Department of Veterans Affairs
	

Office of Inspector General
	

Healthcare Inspection
 

Delays in Cancer Care
 

West Palm Beach VA Medical Center
 

West Palm Beach, Florida
 

Report No. 11-00930-210 June 29, 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) 
Delays in Cancer Care, West Palm Beach VA Medical Center, West Palm Beach, Florida 

Executive Summary
	

The VA Office of Inspector General Office of Healthcare Inspections conducted an 

inspection to determine the validity of allegations of delayed cancer care at the West 

Palm Beach VA Medical Center, West Palm Beach, FL. 

We reviewed allegations that patients did not receive timely treatment after a diagnosis of 

lung or renal cancer; these patients did not receive timely cardiac risk assessment prior to 

surgery; and facility management was aware of, but unresponsive to, these issues. 

We did not substantiate the allegation that lung cancer patients did not receive timely 

treatment. We found no delays in the initiation of treatment for lung cancer patients with 

a confirmed diagnosis, regardless of the treatment modality (surgery, chemotherapy, or 

Fee Basis radiation therapy). 

We substantiated the allegation that renal cancer patients faced delays in treatment. For 

those patients who were referred to another VA Medical Center for care, there was no 

mechanism in place to follow their progress and verify that treatment was provided. 

These patients faced significantly longer wait times for treatment than those patients 

whose treatment option was available at the West Palm Beach VA Medical Center. 

We also substantiated that management was aware of problems with timely renal cancer 

care for one patient, but made no effort to follow up on this. We did not substantiate that 

there were delays in obtaining cardiac risk assessment prior to patients’ surgery for lung 

or renal cancer. 

We made three recommendations. We recommended that the Medical Center Director 

ensure that formal processes are strengthened for tracking the timeliness of cancer care 

through the ongoing use of metrics and milestones, and ensure that processes are 

implemented to improve the coordination of care for patients referred to other VA 

Medical Centers for cancer treatment. We further recommended that the VISN Director 

require a review of surgical wait times for cancer patients at the Miami VA Medical 

Center. 

The VISN and Medical Center Directors concurred with our findings and 

recommendations. Several process improvements have been implemented and the Chief 

of Surgery at the Miami VA Medical Center reviewed surgical wait times for lung and 

renal cancer patients. 

VA Office of Inspector General i 
DEPARTMENT OF VETERANS AFFAIRS
	

Office of Inspector General
	

Washington, DC 20420
	

TO:		 Director, VA Sunshine Healthcare Network (10N8) 

SUBJECT:		 Healthcare Inspection – Delays in Cancer Care, West Palm Beach VA 

Medical Center, West Palm Beach, Florida 

Purpose 

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

an inspection to determine the validity of allegations of delayed cancer care at the West 

Palm Beach VA Medical Center (the facility), West Palm Beach, FL. 

Background 

The facility is a level 1c, tertiary care Medical Center within Veterans Integrated Service 

Network (VISN) 8. The facility offers a number of specialty services involved in the 

treatment of cancer, including oncology, pulmonology, urology, and surgery. Diagnostic 

radiology services are available at the facility while radiation therapy treatments are 

offered to patients through Fee Basis authorizations for services with non-VA community 

providers. Some surgical procedures not available at the facility are provided at the 

Miami VA Medical Center (VAMC), approximately 70 miles away. 

In December 2010, a confidential complainant alleged that there were marked delays 

between diagnosis and treatment for patients with malignant lung or renal (kidney) 

tumors. No patient names were provided, although a time frame of September through 

December 2010 was referenced. Specifically, the complainant alleged that: 

	 Patients did not receive timely treatment after a diagnosis of lung or renal cancer. 

	 These cancer patients did not obtain timely cardiac risk assessment when needed 

for clearance prior to surgery. 

	 Management was aware of, but unresponsive to, the above issues. 

Scope and Methodology 

We conducted a site visit February 16–17, 2011, at the facility and interviewed the Chief 

of Staff and other clinical, administrative, and management staff with knowledge relevant 

VA Office of Inspector General 1 
Delays in Cancer Care, West Palm Beach VA Medical Center, West Palm Beach, Florida 

to the allegations. Follow-up phone interviews were completed on March 22 and 

April 25. We examined peer review reports, journal articles, clinical practice guidelines, 

case conference minutes, committee meeting minutes, cancer registry lists, service 

agreements, and presentations and toolkits from the Veterans Health Administration 

(VHA) Systems Redesign-Cancer Care Collaborative. We reviewed data from Veterans 

Health Information Systems and Technology Architecture (VistA)1 Consult Tracking and 

Appointment Management. We analyzed data published on the Veterans Support Service 

Center website for timeliness of care by treating specialty. We also reviewed electronic 

medical records for patients recently diagnosed with, and treated for, lung or renal cancer. 

The inspection was conducted in accordance with the Quality Standards for Inspection 

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

Efficiency. 

Inspection Results 

Issue 1: Delays in Cancer Treatment 

While we did not find that care was delayed for those patients diagnosed with lung 

cancer, we substantiated that some patients did not receive timely treatment following 

diagnosis of renal cancer. 

Lung Cancer 

The facility uses a designated Advanced Registered Nurse Practitioner (ARNP) as a 

“Tumor Navigator” (TN) to coordinate care, order diagnostic tests and consultations 

(consults), and ensure that multi-disciplinary treatment planning occurs as needed for 

cancer patients. The TN primarily focuses on lung cancer patients. She does not receive 

formal consults, but gets verbal referrals from any provider at the facility, for patients 

with known or suspected cancer. She also performs case finding via a review of imaging 

view alerts (radiology results suspicious for lung tumor). On a tracking spreadsheet, the 

TN records relevant data, including dates of clinical events in the treatment continuum, 

for the patients she follows. Cycle times are not calculated; therefore, overall timeliness 

of care has not been analyzed, nor has timeliness been reviewed by the Cancer 

Committee. 

Patients with lung cancer are reviewed in the Chest Conference. This is an interdisciplinary team meeting that convenes weekly to review treatment planning for patients 

with known or suspected lung cancer. The services typically involved with the treatment 

of lung cancer are pulmonology, oncology, thoracic surgery, and radiation therapy. 

Depending on the location and type of tumor, as well as the stage of disease and other 

medical factors, treatment options include surgery, chemotherapy, radiation therapy, or a 

1 VistA is a VHA health information system. 

VA Office of Inspector General 2 
Delays in Cancer Care, West Palm Beach VA Medical Center, West Palm Beach, Florida 

combination of these. After specialty consultation, and in some cases additional workup, treatment is scheduled. 

We found that 82 patients were newly diagnosed with lung cancer in calendar year 2010. 

We reviewed the medical records of these 82 patients to determine the timeliness of their 

cancer care. The median wait time for new lung cancer patients to be seen by 

pulmonology was 16.2 days. The median wait time for new lung cancer patients to be 

seen by oncology was 17.2 days. While we were on site in February 2011, Medical 

Administrative Service staff used VistA Appointment Management software to provide 

us with the next available appointment for an oncology consult; the wait for a new patient 

was 11 days. 

The median wait time for new lung cancer patients to be seen by thoracic surgery was 

9 days. Although the facility only had one 0.2 full time equivalent (FTE) thoracic 

surgeon, we found no delays due to the surgeon’s limited availability. 

Radiation therapy is available in the community through Fee Basis. For those patients 

whose treatment plan involved Fee Basis care (radiation therapy and/or “Cyberknife”2

), 

the consults were responded to immediately, and authorizations for treatment were 

generally issued within 1 business day. 

For cancer treatment, VHA follows evidence-based standards from the National Library 

of Medicine, National Cancer Institute, Physicians Data Query.3 While these guidelines 

specify recommendations for treatment, they do not include expected timeframes for 

when treatment should occur after diagnosis. In November 2010, the VHA Office of 

Patient Care Services released a study on the timeliness of lung cancer care. The VHA 

data, from 2007, showed the national average time from confirmed diagnosis to treatment 

of lung cancer was 35 days. The facility was included in this study. Their average time 

on the same metric was 37 days. This study also reported national median timeframes by 

treatment modality. Diagnosis to onset of chemotherapy was 28 days, diagnosis to onset 

of radiation therapy was 33 days, and diagnosis to surgical treatment was 50 days. 

Facility data on these metrics were not available. 

We found that 28 of the 82 patients diagnosed with lung cancer in 2010 either did not 

ultimately receive cancer treatment or did not receive their treatment through the VA. 

The reasons for this included: 

	 Choice of the patient 

	 Cancer was diagnosed at an advanced stage and the patient was referred for 

hospice care 

2 Cyberknife Robotic Radiosurgery System is a non-invasive alternative to surgery by delivering beams of high dose
 

radiation to tumors.
 3 VHA Directive 2003-034, National Cancer Strategy, June 23, 2003.
 

VA Office of Inspector General 3 
Delays in Cancer Care, West Palm Beach VA Medical Center, West Palm Beach, Florida 

 Patient pursued treatment outside of the VA 

 Other medical conditions precluded treatment 

 Further work-up was negative for malignancy 

We evaluated the timeliness of care for 47 of the remaining 54 patients. These 

47 patients had a confirmed diagnosis of lung cancer prior to initiation of treatment. The 

median timeframes from confirmed diagnosis to initiation of treatment are shown in 

Table 1 below. 

Table 1. Timeframes from Lung Cancer Diagnosis to Treatment. 

Diagnosis to 

Treatment: 

All Modalities 

Diagnosis to 

Treatment: 

Radiation 

Diagnosis to 

Treatment: 

Chemotherapy 

Diagnosis to Treatment: 

Radiation/Chemotherapy 

Combined 

Diagnosis to 

Treatment: 

Surgery 

28.8 days 26.8 days 35.6 days 24 days 39.3 days 

47 patients 26 patients 9 patients 9 patients 3 patients 

These timeframes compare favorably to the VHA median timeframes reported in the 

2010 report on timeliness of lung cancer care. 

Renal Cancer 

The TN who follows lung cancer patients is also tasked with following renal cancer 

patients. However, we were told that this provider is often detailed to other areas and 

does not have adequate time to closely follow this population. The facility could not 

provide a tracking spreadsheet for renal cancer where milestones in the treatment 

continuum are recorded. Because cycle times could not be calculated, the overall 

timeliness of care for renal cancer patients was not reviewed by the Cancer Committee, 

and delays in treatment were not identified. 

Patients with renal cancer are reviewed in the inter-disciplinary Renal Case Conference, 

scheduled on a monthly basis. Services often involved in the treatment of renal cancer 

are urology and oncology. There were 10 patients diagnosed with renal cancer at the 

facility during 2010. We reviewed the medical records of these 10 patients to determine 

the timeliness of their cancer care. We found that 5 of the 10 patients did not pursue 

further treatment from the VA for their cancer. Treatment was completed for 

four of the remaining five patients; treatment is still pending for one patient. 

Four of the 10 patients diagnosed with renal cancer in 2010 were referred to urology (the 

remaining patients diagnosed with renal cancer were already being followed by urology). 

The median wait for a new renal cancer patient to be seen was 11.75 days. Three of the 

10 newly diagnosed renal cancer cases were referred to outpatient oncology. The median 

wait for a new renal cancer patient to be seen by oncology was 11.7 days. 

VA Office of Inspector General 4 
Delays in Cancer Care, West Palm Beach VA Medical Center, West Palm Beach, Florida 

Per National Cancer Institute clinical practice guidelines,4 the treatment of choice for 

renal cancer is nephrectomy,5 a surgical procedure performed by a urologist. As with 

lung cancer, the VHA clinical practice guidelines for renal cancer do not specify time 

frames for surgical treatment. The National Cancer Institute guidelines are clear; 

however, that early surgical treatment is desirable as the survival rate declines sharply if 

the cancer has time to spread. 

Of the five patients who received their treatment through the VA, two patients had their 

surgery at the facility. Only one of these two patients had a confirmed diagnosis prior to 

surgery. The time from diagnosis to surgery was 35 days. 

The remaining three patients were referred to the Miami VAMC for procedures not 

available at the facility. Patient 1 had a nephrectomy at the Miami VAMC 113 days after 

receiving a confirmed diagnosis of renal cancer. Patient 2 opted for computed 

tomography guided radio frequency ablation (CT Guided RFA), an interventional 

radiology procedure. This procedure was performed 107 days after diagnosis. Patient 3 

was approved for a nephrectomy at the Miami VAMC, but is still waiting for this 

surgery. His scheduled surgery (May 2011) will be 155 days from the date of diagnosis. 

There is a significantly longer wait time for treatment for those patients who were 

referred to the Miami VAMC. Table 2 below illustrates the cycle times for these 

three patients. 

Table 2. Timeframes from Renal Cancer Diagnosis to Treatment at Miami VAMC. 

Time from Diagnosis 

to Referral 

Time from Referral 

to Treatment 

Total Time from Diagnosis 

to Treatment 

Patient 1 21 days 92 days 113 days 

Patient 2 4 days 103 days 107 days 

Patient 3 18 days 137 days* 155 days* 

*Based on date of scheduled treatment; treatment is pending. 

On March 22, 2011, we spoke with the Associate Chief of Staff (ACOS), the Chief of 

Surgery, and a urologist at the facility who concurred that these timeframes for treatment 

of renal cancer were “unacceptable” and told us they were unaware of this issue. The 

urologist told us that these cases should “definitely have been treated as urgent.” 

However, medical record documentation revealed that all three of these consults to 

Miami VAMC were sent with “routine urgency.” We found no documentation to 

4 National Library of Medicine, National Cancer Institute, Physicians Data Query (PDQ), 

http://www.cancer.gov/cancertopics/pdq/treatment/renalcell/HealthProfessional, accessed February 7, 2011.

5 Nephrectomy is the partial or complete removal of a kidney. 

VA Office of Inspector General 5 
Delays in Cancer Care, West Palm Beach VA Medical Center, West Palm Beach, Florida 

indicate that the referring providers called to speak to the Miami VAMC providers about 

the referred patients. 

We were told that there is no service agreement or other memorandum that delineates 

how facility patients should be managed when referred to another VA Medical Center. 

There was no process in place at the facility to track and monitor the progress of those 

patients who were referred to the Miami VAMC for treatment. We also found that there 

was no process in place to notify the referring provider that the procedure had been 

scheduled. Had providers been aware of the protracted wait times for treatment, they 

could have discussed other treatment options with the patients, referred them to another 

facility, or sought Fee Basis authorization for non-VA treatment in the community. 

Issue 2: Delays in Obtaining Cardiology Clearance for Surgery 

We did not substantiate the allegation that there were delays in obtaining cardiology preoperative risk assessment (hereafter referred to as “clearance”) for surgery. We found 

that cardiology consults were responded to in a timely manner for the seven patients with 

lung cancer who were referred for cardiology clearance. We found that six of 

seven consults were answered within the requested timeframe. We also found that six of 

seven consults had documentation of a clearance statement written on or attached to the 

consult note. On average, these patients were seen by cardiology within 14 days of the 

consult request, and the statement that the patient was “cleared” for surgery was 

documented within 25 days of the request. None of the patients with renal cancer in our 

sample were referred to cardiology for clearance. 

Issue 3: Management Responsiveness 

We substantiated the allegation that managers were aware of delays in renal cancer care 

for one patient, but made no efforts to follow up on this. We did not identify significant 

delays in lung cancer care. Managers told us that prior to our February site visit, they 

were unaware of problems with timely renal cancer care. Although we discussed this 

issue with the ACOS, the Chief of Surgery, and the urologist on March 22, 2010, and the 

urologist again on April 25, no action was taken to expedite care for one patient still 

awaiting treatment—at that time, 126 days since confirmed diagnosis. 

On March 22, we conducted a telephone interview with the ACOS, the Chief of Surgery, 

and the urologist to discuss delays in care for patients referred to the Miami VAMC. We 

informed them that two patients referred to the Miami VAMC had waited 107 and 113 

days for surgery following confirmed diagnosis of renal cancer, and that a third patient 

was still awaiting surgery which was scheduled to occur 155 days post diagnosis. The 

ACOS told us that had he been informed of the long waits faced by patients referred to 

the Miami VAMC for surgical treatment of their renal cancer, these patients would have 

been approved for Fee Basis treatment. He also told us that he was aware that the TN 

VA Office of Inspector General 6 
Delays in Cancer Care, West Palm Beach VA Medical Center, West Palm Beach, Florida 

was frequently tasked with duties in other clinical areas and did not have dedicated time 

to follow or track the renal cancer patients at the facility. 

The Chief of Surgery and the Urologist told us that they were also unaware of these long 

delays. We informed them that Patient 3 was still awaiting treatment, because the 

surgery was scheduled for late May 2010. These clinical leaders responded that this 

cycle time of 155 days was unacceptably long, especially because this patient’s work up 

for suspected renal cancer had initially begun in June 2010. 

On April 25, 4 weeks after we first discussed this with the facility, we reviewed 

Patient 3’s medical record to see if any action had been taken. We found no evidence 

that anyone from the facility had contacted the Miami VAMC or the patient about his 

surgery date. There was no documentation of any effort to arrange Fee Basis treatment. 

We found documentation that Patient 3 had presented to the Medical Center’s Emergency 

Department with pain (described by the treating provider as “cancer pain”) in late April. 

He was given morphine and instructed to keep appointments as scheduled with the Miami 

VAMC. 

On April 25, we again interviewed the urologist. He was unaware of the patient’s recent 

visit to the Emergency Department and confirmed that there had been no attempt to 

expedite treatment for this patient. The patient’s surgery was still scheduled for late May 

at the Miami VAMC, 350 days from first suspicion of renal cancer and 

155 days from confirmed diagnosis. 

Conclusions 

While we found no pattern of delays in care for those patients diagnosed with lung 

cancer, we substantiated the allegation that there were delays in treatment for patients 

diagnosed with renal cancer. 

We found that renal cancer patients referred to the Miami VAMC waited between 

3 and 5 months from confirmed diagnosis for their treatment. Facility providers sent 

consults to the Miami VAMC on these cancer patients with routine urgency, and there 

was no mechanism in place to follow their progress and verify that treatment was 

provided. 

We substantiated the allegation that facility management was aware of problems with 

timely renal cancer care for one patient, but made no effort to follow up on this. We did 

not substantiate the allegation that there were delays in obtaining cardiology risk 

assessments for lung and renal cancer patients scheduled for surgery at the facility. 

VA Office of Inspector General 7 
Delays in Cancer Care, West Palm Beach VA Medical Center, West Palm Beach, Florida 

Recommendations 

Recommendation 1. We recommended that the Medical Center Director ensure that 

formal processes are strengthened for tracking the timeliness of cancer care through the 

ongoing use of metrics and milestones. 

Recommendation 2. We recommended that the Medical Center Director ensure that 

processes are implemented to improve the coordination of care for patients referred to 

other VA Medical Centers for cancer treatment. 

Recommendation 3. We recommended that the VISN Director require a review of 

surgical wait times for cancer patients at the Miami VAMC. 

Comments 

The VISN and Medical Center Directors agreed with our findings and recommendations 

and provided acceptable action plans. See Appendixes A and B (pages 9–14) for the full 

text of the Directors’ comments. We will follow up on the proposed actions through 

completion. 

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

Assistant Inspector General for
 

Healthcare Inspections
 

VA Office of Inspector General 8 
Delays in Cancer Care, West Palm Beach VA Medical Center, West Palm Beach, Florida 

Appendix A 

VISN Director Comments 

Department of 

Veterans Affairs Memorandum 

Date: June 2, 2011 

From: Director, VA Sunshine Healthcare Network (10N8) 

Subject: Healthcare Inspection – Delays in Cancer Care, West Palm 

Beach VA Medical Center, West Palm Beach, Florida 

To: Director, Bay Pines Office of Healthcare Inspections (54SP) 

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

I have reviewed and concur with the conclusions presented by 

the Office of the Inspector General in the Healthcare 

Inspection – Delays in Cancer Care, West Palm Beach VA 

Medical Center, West Palm Beach, Florida. 

(original signed by:) 

Nevin M. Weaver, FACHE
 

Director, VA Sunshine Healthcare Network (10N8)
 

VA Office of Inspector General 9 
Delays in Cancer Care, West Palm Beach VA Medical Center, West Palm Beach, Florida 

Appendix B 

Medical Center Director Comments 

Department of 

Veterans Affairs Memorandum 

Date: May 25, 2011 

From: Director, West Palm Beach VA Medical Center (548/00) 

Subject: Healthcare Inspection – Delays in Cancer Care, West Palm 

Beach VA Medical Center, West Palm Beach, Florida 

To: Director, VA Sunshine Healthcare Network (10N8) 

Thank you for your comprehensive report on renal cancer 

tracking when patients are referred to a Medical Center 

outside West Palm Beach VA. 

(original signed by:) 

Charleen R Szabo, FACHE
 

Director, West Palm Beach VA Medical Center (548/00)
 

VA Office of Inspector General 10 
Delays in Cancer Care, West Palm Beach VA Medical Center, West Palm Beach, Florida 

Directors’ Comments 

to Office of Inspector General’s Report 

The following Directors’ comments are submitted in response to the 

recommendations in the Office of Inspector General’s report: 

OIG Recommendations 

Recommendation 1. We recommended that the Medical Center Director 

ensure that formal processes are strengthened for tracking the timeliness of 

cancer care through the ongoing use of metrics and milestones. 

Concur Target Completion Date: June 30, 2011 

Facility’s Response: 

1. The consult entitled “Referrals Outside West Pam Beach (WPB)” has been 

reviewed and the following mandatory field has been added: 

“Is this request for cancer treatment or evaluation?” Yes or No 

When the response is “Yes”, the referral title changes to “Referrals Outside 

WPB-CANCER” and the consult will print on the WPB Transfer 

Coordinator’s printer. When the response is “Yes”, the urgency of the 

consult automatically changes from “Routine” to “Within 2 Weeks.” 

2. The new consult entitled “Referrals Outside WPB-CANCER” asks if the 

WPB provider spoke to a point of contact person (POC) in Miami and if so, 

the name of the POC. 

3. WPB Urology providers have been instructed to ensure all pulmonary and 

cardiac work-ups, if required, are completed prior to placing the consult. A 

third question was added to the consult for non-emergent cases requiring 

the urology provider to document the patient is optimized for surgery. 

4. All hand off communication between WPB and Miami providers will be 

clearly documented in the electronic medical record (EMR). 

5. The WPB Transfer Coordinator will hand off all consults for Referrals 

Outside WPB-CANCER to the WPB Tumor Navigator. 

VA Office of Inspector General 11 
Delays in Cancer Care, West Palm Beach VA Medical Center, West Palm Beach, Florida 

6. All renal cancer patient consults will be coded “90” and an alert to identify 

the renal patients will be sent to the WPB Tumor Navigator and Physician 

Assistant. 

7. The WPB Tumor Navigator will enter all consults for radiology code “90” 

renal cancer into a spreadsheet. 

8. A Physician Assistant in WPB Urology has been identified as the POC for 

all urology cases consulted out to other VAs or as a result of Fee Basis. 

9. A Nursing Coordinator dedicated to Miami Urology has been identified and 

will be the POC for WPB Physician Assistant. 

10. The WPB Physician Assistant will have access on the U-drive to the WPB 

Tumor Navigator spreadsheet. 

11. The WPB Transfer	 Coordinator, WPB Physician Assistant and WPB 

Tumor Navigator will meet monthly to discuss plan of care timeline 

progression and the Physician Assistant will facilitate 

treatments/procedures as required. 

12. The WPB Physician Assistant will follow up when delays are identified 

with the Miami POC to ensure renal patients are seen within 3 weeks as 

requested. Any patient not seen within 3 weeks will be identified and the 

Chief of Surgery and the Section Chief for Urology at WPB will be notified 

by the WPB Physician Assistant. 

13. During the weekly follow-up the WPB Physician Assistant will identify 

patients that have completed WPB work-up and report to Miami Urology 

Nurse Coordinator to ensure renal patients are then scheduled to see Miami 

Urology Surgery timely. 

14. The WPB Transfer Coordinator and the Physician Assistant will review all 

“Plans for Care” after the patients are seen at the referred Medical Center 

and will ensure all treatment/procedures required that are to be completed at 

WPB will be ordered and completed timely. 

15. Timeliness of care cycle times will be calculated and analyzed and will be 

compared to the national average from “confirmed diagnosis to treatment.” 

The data will be tracked and trended and will be reported quarterly by the 

WPB Tumor Navigator to the Cancer Committee up to the Clinical 

Executive Board semi-annually (January and July). 

Status: Pending full implementation 

VA Office of Inspector General 12 
Delays in Cancer Care, West Palm Beach VA Medical Center, West Palm Beach, Florida 

Recommendation 2. We recommended that the Medical Center Director 

ensure that processes are implemented to improve the coordination of care 

for patients referred to other VA Medical Centers for cancer treatment. 

Concur Target Completion Date: June 30, 2011 

Facility’s Response: 

1. The WPB ARNP Tumor Navigator, on an ongoing basis, will track 

cancer case treatment progress internally and externally to ensure timely 

treatment. 

2. The WPB Transfer Coordinator and Physician Assistant will ensure all 

required tests and procedures recommended by the referral facility to be 

performed at WPB are ordered and completed timely. 

3. The WPB Transfer Coordinator will report testing/procedures required 

with the scheduled date to the WPB Physician Assistant. 

4. The WPB Physician Assistant will track test/procedures completed as 

scheduled and will identify all timeliness in care issues when identified. 

WPB Physician Assistant will then discuss issues with the referral POC 

to identify timely resolution. 

5. All timeliness in care issues that cannot be facilitated will be identified 

by the WPB Physician Assistant and reported when identified to the 

WPB Tumor Navigator, the WPB Chief of the Surgery and the WPB 

Urology Department Section Chief. 

6. All timeliness in care issues identified to the WPB Chief of Surgery and 

POC Urologist will be discussed when identified with Miami POC 

Urologist. The updated plan of care will be documented in the EMR at 

both facilities. 

7. During this collaborative meeting, if timeliness of care issues dictates, a 

Fee Basis Consult will be considered and the justification for the 

decision will be documented in the EMR. 

Status: Pending full implementation 

VA Office of Inspector General 13 
Delays in Cancer Care, West Palm Beach VA Medical Center, West Palm Beach, Florida 

Recommendation 3. We recommended that the VISN Director require a 

review of surgical wait times for cancer patients at the Miami VAMC. 

Concur Target Completion Date: June 2, 2011 

Facility’s Response: 

The Chief of Surgery at the Miami VAMC conducted a review of urology 

and thoracic cancer surgery cases to identify potential delays in care. After 

the review and analysis of the cases, no issues were identified regarding 

delays in the thoracic surgery cancer cases. A few patients with urological 

cancers where identified where timeliness may have been an issue. 

However, the disease process was very different in those cases. To effect a 

change in care, the Miami VAMC has determined that all patients with 

kidney or bladder cancer identified in the consults will be seen within 

3 weeks of referral. 

Status: Complete 

VA Office of Inspector General 14 
Delays in Cancer Care, West Palm Beach VA Medical Center, West Palm Beach, Florida 

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	 Christa Sisterhen, MCD, Regional Director, Project Leader 

Karen McGoff-Yost, LCSW, Team Leader 

Michael Shepherd, MD 

VA Office of Inspector General 15 
Delays in Cancer Care, West Palm Beach VA Medical Center, West Palm Beach, Florida 

Appendix D 

Report Distribution
	

VA Distribution 

Office of the Secretary 

Veterans Health Administration 

Assistant Secretaries 

General Counsel 

Director, VA Sunshine Healthcare Network (10N8) 

Director, West Palm Beach VA Medical Center, West Palm Beach, Florida (548/00) 

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 

U.S. Senate: Bill Nelson, Marco Rubio 

U.S. House of Representatives: Alcee L. Hastings, Bill Posey, Tom Rooney, Allen West 

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

VA Office of Inspector General 16