VA Loma Linda blamed for serious staffing shortages at outpatient clinics

The VA Loma Linda Healthcare System failed to provide oversight for a company that encountered serious staffing shortages after assuming management of five outpatient clinics in October 2021, forcing a staggering number of patients to be referred to outside physicians for care, according to a new federal report.

The 40-page report, released this week by the VA’s Office of Inspector General, said that in 2022 VA Loma Linda made 992 referrals from its clinics in Rancho Cucamonga, Corona, Murrieta, Victorville and Palm Desert — the highest among all VA community-based outpatient facilities.

The clinics are managed by Virginia-based STG International, which began operating the facilities on behalf of VA Loma Linda on Oct. 1, 2021.

About two weeks later, according to the OIG report, STGi operational problems surfaced when VA Loma Linda officials received a media inquiry about a patient who encountered “access issues” at the Palm Desert clinic.

VA Loma Linda officials expected the clinics would be fully operational but found instead that services were limited to urgent or emergency care, the report states.

Officials with STGi did not respond to repeated phone calls and emails seeking comment on the OIG report.

Six weeks after STGi assumed management, the five clinics had 63% of the staff required to operate the facilities. By February 2022, staffing levels at the clinics had increased to 73%, the OIG said.

By the end of 2021, each clinic provider was responsible for more than 1,400 patients, exceeding the maximum level established by the VA, the report states.

As a result of staffing shortages and full caseloads for providers, VA Loma Linda officials in May 2022 paused enrollment for new patients at the five STGi-operated clinics and began referring patients to outside physicians in the community. However, the OIG determined that VA Loma Linda did not meet the VA’s expectations for scheduling timely patient referral appointments.

After the pause in enrollment at the clinics, the average time frame for making appointments ranged from 28 to more than 53 days, far exceeding the VA’s target of seven days, said the OIG.

“The OIG is concerned that other factors, such as consult workflow or staff productivity, may have affected the ability of the system’s community care staff to process consults timely,” the report said, adding that no patients were identified as having poor outcomes.

Before handing over management responsibilities to STGi, VA Loma Linda lacked an organizational structure to provide oversight of outpatient clinics, communicate with stakeholders and review performance metrics, the OIG said

“The OIG determined that this lack of structure, coupled with the need to take steps to improve clinic management and a turnover of key leadership positions, created a vulnerability in the overall management and oversight of primary care services provided at the clinics,” the report states.

VA Loma Linda said it has taken steps to address and correct issues uncovered by the OIG.

“We appreciate the Inspector General’s review and have swiftly implemented multiple process changes to Increased Utilization of primary care in the community by the VA Loma Linda Healthcare System … ensuring that we are fully ready to provide world-class care to veterans,” VA Loma Linda said in a statement. “In addition, we initiated improvements in access and expanded sites of care with an increase in clinical staffing.”

VA Loma clinics have reduced the use of referrals to outside, community providers by 75%

Also, as of this month, primary care access has improved, with wait times for new patients averaging about 22 days, a substantial decrease from previous years, VA Loma Linda said.

The OIG’s findings are the latest in a string of management issues at VA Loma Linda.

For more than a year, employees have complained of retaliation for reporting missteps including the promotion of a supervisor who routinely harassed workers, the mismanagement of more than $1 million in patient transportation funds, and the illegal use of involuntary psychiatric holds.

Congress is investigating complaints from VA Loma Linda employees.

Source: Orange County Register