United States Veterans Affairs medical centers (VAMCs) did not report most physicians whose clinical care was found to be or suspected of being substandard to the National Practitioner Databank (NPDB) or to state licensing boards, according to a recent report by the US Government Accountability Office (GAO). Some of these physicians went on to work in other VAMCs or in non-VA hospitals and clinics.
GAO examined the records of five VAMCs and interviewed their staffs. Of the 148 providers whose clinical care was reviewed from 2013 to 2017, five were subject to adverse privileging actions and four resigned or retired while under review but before adverse actions were taken. Only one of these nine individuals was reported to the NPDB and none was reported to his or her state medical board, GAO said.
The VAMCs reported two providers to state licensing boards for reasons other than adverse privileging actions. These providers failed to meet the expected standard of care, raising patient safety concerns, GAO said. But it took the VA hospitals more than 500 days to make their reports on the providers, although VA policy is to complete the reports within 100 days of such determinations.
In addition, GAO found, one VAMC terminated the services of four contract providers because of deficiencies in their clinical care. None of these people were reported to the NPDB or to their state licensing boards.
As a result of the VAMCs not reporting the problems with some of its providers, GAO said, “[the Veterans Health Administration’s] ability to provide safe, high quality care to veterans is hindered because other VAMCs, as well as non-VA health care entities, will be unaware of serious concerns raised about a provider’s care. For example, GAO found that after one VAMC failed to report to the NPDB or [state licensing boards] a provider who resigned to avoid an adverse privileging action, a non-VA hospital in the same city took an adverse privileging action against that same provider for the same reason 2 years later.”
Congressional Committee
Because GAO audited only five VAMCs, a small percentage of the VA system’s nearly 40,000 providers, its researchers deemed their report “non-generalizable.” However, in testimony on December 1 before the House Committee on Veterans’ Affairs Subcommittee on Oversight and Investigations, Humayun Chaudhry, DO, president and CEO of the Federation of State Medical Boards (FSMB), said that his organization had consulted several of its member boards and had confirmed that the VA does not always alert state boards in a timely fashion about disciplinary actions against VA physicians.
“Providers who are unqualified or unsafe to practice medicine in the VA should not be allowed to practice outside of, or elsewhere in, the VA, nor should such providers be able to conceal their disciplinary actions with secret settlement arrangements,” said Dr Chaudhry. “Proper notification of provider disciplinary proceedings within the VA to the appropriate state medical board and the NPDB will help ensure that unsafe and dangerous physicians are identified and prevented from also treating patients outside the VA.”
The FSMB is calling for improved information sharing across the board between the VA and state medical boards.
VA Response
The VA has policies requiring its facilities to report providers with significant clinical deficiencies to the NPDB and state medical boards. The GAO suggested there were two reasons why this was not done in these cases. First, VAMC officials were not familiar with or misinterpreted VA policies related to reporting. Second, officials at the VA network level were not required to oversee whether VAMCs were reporting providers to the NPDB or state licensing boards when warranted.
In response to GAO’s report and in testimony to the subcommittee, VA officials said the agency was taking three steps to improve reporting of providers who don’t meet required standards:
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Reporting more clinical occupations to the NPDB
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Improving the timeliness of reporting
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Enhancing oversight to ensure that no settlement agreements waive the VA’s ability to report to NPDB and state licensing boards
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