5-0061 From: Krause, Melanie R. (DIG). Sent: Wednesday, October 22, 2014 11:40 AM To: Krause, Melanie R. (016) Subject: Upcoming OIG inspection Good morning, i am contacting you on behalf of the Office of Inspector General, Of?ce of Healthcare inspections. We recently began work to examine the following allegations: 1. Beginning in the 2011 timeframe, VA Maine Healthcare System leadership instructed staff to utilize the following inappropriate practices in order to meet mental health access?related benchmarks: a. For an unspecified amount of time, discontinue using the consult package to track referrals for mental health services. In lieu of using the consult package, referrals were made via phone, in person or through "view alerts" in the patient records. After resuming the use of the consult package to track referrals to mental health services, restrict who could submit mental health consults and implement practices to close consults before the requested services were rendered. For an unspecified amount of time, included language in the consult package to direct providers not to request mental "health consults if the patient was not willing to be seen within 14 days. . Utilize "intake workshops,? mental health classes, or any other type of mental health?related individual or group session in order to meet benchmark for timely mental health assessments and ?mental health workshops? to meet benchmark for timely follow up referrals, despite staff concerns about the clinical appropriateness of these practices. For a several week period, in order to meet benchmark for same day access, discontinue scheduling mental health appointments in advance and instead utilize drop-in clinics. Omit information related to mental health conditions that could be service connected from clinical notes in order to limit the number of veterans seeking mental health services. (For LlPs) See patients for medication management, even though this was outside of their scope of practice. 2. Some of these inappropriate practices have persisted, despite an Administrative Review and reviews by Of?ce of Mental Health Operations and National Center for Organizational Development. We will be at the Togas VA Medical Center on October 27 29 and, during that time, we will be hosting a number of interviews. if you would like to meet with us separately to provide facts pertaining to the allegations listed above, please contact me directly so that we can arrange for a time to meet on or off?site or to talk over the phone. Kind regards, Melanie Wisteria. 323 Associate Director, Clinical Review Management VA Of?ce of inspector General, Office of Healthcare inspections Ph: (202) 461?4742 Brown, Austin E. Jr. From: . Pudlowski, Keith B. Sent: Tuesday, October 28, 2014 9:21 AM To; Brown, Austin F. Jr. Cc: -Tibbetts, Mary Subject: FW: Notification and Document/Data Request for Healthcare Inspection: V-A Maine Healthcare System i Attachments: Hotline Visit Notification Memodoc Signed By: keithpudlowskiZCQx/agov Austin, Here is the e-mall from Dri?ibbetts that is requested by the-Ki FOEA. ?v/r Keith B. Padiowski Administrative Officer, Meetai HealthServices VA- Maine? Healthca re, Systems (207) 623-8411 ext 5134 FromtTibbetts, Mary Sent: Friday, October 17, 2014, 1:12 PM To: VHATOG MHSALL Cc: Murphy, Joel R. Subject: Noti?cation and Document/ Data Request. for Healthcare Inspection: VA Maine Healthcare? System Colleagues, We learned late yesterday afternoon that we are being visited by a team from the speci?caliy focusing on MH issues. A team of 4. Dis staftwiil be on the Togus campus from Monday?Wednesday October 27-23 Their stated purpose. is to review ?selected mental health?revisited clinical and administrative operations?. Other service tines - inciuding CLC and Pharmacy have also had reviews over the past year; We are in the process of providing them with initially requested documents. However, as their visit proceedsthey may request; other documents or interview staff as they see fit.? Please cooperate with them fully and honestly MHS Administration may also ask for your help with certain documents or reports; please make yourseif. availabie for these requests. We are a group of strong, dedicated healtheare professionals who provide excellent healthcare te Maine Veterans. i am proud of ourstahc and all ofthe hard work thatwe do fer Maine Veterans, We are always interested in. any guidance that result in improved care to Veterans. Thank you for your cooperation arid support! Mary Mary W. Tibbetts, MD, MBA- Chief, Mental Heaithj services VA Maine Healthcare System 15?0061 zo7f623?8411 x4935 207-623-5748 fax YOU MEET is FIGHTING A HARD TO PLATO ?Frem: Krause, Melanie R. (DIG) Sent: Thursday, Gcteber 16, 2014 10:42 AM To: Ryan S. Mayo~Smjith, Michael; VHA IOAR MRS OIG Hotlines Cc: Gudgeli, Kathy Julian,?Terri Mailinger; Alan (GIG) . Subject: Noti?cation and Dcument/Data Request for Healthcare Inspection: VA Maine Healthcare System Good morning, The purpose of this email is to aier-t you to a hotiin'e investigation that we recently initiated on alleged quality of mental heaith care issues at the VA Maine Heaithcar?e System. As detailed in the attached memo, 'we are planning a site visit to the Togus VAMC beginning on MQnday, October 27?, 2014. At your earliest Convenience, please assign a facility point of contact who we can work with on'our documentation request and iogistiCs "of the site visit. Piease don?t hesitate to contact me if you have any questions, 0r concerns, Melanie WKW, $9523. .273 Associate Director, Ciinicai Review Management VA Of?ce [of lnspectOr General, Office of Healthcare inepections Ph: (2034614742 apartment of - Veterans Affairs Date: October 15, 2014 From: Melanie Krause, RN, Office of Healthcare inspections (54D) Sub}: Notification and DccumentlData Request for Healthcare inspection To: Ryan Lilly, Director, VA Maine Healthcare System (402) Michael Mayo?Smith, Network Director, 1 (10N1) This memo is to notify you that the Of?ce of inepector General (OIG) wiil conduct an onsite review at the Togus VAMC. We wilt be arriving on Monday, October 27, 2014, at approximateiy 8:00 am. We wouid like to meet with the facility director after morning report, if possible, on day one. The purpose of our visit will be to review selected mental health-related clinical and administrative operations. employees from the Office of Heaithcare inspections will perform the reviews. The members of the review will be: a Healthcare inspections Medical Consultant: Alan Malinger, VA 026 Central Office - Healthcare inspections Team Leader: Melanie Krause, VA Central Of?ce a Healthcare lnspections Team Member: Kathy Gudgeil, VA Central Of?ce a Healthcare inspections Team Member: Terri Julian, VA Baltimore Field Of?ce To facilitate the visit and to lessen any disruption in operations, we ask that you appoint a liaison representative for our visit. Once appointed, please have the liaison contact the Team Leader. in addition, facility supervisors and employees shouid be made aware of the visit. in preparation for our visit, we would appreciate it if you would have the following information availabie to us no later than close of business on Monday, October 20, 2014: Overview of the VA Maine Healthcare System, in general, (eg. a ?trip pack?) and mentat health services available at the Togus VA medicai center, in particular. Roster of names, titles, and hire date for alt mental health staff; 0 Copies of any VHA, and/or facility-level summaries/reviews from FY 2010 FY 2014 related to mental health services at the Togus VA medical center, including, but not limited to the folto'wing: OMHO Consultative Site Visit Report(s), including the report from the initial review in 2011/2012 as well as the report from any subsequent revisits, 0 Reports from the National Center for Organizational Design, and 0 Findings from pertinent Administrative Reviews. a Local and VISN policies related to scheduling rnentai health appointments and entering or responding to mental health-related consults. We also would like you to arrange interviews with the following staff: 1. Facility Director 2. Chief of Mental Health Services 3. Chief of HAS fl. [Additional staff interviews to be determined, pending review of the staff roster] Allow 45?minutes for each individual interview, with 15~minutes between, and schedule interviews between 8:00 am? 1"2:00 pm and 1:00pm 4:00pm on Monday, October 27, and Tuesday, October 28; and Wednesday, October 29. Automated VA FORM 2105 15006? 341005 Page 2 We would like to exit with the Facility Director at 4:30 pm on Wednesday, October 29, 2014. All information should be saved and provided to on a secure shafed drive that is administered by the Facility. Please contact the Melanie Krause at 202?461?4742 if you need ,ciari?cation concerning any of the requested information. After we receive the information, we may contact staff to discuss it in further detail. Please inform the liaison representative so that he/she will be prepared to direct us to the appropriate staff for our inquiries. 3. Finally, we will need a workroom for our four-person team that can also serve as an interview room. The room will need to be rekeyed and keys provided oniy to the team members. The workroom shouid be located away from the executive offices. Please ensure an lnformation Technology Representative is available to assist in providing a hardwire internet connection for the 016 team soon after the team?s arrivai on October 27. 4. Thank you for your assistance in this review of your facility. If you have any questions, please contact Melanie Krause at We look forward to meeting with you and your staff. Respectfully, Melanie Krause Associate Director, VA (54D) cc: Director, Management Review Service (VHA ioAR MRS Hotiines) Jeanne Martin,0ffice of Healthcare inspections (548m Sean Smith, Of?ce of investigations (51MA) Automated VA FORM 2105