Care Concerns and the Impact of COVID-19 on a Patient at the Fayetteville VA Coastal Health Care System in North Carolina

The VA Office of Inspector General (OIG) conducted a healthcare inspection at the Fayetteville VA Coastal Health Care System in North Carolina to assess concerns related to the quality, coordination, and timeliness of care, and the impact of COVID-19 on a patient with unintentional weight loss who was later diagnosed with oral cancer and died at another VA medical center. The OIG substantiated that the primary care provider and dietitians did not provide quality care to the patient. The primary care provider’s failure to follow-up on an earlier finding and not place an order for a medical test may have led to a delay in the patient’s cancer diagnosis. Dietitians conducted incomplete nutritional assessments given the patient’s declining nutrition status and may have contributed to a delay in diagnosis. The OIG determined that the patient’s PACT nurse and dietitians failed to coordinate care by not communicating the family’s request for a face-to-face appointment and the patient’s declining nutritional status to the primary care provider. The lack of care coordination may have contributed to a delay in examination and diagnosis. The OIG found that incorrect scheduling resulted in the patient not being seen by a dietitian for a follow-up appointment, and that a delay in scheduling a non-VA dental appointment occurred. The OIG concluded that COVID-19 impacted the care provided by dietitians because of the use of telephone visits, which did not allow dietitians to visually assess the patient’s physical characteristics caused by a declining nutritional status. The OIG made six recommendations related to completion of nutrition assessments, care coordination between PACT nurses and primary care providers, guidance on care coordination between dietitians and primary care providers, scheduling of dietitian and non-VA dental appointments, and evaluation of COVID-19 scheduling practices and impact on patient care.