Department of Veterans Affairs
	

Office of Inspector General
	

Healthcare Inspection
 

Provider Privileging and
 

Delayed Patient Care
 

VA Connecticut Healthcare System
 

West Haven, Connecticut
 

Report No. 11-01733-208 June 28, 2011
	 VA Office of Inspector General
	

Washington, DC 20420
	
To Report Suspected Wrongdoing in VA Programs and Operations: 

Telephone: 1-800-488-8244 

E-Mail: vaoighotline@va.gov 

(Hotline Information: http://www.va.gov/oig/contacts/hotline.asp) 
Provider Privileging and Delayed Patient Care, VA Connecticut Healthcare System, West Haven, CT 

Executive Summary
	

The VA Office of Inspector General Office of Healthcare Inspections (OHI) conducted a 

review to determine the validity of allegations regarding a service’s administrative 

practice at the VA Connecticut Healthcare System West Haven Campus, West Haven, 

CT. 

The complainant alleged that the service chief did not recently provide direct patient care, 

did not meet the requirements for physician re-privileging, and intentionally delayed 

patient care based on the assigned provider. 

We did not substantiate that the service chief: 

	 Did not provide recent direct patient care or meet the requirements for 

re-privileging; however, VA Connecticut Healthcare System leadership is taking 

steps to clarify the requirements for documentation of clinical competence for 

privileging based on the OHI Combined Assessment Program Review of the VA 

Connecticut Healthcare System West Haven, Connecticut, Report 

Number 10-03090-87, February 14, 2011. 

	 Delayed patient care based on the assigned provider. 

The VISN and System Directors concurred with our findings. We made no 

recommendations. 

VA Office of Inspector General i 
DEPARTMENT OF VETERANS AFFAIRS
	

Office of Inspector General
	

Washington, DC 20420
	

TO:		 Director, VA New England Healthcare System (10N1) 

SUBJECT:		 Healthcare Inspection – Provider Privileging and Delayed Patient Care, 

VA Connecticut Healthcare System, West Haven, Connecticut 

Purpose 

The VA Office of Inspector General (OIG) Office of Healthcare Inspections (OHI) 

reviewed allegations regarding a service’s administrative practice at the VA Connecticut 

Healthcare System West Haven Campus (facility) West Haven, CT. The purpose of the 

inspection was to determine if the allegations had merit. 

Background 

The VA Connecticut Healthcare System has two campuses located in Newington and 

West Haven, CT. The facility is part of Veterans Integrated Service Network (VISN) 1 

and serves a veteran population of more than 253,000 in Connecticut and southern New 

England. The 230-bed facility provides comprehensive healthcare through inpatient and 

outpatient services in medicine, surgery, psychiatry, specialty areas, physical medicine 

and rehabilitation, neurology, oncology, dentistry, and long-term care services. 

In February 2011, a complainant contacted OIG’s Hotline Division regarding a service 

chief’s administrative practices. The complainant alleged that the facility service chief: 

	 Did not provide recent direct patient care or meet the requirements for 

re-privileging.1 

	 Delayed patient care based on the assigned provider. 

Scope and Methodology 

While onsite April 5–6, 2011, we interviewed facility leaders and staff pertinent to the 

allegations. Additionally, we conducted telephone interviews with staff reported as 

1 Re-privileging is the process of granting a physician continuing permission to practice a specialty within a health 

care setting for a specified period of time. 

VA Office of Inspector General 1 
Provider Privileging and Delayed Patient Care, VA Connecticut Healthcare System, West Haven, CT 

having knowledge of the allegations. We reviewed relevant facility and Veterans Health 

Administration policies and related documents including patient care assignments, 

performance improvement (PI) data, and physician credentialing and privileging files. 

We conducted the inspection in accordance with Quality Standards for Inspection and 

Evaluation published by the Council of the Inspectors General on Integrity and 

Efficiency. 

Inspection Results 

Issue 1: Direct Patient Care and Physician Re-Privileging Requirements 

We did not substantiate that the service chief did not recently provide direct patient care 

and therefore, did not meet a requirement for physician re-privileging. We reviewed the 

service chief’s credentialing and privileging folder as well as patient assignments within 

the service for the previous 18-month period. OHI Combined Assessment Program 

Review of the VA Connecticut Healthcare System West Haven, Connecticut, Report 

Number 10-03090-87, February 14, 2011, recommended physician privileging 

documentation revision. Although the service chief did not have documentation of 

requirements for core privileges, those interviewed reported that the service chief is 

regularly present in patient care areas and is actively involved in direct patient care and 

supervision of resident physicians. Facility leadership is taking steps to clarify 

requirements for documentation of clinical competence for re-privileging to ensure all 

providers have appropriate documentation to warrant re-privileging. 

Issue 2: Delays in Patient Care 

We did not substantiate that the service chief delayed patient care based on provider 

assignments. We interviewed staff and reviewed PI data regarding timeliness of care 

over the previous 18 months. Staff stated that the service chief did change the order of 

patient care assignments based on the needs of the patient and staff involved in the care. 

Staff interviewed could not recall any change that targeted any specific provider by the 

service chief. A review of PI data over 18 months showed that the identified service 

accounted for less than 6 percent of patient care delays, and there was no individual 

provider identified with a higher percentage of delays than with the other providers. 

Conclusions 

We did not substantiate any of the allegations. We found evidence of appropriate 

administrative practices by the service chief. Although the service chief did not have 

facility specific requirements for requesting physician re-privileging documented, the 

facility leadership recognized that all providers’ credentialing and privileging 

requirements needed revision. Facility leadership is taking steps to clarify requirements 

for documentation of clinical competence for re-privileging for all facility providers. 

VA Office of Inspector General 2 
Provider Privileging and Delayed Patient Care, VA Connecticut Healthcare System, West Haven, CT 

OHI inspectors from the recent Combined Assessment Program review will follow up on 

facility physician privileging revisions. The service chief did have recent patient care 

involvement and did not cause patient care delays related to assigned providers. 

We made no recommendations. 

Comments 

The VISN and System Directors concurred with our findings. See Appendixes A and B, 

pages 4–5 for the full text of their comments. 

JOHN D. DAIGH, JR., M.D.
 

Assistant Inspector General for
 

Healthcare Inspections
 

VA Office of Inspector General 3 
ed Patient Care

Director Comments

England Healthcare System (10N1

ection

Connecticut

nagement Review Service (10

Healthcare System (10N1) concurs with

mith, MD,

England Healthcare System (10N1)

Provider Privileging and Dela ,

VI

Department

Veterans Affa

Healthcare I Delayed

Patient Care, Haven,

Dallas

VA New

Director, VA

Connecticut Healthcare Syste

Memorandu

Provider Privileging and

Healthcare System, We

VA New England Healthcare System (10N1) concurs

Provider Privileging and Delayed Patient Care, VA Connecticut Healthcare System, West Haven, CT 

Appendix A 

VISN Director Comments 

Department of 

Veterans Affairs Memorandum 

Date: June 2, 2011 

From: Director, VA New England Healthcare System (10N1) 

Subject: Healthcare Inspection – Provider Privileging and Delayed 

Patient Care, VA Connecticut Healthcare System, West Haven, 

Connecticut 

To: Director, Dallas Office of Healthcare Inspections (54DA) 

Thru: Director, VHA Management Review Service (10A4A4) 

VA New England England Healthcare System (10N1) concurs with 

this report. 

Michael Mayo-Smith, MD, MPH
 

Director, VA New England Healthcare System (10N1)
 

VA Office of Inspector General 4 
Provider Privileging and Delayed Patient Care, VA Connecticut Healthcare System, West Haven, CT 

Appendix B 

Facility Director Comments 

Department of 

Veterans Affairs Memorandum 

Date:	 June 2, 2011 

From:	 Director, VA Connecticut Healthcare System (689/00) 

Subject:	 Healthcare Inspection – Provider Privileging and Delayed 

Patient Care, VA Connecticut Healthcare System, West Haven, 

Connecticut 

To:	 Director, VA New England Healthcare System (10N1) 

VA Connecticut Healthcare System reviewed this healthcare 

inspection report and concurs with the findings. 

(original signed by:) 

Vincent Ng
 

Director, VA Connecticut Healthcare System (689/00)
 

VA Office of Inspector General 5 
Provider Privileging and Delayed Patient Care, VA Connecticut Healthcare System, West Haven, CT 

Appendix C 

OIG Contact and Staff Acknowledgments 

OIG Contact For more information about this report, please contact the 

Office of Inspector General at (202) 461-4720 

Acknowledgments Cathleen King, RN, Project Leader 

Maureen Washburn, RN, Team Leader 

Larry Ross, MS 

Robert Yang, MD, Medical Consultant 

Misti Kincaid, BS, Program Support Assistant 

VA Office of Inspector General 6 
Provider Privileging and Delayed Patient Care, VA Connecticut Healthcare System, West Haven, CT 

Appendix D 

Report Distribution
	

VA Distribution 

Office of the Secretary 

Veterans Health Administration 

Assistant Secretaries 

General Counsel 

Director, VA New England Healthcare System (10N1) 

Director, VA Connecticut Healthcare System, West Haven Campus (689/00) 

Non-VA Distribution 

House Committee on Veterans’ Affairs 

House Appropriations Subcommittee on Military Construction, Veterans Affairs, and 

Related Agencies 

House Committee on Oversight and Government Reform 

Senate Committee on Veterans’ Affairs 

Senate Appropriations Subcommittee on Military Construction, Veterans Affairs, and 

Related Agencies 

Senate Committee on Homeland Security and Governmental Affairs 

National Veterans Service Organizations 

Government Accountability Office 

Office of Management and Budget 

US Senate: Richard Blumenthal, Joseph I. Lieberman 

US House of Representatives: Rosa DeLauro 

This report is available at http://www.va.gov/oig/publications/reports-list.asp. 

VA Office of Inspector General 7