A recent report published by the Government Accountability Office concluded that all four of the VA hospitals examined failed to implement peer review rules. There are three levels of review after an adverse event at VA hospitals. The first is a peer review. Experienced medical providers examine the history of treatment that a patient received. After the review, the board of providers makes a determination about whether the treatment was appropriate. This is the most informal, and it is “protected,” because the proceedings are confidential. The next level of review is for the purpose of determining whether adverse action is appropriate. These two higher level reviews are not confidential and are not “protected.”
Under VA policies, the informal review must be concluded within 45 days. The deadline to complete the two higher level reviews is 120 days. Each hospital must have written policies in place which would “trigger” the review system. In Nashville, Seattle, Dallas, and Augusta, Maine, the GAO found that none met all of the four requirements – timelines were not observed, written policies were not implemented, and doctor competence issues were not sent to unprotected boards. Some hospitals met some rule requirements, other hospitals met other rule requirements, but the performance was inconsistent.