An internal audit has found flaws in the processes by which physicians are appointed to the medical staff of the Vancouver Coastal Health Authority, have their credentials checked, and receive privileges to practise in the region.

The authors noted that such non-compliance to the bylaws “could lead to serious safety and quality of care issues for patients.”

VCH said this week that problems identified in the audit will soon be resolved.

The September 2012 report by the VCH’s internal audit branch was obtained by the Courier under the freedom of information law.

The health authority has about 2,400 physicians across Vancouver, Richmond and coastal regions. The auditors reviewed 25 per cent of the 200 appointment applications and four percent of the 2,200 re-appointment applications made in 2011. (The report noted similar issues for a much smaller number of dentists and midwives.)

Many problems were assigned to the High Priority red category, that is, “an issue that could have a significant impact and should be corrected immediately.” These include missing documentation in staff appointment applications, some staff started work before their temporary privileges were approved by the VCH board, some required references were not obtained and verified, a lack of tracking of which medical staff are the subject of lawsuits, multiple and incompatible databases to track credentialing, and specific procedural privileges not described on the application, thereby making it unclear which procedures staff may perform. On the last point, says the report, “Patient care could be compromised if medical staff provide services outside of their competencies.”

VCH spokesperson Anna Marie D'Angelo stressed to the Courier that the audit identified only potential risks due to paperwork deficiencies and “there is nothing in the audit that indicates that errors actually occurred.” She added that all the audit’s recommendations have been or are being acted upon, and their target dates of this February will be met.

The audit also found that VCH appointed 416 “locums” (that is, substitutes for absent medical staff) in 2011, and they did not have to include suspensions, disciplinary actions or other problems in their re-application forms. One audit concern was marked Moderate Priority: contrary to bylaws, in-depth five year staff performance evaluations were not performed, with the implication that “VCH may re-appoint medical staff who are not capable for providing safe and high quality patient care.”

VCH management responded by writing that many of these problems will be resolved by the new province-wide credentialing system to be implemented across all B.C. health authorities by September.

Dr. Shelley Ross, president of the B.C. Medical Association, told the Courier the BCMA is aware of some of the issues discussed in the audit, and “we suggested it would be beneficial for us to be involved and sit at the table.”

In other health news, the B.C. information commissioner ordered the Provincial Health Services Authority to release five internal audits to the Courier a year ago. But the PHSA appealed that ruling to B.C. Supreme Court, and the case is likely to be heard early this year.