UPDATED: 8:47 p.m. to include comments from Tomah VAMC spokesman Matthew Gowan
MADISON, Wis. — Despite promises to fix past failures and pledges to correct “systemic” problems, a “culture of fear” continues at the Tomah Veterans Affairs Medical Center, current and former employees tell Wisconsin Watchdog.
“I know people who have worked here for many years; the problems still persist. They’re putting a good face on it but they are doing nothing,” said an employee who works in medicine at the troubled veterans hospital. He asked not to be identified, fearing retribution at a medical facility known for retaliation.
“They took away the ‘Candyman,’ but other providers still are pushing medications. The amount that they are still giving is insane,” the insider said.
The scandal-plagued hospital grabbed national headlines following investigative reports that exposed providers overprescribing prescription drugs to veterans at alarming — even deadly — levels.
The prescription policies, according to whistleblower and federal reports, were pushed by Dr. David Houlihan, the hospital’s chief of staff. He was commonly referred to as the “Candyman” and Tomah was known as “Candy Land” because of the prevalence of prescription drugs.
An August 2015 VA Inspector General report found that Marine veteran Jason Simcakoski died Aug. 30, 2014, from “mixed drug toxicity.” The patient had taken 13 prescribed medications, including several known to cause respiratory depression, over a 24-hour period at the hospital. Staff psychiatrists ordered the prescriptions, adding them to Simcakoski’s long list of medications prior to his death.
A lengthy report issued in May by the Senate Homeland Security and Governmental Affairs Committee found “systemic failures and preventable tragedies” at the Tomah VA center, and noted a “culture of fear” punctuated by retaliation against whistleblowers.
“We still have vets, tons of them I see firsthand, overusing medications,” said one source who works on the hospital campus.
Last year, as federal investigators looked into allegations of drug abuse at the medical facility, police were making arrests of alleged narcotics pushers on the hospital grounds.
Drug addiction continues to drive illegal prescription drug sales in and around Tomah, sources say, and strung-out veterans around the hospital routinely look for a fix.
“The profound addition that’s here, it’s amazing. They’re pushing out Suboxone,” the Tomah employee said, referring to the opioid medicine used to treat narcotic addiction. “I see the wife of a patient coming here dealing.”
“People come in here and they have brand new trucks. I think, ‘How do you have a truck, you don’t have a job? You are a disabled veteran and you bought a $40,000 truck,” the insider said. “A lot of them are turning around and selling their narcotics. Some have 95-year-old parents and they’re getting their parents’ meds.”
The Senate committee report claims Houlihan and the psychiatrist’s nurse practitioner may have been “impaired” during a 2012 interview with VA officials.
“It is actually one of the shocking findings of our investigation,” said Sen. Ron Johnson, R-Wis., chairman of the Senate Homeland Security and Governmental Affairs Committee. “When the inspection team originally came here from the Office of Inspector General — these are doctors assessing the condition of Dr. Houlihan and his nurse practitioner — they wondered whether or not they were impaired,” Johnson said at a committee hearing on the report.
Acting Medical Center Victoria Brahm is trying to make Tomah more presentable, but you can’t hide the ugliness beneath, one source said.
In an email to Wisconsin Watchdog Tuesday evening, Public Affairs Officer Matthew Gowan said the Opioid Safety Initiative has and continues to be a major priority at the Tomah VAMC. In the past year, the hospital has collaborated with the Veterans Integrated Network 12 headquarters to incorporate an Academic Detailing team to review the medical centers most complex chronic pain patients, and provide additional recommendations for their care. And health care leaders established a Pain University to assess and customize alternative whole-health pain strategies for veterans.
“When we announced completion of our 100-Day Plan the number of Chronic Opioid Patients on > (greater than) 200 Morphine Equivalent Daily Dose was reduced by 23%. The number of Chronic Opioid Patients on > 400 Morphine Equivalent Daily Dose was reduced by 24%,” Gowan wrote.
“In addition, opioid treatment agreement compliance rose from 39% (from FY2015 Q1) to 98% and Urine Drug Screen compliance rose from 56.8% to 88%. The Tomah VAMC has also mandated the use of the Wisconsin State Prescription Drug Monitoring Program to ensure patients are not obtaining opioid medications from multiple providers.”
Johnson has defended Brahm, saying she has been making strides in changing policy and the culture of the troubled VA hospital. Those positive changes, Johnson said, were evident in how administrators quickly addressed a recent health failure.
As Wisconsin Watchdog reported last week, 592 veterans may have been exposed to HIV, hepatitis C and other infections after a dentist at the Tomah hospital failed to follow standard infection control procedures for months.
The dentist has since resigned, according to The Associated Press. His name has yet to be released. He was expected to appear in front of a review board as he faces administrative proceedings prior to his resignation, according to UPI.
Brahm told news outlets that a temporary dental assistant reported the violations to the dental chief on Oct. 20, the after the violations allegedly occurred. “We took action Oct. 21,” she said.
The hospital employee who spoke to Wisconsin Watchdog said Brahm is trying to implement policy changes but they mean nothing if doctors and staff fail to follow them.
The VA finds itself in a Catch-22. As the agency moves to implement new policies and procedures on opioid prescriptions, it is dealing with frustration among the veterans who have come to depend on painkillers.
“Last month the VA informed me that they will no longer be supplying disabled veterans with pain medications … everyone is being cut off permanently,” a veteran in the VA system told Wisconsin Watchdog. “We have veterans who will be in agony without pain medications as their bodies are broken. The VA doesn’t care. They passed out pain medications like candy for decades. Now they are stopping all of them.”
As the Minneapolis Star Tribune reported in July 2015, “During an 11-year period ending in 2013, the number of prescriptions from the VA for pain meds like oxycodone and morphine surged 259 percent nationally.”
Employee morale continues to be a struggle, although a Tomah VA Medical Center questionnaire, Connecting Workplace Perceptions to Organizational Health, appears to show some signs of improvement.
The annual assessment, obtained by Wisconsin Watchdog, shows small gains or slight declines in key areas such as engagement, workload, job control, and speaking up about concerns (a 1.85 percent decline). Employees reported reduced problems with burnout and turnover.
What remains elusive, one Tomah source said, is staff’s emphasis on the people they are there to serve.
“We need to watch out for veterans. That doesn’t happen, and that speaks to the culture,” the insider said. “We have forgotten who we work for here, and how bad it is.”
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