Review of VISN 21 Clinical Resource Hub Sleep Medicine Physician Privileging

The VA Office of Inspector General (OIG) conducted a healthcare inspection to evaluate allegations that sleep medicine physicians at the VA Sierra Pacific Network, Veterans Integrated Service Network (VISN) 21 Clinical Resource Hub (CRH) treated patients without having sleep medicine privileges. The OIG found noncompliance with VHA Directive 1100.21(1) and VHA Credentialing and Privileging Office Standard Operating Procedure – P11, “Lapse of Privileges.”

The OIG substantiated that two VISN 21 CRH sleep medicine physicians treated patients during a lapse in their sleep medicine privileges. Inadequate oversight by the San Francisco Healthcare System (system) Chief of Staff and administrative deficiencies by the medical staff office contributed to the lapse. The two physicians maintained privileges in areas other than sleep medicine and should have been removed from patient care while their care was reviewed. The OIG did not learn of patient harm or receive complaints related to patient harm.

The OIG determined that a lack of national guidance for sleep medicine privileges contributed to a lack of clarity among sleep medicine physicians and CRH leaders about privileging sleep medicine physicians. Although aware of sleep medicine physicians’ concern following the standardization of sleep medicine privileges, the VISN 21 CRH director did not resolve confusion among sleep medicine physicians regarding the impacts of privileging changes, including potential disruptions in sleep medicine services due to the lack of other specialty privileges. 

The OIG made five recommendations. The Acting Under Secretary for Health agreed to providing detailed written guidance regarding privileging sleep medicine physicians. The VISN reported educating VISN and system leaders. The System Director confirmed monitoring of CRH sleep medicine practitioners privileges, planning to provide sleep medicine practitioners with core privileges and education regarding referring veterans to other specialists, and notifying medical center directors and chiefs of staff of privileging and practice changes.