, the OIG determined that the VA Eastern Kansas Health Care System’s bylaws had not been updated to reflect VA’s 2017 amendment to its medical regulations permitting full practice authority for Advanced Practice Registered Nurses. The Facility did not meet Veterans Health Administration surgical complexity requirements for surgeons or anesthesia service. Facility staff could not provide lists of after-hours on-call social workers, mental health staff, specialists, and radiologists. Ultrasound scans were not available during all emergency department hours. The OIG made six recommendations related to providers’ clinical privileges; updating bylaws; requirements for after-hours surgeon staffing, pre-operative risk and anesthesia assessments, and anesthesia service coverage; specialty care consults’ timeliness; on-call specialists’ availability; and timely emergency department specialty resources.