Healthcare Inspection Case Review of a Patient with End-Stage Cancer, John D. Dingell VA Medical Center, Detroit, Michigan

The VA Office of Inspector General Office of Healthcare Inspections evaluated the validity of allegations that facility staff did not respect a patient’s treatment decision, misrepresented the family’s wishes, and treated the patient and family disrespectfully. We did not substantiate that the patient’s attending physician misrepresented the family’s wishes and was unprofessional. We substantiated: (1) staff did not provide comfort care to the patient prior to the patient’s transfer from acute care to hospice care, (2) physicians delayed the patient’s transfer to the hospice unit, and (3) nursing staff did not show compassion to a dying patient and the patient’s family. We recommended that the Medical Center Director ensure that all clinical staff receive training in hospice and palliative care and that the Medical Center follow hospice care guidelines to ensure all family members have adequate privacy for initial bereavement. The VISN and Medical Center Directors concurred with our findings and recommendations and provided acceptable action plans. We will follow up until the planned actions are completed.