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. Photo Credit: Alex Seibel
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 and lapses in monitoring of drug programs.
The hearing and testimony revolved around a February 2017 report from the Government Accountability Office that found lapses in monitoring of drug programs and oversight of the employees that handle opioid medications.
VA facilities failed to perform scheduled inspections of drug supplies and areas where drugs are used and can potentially be stolen, like operating rooms. There were also failures to drug test job applicants and randomly test current employees in positions with high potential for abuse, according to the report.
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 across the VA system.
Committee chairman Rep. Jack Bergman, R-Mi., opened the hearing by citing a case of an employee at an Arkansas VA facility that used his access to online drug retailers to purchase more than $70,000 in opioid and erectile-dysfunction medications with the intention of selling them for profit, at a street value of $160,000. Bergman said that the VA needed to make changes to reduce risk of abuse and misappropriation of drugs by employees and patients.
“I am concerned that VA’s oversight program is not working and that staff who fail to follow proper procedures are not being held accountable for violations,” Bergman said.
The committee requested GAO report audited the drug control and employee oversight practices of four VA facilities for about a year and found weaknesses in their controlled-substance inspection programs, with two facilities experiencing lapses in monthly inspections. One facility missed up to 43 percent of inspections, with a second facility missing 17 percent over an inspection period between January 2015 and February 2016, according to the report.
Bergman’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.
Ranking member Rep. Anne McLane Kuster, D-NH., cited from the report the case of a technician at a VA facility in New Hampshire, who worked at a dozen previous hospitals outside of the VA, that had Hepatitis C and would inject himself with fentanyl meant for patients. Up to fifty of these patients, including some veterans, were infected.
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 is needed to run the inspection programs and to also handle backlogs of background checks and drug testing, citing a facility in Atlanta that had a particularly high backlog, according to the 2015 OIG report.
“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, who is in charge of ethics and oversight programs as VA 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 in her testimony, adding that it was due to the controls that culprits of drug diversion were identified.
Clancy also said 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 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.
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, said that opioid abuse was not just an issue with the VA but a nationwide problem, one that the VA should fix and lead by example. Bost 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. Clancy said that drug inspections were not the only responsibility of the inspectors.
“Some of these (drug inspection) coordinators have (extra) 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.
Bost also asked Dr. Keith Berge, an anesthesiologist consultant with Mayo Clinic, about the consequences of hiring someone without a background check, including drug use history. Berge said 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” Berge said, adding that a drug test would be done for a prospective employee after an offer for employment was made.