FAYETTEVILLE, Ark. — After an investigation, the Veterans Health Care System of the Ozarks in Fayetteville was found to have failed to properly schedule a cancer patient's treatment.
According to a report released by the VA Office of the Inspector General (OIG), an independent organization that investigates VA programs, necessary surgery needed within 30 days wasn't scheduled until 205 days after the initial consult.
Veterans can be eligible for VA benefits through non-VA health providers, such as a local community hospital. But in most cases, the VA has to determine their eligibility beforehand.
According to the OIG's investigation, the patient requested radiation therapy and a chemotherapy evaluation appointment through a community hospital, but the Fayetteville VA facility denied approval for "lack of Veterans Health Administration OCC guidance."
However, the facility failed to communicate the urgency of the patient's care to its own oncology providers, according to the investigation.
"Facility OCC staff could not provide an explanation for the failure to act or the delays," OIG said.
Ultimately, the investigation found that the facility failed to act or delayed acting on five surgery consults from the community hospital for the patient's surgery, which took nearly seven months from the first consult instead of 30 days.
Nine weeks after the delayed surgery, the facility's oncology provider observed the patient's "changes" in the development of oral cancer and advised radiation therapy wouldn't be "beneficial," according to OIG.
The next steps led the patient to be placed in palliative care where they died.
The OIG's recommendations include one recommendation to the facility's undersecretary for health to standardize follow-up requests from the community provider and two recommendations to the facility director related to completing consults within 30 days and coordinating oncology care in the community.
According to the investigation, "The OIG concluded that the facility’s failure to schedule community care appointments timely, failure to coordinate radiation therapy, and delay in coordinating chemotherapy within the requested time limited the patient’s opportunity to receive optimal treatment and potentially a more favorable outcome."
“We believe that this is a problem that can be resolved with a change in protocol. It’s not a blame game, let’s not blame the VA, let’s not blame the doctors of the private care," said Jannie Layne, Founder, Bo's Blessings.
Layne says this isn’t the first-time situations like this happened…her organization specializes in stepping in when the government gets in the way. Going forward she believes in solutions.
“We've got to find ways to quit layering on levels to prevent healthcare. Communication, Communication is the key if we could get our private sector and our military sector to communicate more with one another," said Layne.
Arkansas US Senators John Boozman and Tom Cotton along with Congressman Steve Womack gave a statement Tuesday on the report released by the OIG.
Sen. Tom Cotton:
“The Fayetteville VA Medical Center’s staff failed in their duty to this veteran—completely unacceptable. I will work with my colleagues to investigate this incident, hold to account those responsible, and prevent this negligence in the future."
Sen. John Boozman
“In this instance, the Fayetteville VA Medical Center failed to live up to its mission. Negligence in ensuring a veteran receives the quality and timely care they deserve is unacceptable. I will be working with my colleagues to ensure those responsible will be held accountable and this never happens again, in Arkansas or elsewhere."
Congressman Steve Womack
“The report details an unacceptable failure on behalf of one of our heroes. Actions, or lack thereof, which jeopardize the health and well-being of any veteran breach the required and deserved standard of care. It’s a situation never to be repeated—and those liable must be held accountable. I will be working alongside my colleagues to ensure those obligations are met."
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