Deficiencies in Consult Management in the Endocrinology Service at the VA Fayetteville Coastal Healthcare System in North Carolina

The VA Office of Inspector General (OIG) conducted a healthcare inspection to review allegations regarding internal endocrine consult management, endocrine clinic utilization, and patient access to gender-affirming hormone therapy (GAHT) at the VA Fayetteville Coastal Healthcare System (system) in North Carolina. The OIG also reviewed leaders’ awareness of and response to these concerns.

The OIG substantiated that the chief of medicine (COM) did not effectively manage internal consults. Specifically, the COM did not communicate endocrine consult management process changes to key stakeholders, did not process consults according to Veterans Health Administration (VHA) timeliness requirements, canceled a large volume of consults without communicating to sending providers, converted face-to face consults to e-consults without providing a mechanism for sending providers to communicate concerns, and delayed implementation of a required service line agreement. 

The COM’s deficient management of endocrine consults negatively impacted endocrine clinic utilization and resulted in provider-created workarounds and patients not receiving timely endocrine appointments. From February through early October 2024, patient access to GAHT was delayed because of the COM’s actions, resulting in adverse clinical outcomes. The OIG found the COM’s interpersonal communication skills did not reflect the high reliability organization (HRO) values of clear communication and respect for others, and negatively affected system staff across multiple services.

The OIG made one recommendation to the Veterans Integrated Service Network Director to review the leadership performance of the COM, and six recommendations to the System Director related to reviewing the endocrine consult management process, reviewing patients affected by delayed endocrine consults, ensuring service line agreements are developed, confirming effective utilization of endocrine clinic appointments, ensuring there is a process for monitoring and tracking clinic profile modification requests, and evaluating communication gaps between leaders to comply with HRO goals.