Complaints of severe overuse of opiates at the Tomah WI VAMC led to an OIG investigation of the facility and prescribing practices there. Hospital staff have reported stoned veterans drooling in wait rooms. Data show the number of opiate prescriptions quintupled at the facility since 2004 even as the number of veterans treated at the facility declined. From 2004 to 2012, Tomah VA dispensed 50,000 oxycodone pills to approximately 25,000 veterans, and the total skyrocketed to 712,000 as the treatment population decreased. Here is the Summary of the Report:
“This inspection was originally administratively closed in March 2014 because we could make no conclusive finding of inappropriate prescription practices. We previously released the report pursuant to the Freedom of Information Act. Because of continuing public interest, we are now publishing the report. OIG conducted a review to assess the validity of multiple allegations of misprescribing and diversion of opioid drugs and a physician’s abuse of administrative and clinical authority at the Tomah VA Medical Center, Tomah, WI (facility). We did not substantiate the majority of allegations made in the various complaints that OIG received. Although the allegations dealing with general overuse of narcotics at the facility may have had some merit, they do not constitute proof of wrongdoing. We did not find any conclusive evidence affirming criminal activity, gross clinical incompetence or negligence, or administrative practices that were illegal or violated personnel policies.We briefed the facility and VISN director and brought several suggestions to their attention to improve communication between staff and clinicians concerning opioid prescription practices, assist with the treatment of patients who have complex pain management issues, and evaluate and monitor facility and provider opioid prescribing practices. Please note that we identified an error on page 8, in the sixth line of paragraph two, the morphine equivalents per unique patient range is listed incorrectly. The correct range is 8,989 to 63,184.”
You can download the full Report at http://www.va.gov/oig/pubs/VAOIG-11- 04212-127.pdf ¤
Franklin Named Director of DoD’s Suicide Prevention Office
The Pentagon has named a new director for its Defense Department Suicide Prevention Office. DoD recently announced that Dr. Keita Franklin — the former chief of the Marine Corps' behavioral health branch — has replaced Jackie Garrick as director. Garrick has served as either acting director or director of the office since 2011.
The DoD release gave scant details about the new appointment, other than to praise Franklin's credentials and say the position is now a career senior executive service post, "reinforcing the department's commitment to decreasing the incidence of suicide and increasing resiliency across the armed forces."
"I am very pleased to have Dr. Franklin take the lead in this very important mission," Under Secretary of Defense for Personnel & Readiness Jessica Wright said of Franklin, who holds a doctorate in social work from Virginia Commonwealth University.
DoD established the Defense Suicide Prevention Office in 2011 to oversee development and implementation of suicide prevention programs within the department and military services.
Garrick came into the job just as the issue was cresting at the Defense Department. In 2012, the number of active duty military suicides hit a record of 352. That number declined to 286 in 2013 and remained steady in 2014 at 288, according to preliminary data furnished by the Defense Department.
The suicide rate among active-duty U.S. military personnel also declined in 2013, to roughly the same rate as the civilian population adjusted for similar demographics.
The 2013 Defense Department Suicide Event Report shows the suicide rate for troops on active duty in 2013 was 18.7 per 100,000 population, down from the 2012 rate of 22.7 per 100,000.
Under Garrick's direction, the Defense Department Suicide Prevention Office was tasked with reviewing and analyzing the department and military services' multiple behavioral health and suicide prevention programs to determine their effectiveness.
It also developed outreach programs designed to reach troubled troops outside traditional psychiatric care and introduced peer-to-peer counseling programs as well as education programs to teach service members, family members and friends to recognize the warning signs of suicide. Before working for the Marine Corps, Franklin supervised family programs at the installation and regional levels for the Army and Air Force.
Eight Months After Phoenix, Is the VA on Track to Recovery?
Nearly a year ago, the VA was rocked by a scandal revealing secret waiting lists and delayed care for Veterans, prompting a series of congressional hearings that are still continuing. The VA Secretary was replaced, additional funds were approved to help resolve the problems, and big changes were promised. So, have these events cured the VA’s issues?
In a word: No. The collective assessment by VA employees: “Nothing has changed in our facility.”
The VA continues to receive bad news and bad reviews. Instead of kudos, the VA was recently added to the Government Accountability Office’s High Risk List, officially ranking it among the most troubled federal agencies. The list is to call Congress’ attention to problematic, risky or troubled programs. Congress hardly needs any reminder of the agency’s problems, and it along with Veterans Service Organizations (VSOs), Veterans, and VA employees continue to give VA efforts poor evaluations and claim that things are not improving at the frontline Veteran-care level.
Sweeping, bold changes are needed. Instead, a proposed but unimplemented reorganization is presented. A customer service program implemented a few years ago called “I CARE” has been resurrected, but new training sessions for I CARE have not been implemented, just a paper reintroduction. Changing a culture is hard. The release of a brochure will not accomplish it.
The “I CARE Quick Reference” spells out the desired core values of the VA: Integrity, Commitment, Advocacy, Respect and Excellence. The accompanying memo says the VA is “a model of unrivaled excellence due to employees who are empowered, trusted by their leaders, and respected for their competence and dedication.” But after a year of focused attention many agency employees and veterans are questioning the “I CARE” program as a cosmetic effort that has done little to improve services. “Management has made a mockery of it,” said one VA employee, who asked not to be named for fear of retaliation. In reality, according to VA employees from around the nation:
Announced programs and changes have not resulted in improvements in their facilities.
Employees are no more empowered than before and feel less trusted and less respected.
Despite additional funding from Congress, employees report that acquiring critically needed patientcare staff is harder than before. However, additional non-patientcare staff show up routinely.
Impediments to improved care and operations have not been removed. No operational or structural changes that would increase the efficiency of physicians and dentists have been implemented.
Changes announced by the Secretary are not being consistently implemented in local facilities, perhaps because the facility leaders have not understood these changes were intended as mandatory.
The new physician pay panel intended to recruit and retain physicians has generally been applied only to new physicians. If continued, this will lose the VA experienced physicians. In one facility, where the Secretary apparently had a personal conversation with the Chief of Staff, the new pay panel is reportedly being applied to all physicians.
Rewards for excellent care are shrinking, not improving.
The “Choice Card” program, intended to allow Veterans to receive care outside the VA if necessary, has been so narrowly defined as to be useless in many cases, and it appears that the VA is campaigning to to shut it down and use its funds for other projects.
Support for physician continuing education (CME) continues to decline from its already low levels.
Performance Pay levels for physicians and dentists remain lower than the prescribed level in the Pay Law, and inconsistently applied. A few locations have reportedly raised the maximum achievable level, but the Goals to receive Performance Pay have also been raised.
Biased and manipulative productivity assessments of physicians continue, impacting even a NAVAPD Board Member. Thirty-four years after first being mandated by Congress, the VA still has no comprehensive system to determine the staffing needs of specialty physicians, and no validated system of assessing productivity of specialty physicians.
Abuse of Temporary Status continues and grows by indefinite extension. Professionals hired as Temporary essentially remain on infinite probation.
The VA continues to be a collective of 150+ facilities operating independently rather than as an aligned and unified system. Pronouncements from the Secretary appear to be considered suggestions rather than mandates by leaders at VISNs and facilities. There is a disconnect between what the Secretary has called for and what is being done by the leaders in the facilities. To be successful with change, the Secretary must eliminate that disconnect, perhaps directly and personally.
The head of a veterans group spoke for many when he said veterans and active -duty service members are still waiting for “real, meaningful change” in the VA’s quality and promptness of health care services.
“Adopting a catchy acronym and circulating a checklist is not enough,” said Pete Hegseth, CEO of Concerned Veterans for America. “It’s easy to put on an ‘I CARE’ pin, but it doesn’t matter unless you actually demonstrate that care through your actions and the results you deliver. That’s what veterans, military members and their families are looking for: real results, not a slogan.”
So far there has not been the new age of successful. transformative change for which we had all been hoping.