Drug Diversion, lapsed monitoring, remains a problem in VA facilities

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Representative Ann McLane Kuster, ranking Democrat of the House Veterans Affairs Committee, listens to testimony about employee theft of drugs in the VA health system.

By Alex Seibel
Washington- Officials from the Veterans Administration testified before the House Veterans Affairs Committee Monday at a hearing about employee theft and abuse of opioid medications at several VA facilities where enforcement of controlled substance inspection programs and drug testing have been lax, causing harm to veterans.

Committee chairman Rep. Jack Bergman, R-Mi., said he was “concerned” that the drug oversight program is not working and that staff are not being held accountable for failing to follow procedures, which are not being applied consistently throughout the VA health system.

“We are in the midst of an opioid epidemic and it is time for the VA to start making effective changes to avoid putting veterans and the employees who serve them at risk,” Bergman said.

The hearing was prompted by a recent report from the Government Accountability Office that investigated four VA facilities and found weaknesses in their controlled substance inspection programs, with two facilities missing monthly inspections. One facility missed up to 43 percent of inspections, with a second facility missing 17 percent. The committee’s opening statement also cited previous reports from 2014 and 2009 that showed spotty enforcement of inspection procedures, as well as a 2015 report from the Office of Inspector General that found issues with drug testing of employees, with about 15,800 not being tested before being hired and at least 19,100 employees not being subjected to random drug tests as required.

Staff at VA facilities have been found to be stealing opioid drugs for personal use or gain. Rep. Bergman mentioned a case of an employee at an Arkansas VA facility using access to online drug retailers to divert more than $70,000 in opioid and erectile dysfunction medications for resale at a street value of $160,000. Ranking member Rep. Anne McLane Kuster, D-NH., mentioned a technician at a VA facility in New Hampshire, that worked at a dozen previous hospitals, who had Hepatitis C and would inject himself with fentanyl meant for patients. Up to fifty of these patients, including some veterans, were infected according to Rep. Kuster.

Rep. Kuster also voiced concern over the hiring freeze put in place by President Donald Trump and the negative effect it could have on efforts against drug diversions. Kuster cited the conclusions of the Government Accountability Office and the Office of Inspector General reports that more staff was needed to run the inspection programs and to also handle backlogs of background checks and drug testing, mentioning a facility in Atlanta that had a particularly high backlog.

“Without adequate support staff in place, VA medical facilities will continue to struggle to comply with the procedures and programs they must follow to ensure that our veterans receive safe care,” Kuster said.

Dr. Carolyn Clancy, deputy under secretary for Health for Organizational Excellence, said that the GAO recommendations from the 2017 report are on track to be fully implemented by October. These improvements include increased staffing, training, and other refinements to inspection procedures and program reviews, according to the report.

“Although GAO and VA Inspector General identified selected instances of noncompliance within these robust controls, I believe the system is working as designed to make it difficult for VA staff to divert drugs and most importantly to give us the tools to be able to detect diversion rapidly and take action when it does occur,” Clancy said, adding that it was due to the controls that culprits of drug diversion were identified.

Clancy also mentioned that the VA health system was working to implement alternatives to opioid medications for patient pain management, including the use of acupuncture and chiropractors. Clancy said that back up audits are needed for adequate program monitoring. Clancy stated that the number of VA patients receiving opioid medications had decreased by 30 percent since 2013

Kuster mentioned testimony she had previously heard from a medical researcher that said of the 60,000 surgeries a year in the United States, 99 percent of patients get opioid medications and one in 15 will become addicted, fueling the epidemic.

The Comprehensive Addiction and Recovery Act of 2015, or CARA, provided a program for the VA to reduce opioid drug use with patients. Clancy said that the VA has been meeting expectations for the program, including a 31 percent decrease in patients being prescribed opioids since 2013, as well as increased drug testing of patients to ensure that they are receiving the medications that are prescribed.

“I want to be clear, we are not done, and we will continue to monitor this, and I am very proud of the work we are doing to offer veterans alternatives to chronic pain management,” Clancy said.

Rep. Michael Bost, R-IL, asked Clancy why issues with gaps in inspections were still so prolific despite the previous 2014 report on the problem and the time program heads had to fix it. He added that it was not just an issue with the VA but a nationwide problem, one that the VA should fix and lead by example.

“Some of these coordinators have collateral duties, I do note that for many of our facilities, anesthesia and the operating rooms tend to be areas, probably because of the hours, where there have been problems conducting inspections,” Clancy said.

Dr. Keith Berge, an anesthesiologist consultant with Mayo Clinic, mentioned in response to a question from Bost about the consequences of hiring someone without a background check including drug use history that hiring law prevents an employer directly asking about previous treatment for drug use.

“We have had such people come in that develop fentanyl addiction and in retrospect, well they have gone through treatment for cocaine abuse in the past, so in some ways we are barred from asking all those questions but we would complete the post offer of employment drug testing,” Berge said.

GAO’s healthcare team director Randall B. Williamson estimated in response to questioning from Rep. Bruce Poliquin, R-ME, that about 15 percent of the VA facilities in the nation have adequate drug testing and inspection processes, and that more uniform inspection procedures are needed.

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