Healthcare Inspection Pulmonary Services and Quality of Care Issues, North Florida/South Georgia Veterans Health System, Gainesville, Florida

The purpose of this review was to determine the validity of allegations regarding quality of care issues and the adequacy of pulmonary services at the North Florida/South Georgia Veterans Health System in Gainesville, Florida. We did not substantiate the allegation that the system received funding for four full-time pulmonary fellows, yet only one fellow was at the medical center at any given time. We did not substantiate the allegations that inadequate pulmonary consultative care contributed to the death of a patient, cancer treatment was delayed, or that a pulmonologist was inappropriately privileged to perform medical thoracoscopies. We substantiated the allegation that one fellow was previously responsible for covering inpatient consultations, most bronchoscopies, and the medical intensive care unit (MICU). However, prior to our arrival, there was a realignment of duties, which resulted in increased pulmonary coverage. We substantiated the allegation that on weekends, one fellow managed critically ill patients in the VA MICU and also covered Shands Hospital at the University of Florida. However, we found that the medical center had back-up assistance, and there was no evidence that pulmonary coverage on weekends negatively impacted patient care. We substantiated that fee basis requests for various treatments for lung cancer had declined, but we found that this decline was the result of improved processes. We made no recommendations.