Synergy - September/October 2012 - 23

namss focus

VA signed the MOU with HHS in November 1990 and published governing regulation and policy (38 C.F.R, RIN 2900-AJ76). As there is no provider identified in the payment of a federal tort claim, there are no allegations against a provider, so providers have no right or authority to defend themselves under the FTCA. The MOU, signed with HHS and VA’s implementing regulations, require VA to conduct a formal review on all paid tort claims to determine if there was substandard care, professional incompetence or professional misconduct associated with the episode of care for which there was the payment. If there was, a licensed healthcare provider(s) can be identified as the cause of such care. At the time of payment, the staff of the VA medical center review the case and afford any provider who may be associated with potential substandard care, professional incompetence or professional misconduct the opportunity to provide a written statement to the Office of Medical-Legal

Affairs (OMLA), which is delegated the responsibility to review the care provided for all paid tort claims. OMLA convenes a panel that consists of a minimum of three healthcare professionals, one of whom must be a member of the same profession or occupation as the provider being reviewed. The panel reviews the medical record for the episode of care and any other documents not protected by statute or regulations (e.g., investigations conducted by the facility). The review panel makes a determination as to whether the payment was a result of substandard care, professional incompetence or professional misconduct that can be associated with the care provided by a licensed healthcare provider. If so, then OMLA advises the facility to report the provider(s) to the NPDB. Reporting proceeds the same as private sector hospitals at this point. Final adverse clinical privileging actions that are greater than 30 days are reported to the NPDB in accordance with VA policy and regulations.

Reporting to State Licensing Boards: VA’s policy is to cooperate, whenever possible, with state licensing boards (SLBs) through clearly defined policies and procedures for not only reporting licensed healthcare professionals to SLBs on its own initiative, but also with policies on how to respond to SLB inquiries regarding VA licensed healthcare professionals. The rationale for this reporting is that these providers are under the continuing jurisdiction and supervisory control of VA, and VA is reporting identified deficiencies that might impact the safety of patients in the SLB’s jurisdiction. These professionals may provide healthcare services to patients other than VA patients elsewhere under a SLB’s jurisdiction. With a broad statutory authority, as well as federal regulation, these policies lay out the process to be followed for reporting licensed healthcare professionals, employed or separated, whose behavior or clinical practice significantly failed to meet
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Synergy - September/October 2012

Table of Contents for the Digital Edition of Synergy - September/October 2012
