Probe launched on overmedication, retaliation claims at Wisconsin VA center

By CHRIS HUBBUCH | La Crosse Tribune, Wis. (Tribune News Service) | Published: January 16, 2015

The Department of Veterans Affairs is launching two new investigations at the Tomah VA Medical Center in response to recent media reports of over-medication and workplace intimidation.

The investigations come in the wake of a story by the Center for Investigative Reporting that said the number of opiates prescribed more than quintupled over the past decade, even as the number of veterans seeking care at the hospital declined.

According to the report, one veteran died of a drug overdose while at the hospital, and patients have taken to calling the Tomah facility “Candy Land.”

The VA said in a statement Thursday it is “actively reviewing allegations of retaliatory behavior and over-medication at Tomah.” Within the next two weeks, a team from the Veterans Health Administration will look into opiate prescription practices while the VA’s Office of Overview and Accountability will examine claims that senior medical personnel created an atmosphere of intimidation.

The VA also outlined a number of steps taken over the past eight months in response to an investigation by its own Office of Inspector General.

U.S. Rep. Ron Kind, D-La Crosse, and U.S. Sen. Tammy Baldwin, D-Wis., spoke Thursday with VA Secretary Robert McDonald and praised the decision to launch the new investigations as well as the removal of Dr. David Houlihan, the hospital’s chief of staff.

“These are important initial steps, and I will closely monitor the investigation’s progress and work to ensure that its scope and resulting remedial actions will achieve and maintain the goal of providing the timely, highest-quality care that our Wisconsin veterans have earned,” Baldwin said in a statement.

Sen. Ron Johnson, R-Wis., praised the CIR for bringing the issues to light. A spokeswoman said when Johnson’s staff received reports of problems at the Tomah VA, aides referred the matter to the Senate Subcommittee on Federal Contracting Oversight, of which he was the ranking member.

Kind was scheduled to meet Thursday with Tomah VA Director Mario DeSanctis and separately with a group of whistleblowers. He said he hoped the meetings would allow him to provide guidance to the teams conducting new investigations.

Kind, the La Crosse Democrat whose district includes the Tomah VA, was first alerted to problems at the Tomah VA in 2011, when his office received an anonymous complaint that alleged heavy opiate prescription by Dr. David Houlihan, a psychiatrist and chief of staff for the hospital.

It detailed the case of one veteran with a history of drug abuse who spent a month in the hospital for detoxification only to be prescribed oxycodone on release. He returned a few days later after a drug binge, according to the letter, which went on to outline a pattern of intimidation by Houlihan.

“If anyone disagrees with Houlihan he finds ways of getting rid of them,” the complaint stated.

That complaint, in part, sparked a two-year investigation by the VA’s Office of Inspector General, which showed that in 2012, three providers at the Tomah facility were among the highest prescribers of opiates in the entire Great Lakes network, which serves more than 220,000 veterans in three states.

According to the OIG report, a Tomah provider was the top prescriber in the network, dispensing more than twice the amount of opiates as the 10th highest provider in the network, despite having fewer patients.

The OIG report, issued in March, found “no conclusive evidence” of criminal activity or clinical incompetence, but it did say the high prescription rate “raised potentially serious concerns.”

In a statement released Thursday, the VA outlined steps taken in response to the OIG report, which it said was received in June.

In November, pharmacy staff were removed from Houlihan’s supervision to allow them to appeal clinical decisions without the potential for conflict of interest.

Houlihan and his psychiatric nurse practitioner were directed to transfer their most clinically complex patients to another provider based on their high prescribing of opiates.

A pain control physician was designated to oversee pain management care for high dose pain patients, separate from psychiatric care.

Houlihan was removed as co-chairman of the Pain Committee.

Kind said Thursday that the OIG failed to notify him or anyone else in Congress of the investigation, which was brought to light by the CIR story.

Kind said he was disturbed by a lack of transparency from Tomah officials when he met with them after news broke in 2014 of secret waiting lists at a VA hospital in Phoenix.

Kind said DeSanctis did not mention the OIG investigation when asked if there were any problems he should know about at Tomah.

“Not boo. Not word one,” Kind said. “When people show up at your doorstep, having candid conversations is more productive.”

©2015 the La Crosse Tribune (La Crosse, Wis.)

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