Healthcare Inspection Contract Community Based Outpatient Clinic Issues New Mexico VA Health Care System Albuquerque, New Mexico

The VA Office of Inspector General Office of Healthcare Inspections conducted a review to determine the validity of allegations regarding patient care at contract community based outpatient clinics (CBOCs) affiliated with the New Mexico Veterans Affairs Healthcare System. The confidential complainant alleged that: Contract issues negatively impacted patient care. A CBOC physician underwent three level-III peer reviews (PRs) following the death of a patient. From April to September 2010, four patients with positive colorectal cancer (CRC) screening tests were not referred to a gastrointestinal specialist to determine the cause for bleeding. There were numerous complaints from veterans unable to get access to care when needed. We substantiated the allegation that contract issues negatively impacted patient care. Although not required by the contract, the facility contracting office directed that communication be routed through their staff, which caused delays in handling patient care matters. We did not substantiate that there were three level-III PRs assigned to a CBOC physician. However, we did find issues related to PR timeliness and confidentiality when the results were communicated to facility contracting staff. We did not substantiate the allegation regarding positive CRC screenings for four patients. We found the facility was not timely in referring patients for colonoscopies following positive CRC screening tests; however, they had an acceptable action plan. We substantiated that there were issues with access to care at the CBOC. The extent of the problem could not be determined because the CBOC did not follow Veterans Health Administration requirements for scheduling patients and monitoring access, and the facility patient advocates did not document and track patient complaints. We recommended that the Network Director ensure free and direct clinical information between the facility and El Centro Family Health staff. We also recommended that facility managers assure timeliness and confidentiality of peer reviews; and that CBOCs follow Veterans Health Administration requirements for monitoring access to care and patient satisfaction.