A Veterans Affairs investigator told the Senate Thursday he had been aware that opiates have been over-prescribed at VA medical facilities for at least a dozen years, though the VA only began addressing the problem in 2012.
Dr. John D. Daigh Jr., assistant inspector general for health care inspections, said he initiated a 2012 nationwide investigation in order to encourage the VA to address the problem, which he began noticing when he joined the VA 12 years ago.
"If you look at [calls to] our hotlines, as long as I've been at the VA it's been a problem," Daigh said. "It's been my experience that in order to get VA to respond, to make change, you need national data. So we put a tremendous amount of effort into providing a national report to demonstrate what we think the level of the problem is and then encourage VA to move forward."
Following that report, the VA launched an initiative in 2013 to improve oversight of each individual prescriber and their patients, Interim Under Secretary for Health Dr. Carolyn Clancy told the Senate panel.
Clancy said VA has recognized the problem since the 2012 IG report. She has been with VA since 2013. She became interim head of VHA last July after Dr. Robert Petzel was asked to retire early because of the patient wait-times scandal.
The VA is currently conducting a pair of investigations into over-medication and the overdose death of a veteran at the Tomah VA Medical Center in Wisconsin. According to a report by the Center of Investigative Reporting, the number of opiates prescribed at the Tomah facility more than quintupled since 2005 even though the number of veterans getting care at the hospital has declined.
Patients called the hospital "Candy Land" because of the availability of medications.
The IG has found that three providers at the Tomah facility are among the highest prescribers of opiates across the Veterans Integrated Service Network covering the Great Lakes region. This one provider dispensed more opiates than any other prescriber in the network though it had fewer patients.
Clancy told the committee that two investigations are underway. One is by the Office of Accountability Review will look at the actions of senior executives at VA hospitals to determine what responsibility they may bear for such problems. The investigation will also look back further than 2012, she said.
"Part of that investigation will include any previous allegations or issues that have surfaced," she said.
Separately, the VA is also investigating allegations of over-medicating at the Tomah hospital, as well as claims employees reporting problems were retaliated against.
Sen. Ron Johnson, R-Wisconsin, said the Senate committee is conducting its own investigation and will require some of the VA's files "so that [it] can – first and foremost ... make sure these tragedies never happen to another veteran or their families, but also to find out who knew what, when and hold those individuals responsible."
Sen. Johnny Isakson, R-Georgia, chairman of the committee, noted that more than 50 percent of veterans receiving VA care experience chronic pain, and many of these diagnosed with other problem, as well. This seriously increases the risk they could be over-prescribed, he said.
"Abuse and over-prescription of opiates is bad for the recipient, it's bad for the country and it is a bad way to mask problems rather than treat problems, which is what we are all about in terms of the Department of Veterans Affairs," said Isakson.
-- Bryant Jordan can be reached at firstname.lastname@example.org