Thousands of medical tests delayed, improperly canceled at VA facilities, audit finds

Donovan Slack | USA TODAY

Show Caption Hide Caption VA canceling thousands of diagnostic tests across the country Radiology technologist Jeff Dettbarn, alleges thousands of tests at the Iowa City VA were improperly canceled, potentially risking veterans’ lives.

WASHINGTON – Veterans Affairs employees improperly canceled tens of thousands of orders for diagnostic medical tests such as X-rays and cardiac imaging, jeopardizing the health of some patients, a wide-ranging audit by the VA's inspector general found.

In other cases, tests were delayed for weeks.

Auditors blamed the problems on backlogs, breakdowns and mismanagement at every level, from the facilities around the country where veterans get medical care to headquarters in Washington, D.C.

In one case outlined by auditors, a veteran waited 42 days for an MRI after a CT scan detected a lesion in his brain. Urgent tests like that should be done within two weeks.

The patient's test was not scheduled until a doctor called, more than a month after ordering the test, to ask why it hadn't been done.

The test result "identified a type of malformation that can cause brain hemorrhages,” the audit said. It didn't identify the facility where the delay occurred.

The audit, released Tuesday, corroborates a USA TODAY investigation last year that revealed more than 250,000 radiology orders at VA hospitals across the country had been canceled since 2016.

Investigation: Mass cancellations of diagnostic test orders at VA hospitals draw scrutiny

Mass cancellations

After reviewing exam orders at VA facilities in several states, auditors concluded staff did not follow guidelines when canceling an estimated 106,000 requests for radiology and nuclear medicine tests. That meant tests were delayed or may not have been done.

The cancellations occurred from September through December 2017, but many of the tests had been ordered months or years earlier.

Radiology supervisors didn't have controls “to ensure canceled ... requests received the appropriate clinical review,” auditors wrote.

Auditors did not conclude veterans had been harmed, but they found lapses that put them at risk.

The VA's inspector general referred a half-dozen cases, out of a sampling of 113 canceled orders, to VA officials for further review because those patients may still need the diagnostics.

They included an ultrasound exam of a veteran’s liver ordered in 2016, a CT scan of a vet’s chest requested in 2017, a kidney ultrasound order from 2017 and an aortic ultrasound requested in 2015.

VA pledges improvement

VA officials acknowledged the problems and pledged to make changes. That includes ensuring those veterans get any needed care they didn't receive.

"Our office has expended considerable resources and time to develop solutions to the concerns raised," the national VA radiology office said in a written response to the audit.

USA TODAY's report raised questions about whether some facilities, in an effort to clear out outdated or duplicate diagnostic orders, canceled orders that veterans may still have needed.

Employees at VA hospitals in Iowa City, Iowa, and Tampa, Florida, told USA TODAY that veterans showed up for CT scans or mammograms, only to learn orders for the tests had been canceled. In other cases, upcoming follow-up scans were canceled.

"I feel justified in speaking out," said Jeffrey Dettbarn, a CT technologist who raised concerns about cancellations at the Iowa City VA. "I look forward to seeing the accountability for those responsible and that the veterans receive the care they’re entitled to."

Dettbarn was reassigned to administrative duties after speaking out in July 2017.

To assess exam backlogs and order cancellations, auditors examined nine VA facilities and contacted staff at about 40. In addition to Iowa City and Tampa, they examined facilities in Cleveland; Las Vegas; Los Angeles; Dallas; Salisbury, North Carolina; Aurora, Colorado; and Bay Pines, Florida.

Tests delayed

They concluded as many as 115,000 exams hadn't been completed on time — within two weeks for urgent requests or within a month for routine tests. That was out of an estimated 660,000 exams completed from October through December 2017.

Roughly one in six routine tests took an average of 43 days to complete. One in four urgent exams took an average of 34 days, more than twice as long as they should have.

Auditors blamed the delays on short-staffing at VA health care facilities, equipment shortages and poor oversight.

In an effort to eliminate a growing backlog of tests, officials in charge of radiology nationwide issued four different policies in 2016 and 2017, with differing or unclear instructions on who was authorized to review or cancel orders and when.

National VA officials expected regional managers to ensure local facilities followed policies. But, auditors wrote, “there was no clear direction that outlined these expectations,” and regional oversight was inconsistent.

At the local level, VA managers failed to make sure clinical providers reviewed outdated or overdue orders before they were canceled, in case patients still needed the tests.

Auditors recommended the VA improve oversight of diagnostic test orders and exams, implement internal audits to catch problems and ensure veterans get the tests they need.

VA officials pledged to have fixes in place by July.