Healthcare Inspection—Inadequate Intensivist Coverage and Surgery Service Concerns, Gulf Coast Veterans Healthcare System, Biloxi, Mississippi

The VA Office of Inspector General (OIG) conducted an inspection to evaluate allegations of inadequate staffing of intensivists (physicians who are specialists in the care of critically ill patients) and other Surgery Service concerns at the VA Gulf Coast Healthcare System (System), Biloxi, Mississippi. The OIG substantiated the System did not have full-time intensivist coverage during part of fiscal year 2017. However, the System had taken actions to mitigate patient risk during times that an intensivist was not available, including granting core critical care privileges for hospitalists (physicians who are specialists in the care of patients in the hospital) and diverting admissions for patients possibly needing intensive care unit (ICU) services. The System did not fully comply with risk-based surgical screening processes and selective scheduling of more complex surgeries. The System also did not fully comply with limiting surgeries to patients with pre-operative mortality risk calculations greater than 7.5 percent. The OIG did not find evidence of clinically significant adverse patient outcomes related to this non-compliance. The OIG did not substantiate that ICU patients died from complications as a result of inadequate [intensivist] staffing. Two ICU deaths occurred in late 2017 when an intensivist was not available. In both cases, the patients had metastatic (spread to distant sites) cancer and were subsequently placed on hospice or comfort measures only. The OIG substantiated that some of the intensivist staffing and Surgery Service-related conditions were not remedied after an external inspection. However, the System implemented an action plan to address identified concerns. The OIG also found examples of poor communication and responsiveness, and of improper documentation. The OIG recommended the Veterans Integrated Service Network Director provide oversight of ICU and Surgery Service-related operations until conditions are resolved, and the System Director follow through on incomplete actions and address improper health record documentation by two providers.