Veteran dies after receiving improper care at Memphis VA hospital, according to inspector general report

Veteran dies after receiving improper care at Memphis VA hospital, according to inspector general report
Memphis' Veterans Affairs Hospital is among four facilities in Tennessee flagged for further review following a nationwide audit.

MEMPHIS, Tenn. (WMC) - A health care inspection at the Memphis VA Medical Center calling attention to the allegation of a patient not receiving the proper care has been released.

The VA Office of Inspector General’s inspection report summary says the veteran was seeking treatment for insomnia and psychiatric medication refills. The patient died of suicide a day later after a visit to the VA hospital’s emergency department.

“The Emergency Department physician documented evaluating the patient and after a negative screen for suicidal thoughts, discharged the patient with instructions to go to the facility’s Outpatient Mental Health Clinic immediately for medication management. The OIG found no documentation that the patient registered or received treatment in the clinic.”

The OIG says it found that the patient did not receive the care needed and the facility did not have a clear referral process for patients who have been discharged from the emergency department.

The OIG also says the patients received care through the community where the facility did not keep a record of his/her medical history for treatment which left the patient unable to refill several medications.

The report states facility leaders were aware of the patient’s manner of death within three days but the OIG could not to find evidence that executives or family of the patient were notified.

The OIG says it made 16 recommendations to the facility director regarding the issue.

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