Colorectal Cancer Screening, Timely Colonoscopies, and Physician Coverage in the Intensive Care Unit at the James H. Quillen VA Medical Center, Mountain Home, Tennessee

The VA Office of Inspector General (OIG) conducted a healthcare inspection regarding a complainant’s allegations of inadequate colorectal cancer (CRC) screening, timely performance of colonoscopies, and Intensive Care Unit (ICU) physician coverage at the James H. Quillen VA Medical Center, Mountain Home, Tennessee. The OIG did not substantiate that veterans were dying due to the use of fecal immunochemical tests (FIT) rather than screening with colonoscopies. VHA recognizes multiple CRC screening methods and FIT is an acceptable option. The OIG could not substantiate that a specific delay or timeframe interval impacted a particular patient’s care. However, of the 1,439 patients OIG staff reviewed, 15 patients had CRC or carcinoid and longer intervals between identification of a need for and completion of a colonoscopy than other patients. Although OIG staff could not identify a specific or minimum delay interval, patients who had CRC or carcinoid and the longest colonoscopy intervals were most likely impacted by the longer intervals. OIG staff also identified deficiencies with the facility’s FIT specimen labeling, tracking, and monitoring processes. Although the OIG substantiated a lack of ICU attending physician coverage between March and September 2016, temporary physicians were used to provide coverage and inconsistent ICU physician coverage was resolved in February 2017. The OIG made seven recommendations related to clinical patient reviews/disclosures, tracking patients’ surveillance colonoscopies, tracking follow-up of positive FIT patients, ensuring availability of non-VA colonoscopy reports, providing a diagnostic colonoscopy after patients’ positive FITs rather than repeating FITs, notifying patients to re-submit FIT specimens, and tracking the distribution of patients’ FIT kits.