Facility Hiring Processes and Leaders’ Responses Related to the Deficient Practice of a Radiologist at the Charles George VA Medical Center, Asheville, North Carolina

The VA Office of Inspector General (OIG) conducted a healthcare inspection to evaluate concerns regarding deficiencies identified in the practice of a fee basis radiologist (subject radiologist), and the facility’s oversight of the subject radiologist’s performance during the six month tenure in 2014. Facility leaders did not complete the credentialing and privileging of the subject radiologist per Veterans Health Administration requirements. Specifically, the references used to approve the subject radiologist’s request for privileges did not include a reference from peers and a most recent employer. Facility managers did not provide adequate oversight of the subject radiologist and did not timely complete a focused professional performance evaluation. Facility leaders did not take timely administrative action in response to inaccurate interpretations of radiology imaging and clinical documentation. Facility managers and leaders failed to timely complete the subject radiologist’s Exit Memorandum, required by Veterans Health Administration to comply with state licensing boards reporting requirements, during the mandatory reporting period of seven days after the employee’s separation from the facility; and failed to report the results to the facility professional standards board until August 2018, three years after the assigned target date. The Patient Safety Manager was never notified while the review of cases was being conducted, nor after the results were issued. Facility leaders did not timely submit an issue brief to the Veterans Integrated Service Network, as is required for significant clinical incidents negatively affecting patients. On January 25, 2019, the Facility Director issued notices to eight state licensing boards citing that the subject radiologist failed to meet generally accepted standards of clinical practice. Two disclosures were made to patients. The OIG made four recommendations related to credentialing and privileging requirements, state licensing board reporting, reporting of adverse events, and potential administrative actions.