Inadequate Supervision of a Mental Health Provider and Improper Records Management for a Female Patient at the VA Greater Los Angeles Health Care System in California

The VA Office of Inspector General (OIG) conducted a healthcare inspection to assess allegations related to the mental health care of a female patient at the VA Greater Los Angeles Healthcare System (facility) in California, which included that a psychiatry physician resident (psychiatry trainee) was inappropriate during treatment discussions with the patient. The psychiatry trainee utilized a modality called Intensive Short-Term Dynamic Psychotherapy in which a therapist seeks to understand a patient’s interpersonal difficulties, intensify and challenge resistance, analyze transference, explore conflict, and work through unconscious issues. The OIG did not substantiate that the psychiatry trainee’s behavior with the patient was inappropriate. Although the psychiatry trainee did not always engage in effective therapeutic intervention, the OIG was unable to determine that the treatment resulted in a decline in the patient’s mental health causing decreased trust and mental functioning. The OIG found the supervisor did not provide adequate supervision to the psychiatry trainee, to include the psychiatry trainee’s documentation and the supervisor’s documented oversight. The inadequate supervision may have impeded the supervisor’s ability to inform the therapy and hinder the opportunity to achieve a more desirable therapeutic outcome. In addition, the OIG substantiated that Mental Health Department leaders were not responsive to the patient’s concerns. During the inspection, the OIG identified an additional concern regarding the improper creation, storage, and disposition of video recordings and consent forms. The OIG made one recommendation to the Under Secretary for Health to assess the possible scope of current and former VA psychiatry residents being in possession of patients’ personal health information; two recommendations to the Veterans Integrated Service Network Director related to supervision, documentation, document control, and treatment protocols; and three recommendations to the Facility Director related to responses to the patient’s concerns, records, and utilization of video recordings.