Inspectors reviewed medical records of patients who had completed ADs, and interviewed employees who had worked directly with patients in the AD process. We concluded that VHA's AD program operates effectively but could be strengthened in several areas. Inspectors found that physicians complied with patients' ADs in a majority of the reviewed cases, and that clinicians provided reasonable treatment and comfort interventions for all patients who had completed ADs.
Social workers are clearly leaders in counseling patients regarding ADs.
Most employees regard VHA's AD forms as too complex in format and language for the patient population. Some VAMC employees refuse to witness patients' AD documents because they do not feel qualified to determine the patients' AD status, and freedom from duress. Medical Center employees filed AD forms in a variety of medical record locations, resulting in problems locating these forms.