VA Pledges to Stop Covering Up Its Doctors' Bad Behavior

The Veterans Affairs Department  pledged to boost its oversight and reporting of poorly performing doctors, telling lawmakers at a congressional hearing Wednesday it was already taking steps to fix the lack of accountability first identified in a watchdog investigation unveiled this week.

VA promised to more quickly investigate and report its doctors’ malfeasance to proper data banks and state licensing boards, as required by the department’s policies. In a spot review of five medical centers, the Government Accountability Office found VA medical center officials failed to investigate nearly half of complaints lodged against 148 providers between October 2013 and March 2017. In more than a dozen other cases, the department did not act expeditiously to investigate, taking between three months and multiples years to launch reviews.

GAO found that VA did not report to state licensing boards any of the nine cases in which doctors had privileges at VA medical centers revoked, and it reported such actions to the National Practitioner Data Bank only once. Auditors said those failures could hurt veterans and patients at non-VA facilities, citing as an example one case in which a doctor resigned from VA to avoid an “adverse privileging action”—the suspension, revocation or denial of clinical privileges—and subsequently was hired by a private hospital in the same city. Two years later, that physician received an adverse privileging action at the new hospital for the same reason the individual was forced to leave VA.

“Without documentation and timely reviews of providers’ clinical care, VAMC officials may lack information needed to reasonably ensure that VA providers are competent to provide safe, high quality care to veterans and to make appropriate decisions about these providers’ privileges,” GAO said.

Gerard Cox, VA’s acting deputy undersecretary for health for organizational excellence, told a panel of the House Veterans Affairs Committee the department has reached out to each of the facilities in question to determine exactly what shortfalls led to the reporting failures and is considering possible disciplinary action. VA is currently in the process of reporting all of the adverse actions to both the data bank and to state licensing boards.

In some cases, GAO found, medical center officials struck a deal with malfeasant doctors to not report their mistakes to the appropriate boards on the condition the doctors resigned from VA. Cox said such agreements are both against department rules and illegal, and vowed to clarify that position across the VA network. The department is working to clarify the roles and responsibilities of individual centers and the larger regional offices, known as Veterans Integrated Service Networks, which Cox acknowledged has been a longstanding issue.

Humayun Chaudhry, president and CEO of the Federation of State Medical Boards, said the reporting failures were a problem throughout the medical community.

“This issue is not unique to the VA,” Chaudhry said. “The state medical boards could do more for the nation in protecting to the public if they had access to more timely information from all sorts of sources.”

VA pledged to accept GAO’s recommendations, which included better documentation and more timely reviews of medical providers facing complaints. Regional VISN officials should oversee those investigations and ensure adequate reporting to appropriate boards, GAO said, adding the reviews should be “retrospective and comprehensive.” Cox told the Operations and Investigations subcommittee that VA planned to complete those proposed changes in 2018.

Rep. Phil Roe, R-Tenn., the chairman of the larger committee, said he found it “astonishing” and “amazing” such standards were not already widespread and enforced.

Cox said VA has an “ethical and moral obligation” to report certain providers to the National Practitioner Data Bank and state licensing boards, and outlined several steps the department is taking to ensure it follows proper procedures. Those include ensuring that no settlement agreements prevent reporting, reporting more occupations than just doctors and dentists, and reporting more quickly.