Delay of a Patient’s Prostate Cancer Diagnosis, Failure to Ensure Quality Urologic Care, And Concerns with Lung Cancer Screening at the Central Texas Veterans Health Care System in Temple

The VA Office of Inspector General (OIG) conducted a healthcare inspection to review allegations of a delay in diagnosis of a patient’s prostate cancer and lung cancer at the Central Texas VA Health Care System (facility) in Temple, Texas. The OIG substantiated a delay in the diagnosis of the patient’s prostate cancer, identified concerns with the quality of care provided by two nurse practitioners in the urology clinic, and found facility leaders failed to ensure the competency of nurse practitioners to practice independently. The OIG was unable to substantiate a delay in the patient’s lung cancer diagnosis. However, the OIG identified a related concern regarding leaders’ failure to communicate expectations that providers offer patients low-dose computed tomography (CT) scans in the community for lung cancer screening. Two nurse practitioners failed to offer the patient a prostate biopsy despite elevated prostate-specific antigen levels and an abnormal prostate exam. Additionally, facility leaders did not complete required focused professional practice evaluations when the nurse practitioners were granted independent privileges and ongoing professional practice evaluations did not include any urology-specific indicators. Finally, although facility leaders informed providers about low-dose CT for lung cancer screening, the communication lacked clear expectations and direction for which patients should be screened. The OIG made four recommendations to the Facility Director: (1) to review the care both nurse practitioners provided to the patient, (2) to review the care both nurse practitioners provided to other urology patients, (3) to review the privileging and professional practice evaluation processes and performance indicators for nurse practitioners granted full practice authority in specialty care clinics, (4) and to ensure that facility leaders communicate expectations related to low-dose CT to facility primary care providers.