MADISON, Wis. — Despite reports of ongoing painkiller prescription practices and health care delivery concerns at the Tomah Veterans Affairs Medical Center, the scandal-plagued hospital has noted considerable improvement over the past 18 months, according to new data obtained by Wisconsin Watchdog.
The facility, described by veterans as “Candyland” because of its practice of overprescribing opioids, has seen pronounced declines in highly addictive painkiller prescriptions, according to a Tomah VAMC fact sheet. While the numbers fluctuate, the report snapshot found:
- A 48 percent reduction in the amount of veterans receiving both opioids and benzodiazepines, the class of highly addictive sedative and muscle relaxant drugs.
- A 49 percent decline in the number of veterans receiving greater than 100 morphine equivalent milligram daily dosages.
- A 73 percent drop in the number of vets receiving greater than 400 morphine equivalent milligram dosages.
“Each veteran’s case is looked at individually through the Opioid Safety Initiative Committee and Academic Detailing at the (Veterans Integrated Services Network),” said Tomah VA spokesman Matthew Gowan.
The Opioid Safety Initiative is a “comprehensive effort to improve the quality of life for the hundreds of thousands of veterans suffering from chronic pain,” according to the U.S. Department of Veterans Affairs.
Launched in October 2013 in Minneapolis, the initiative aims to lower opioid dependency by alleviating patient pain through non-prescription methods.
The Tomah VA Medical Center’s alarming opioid over-prescription practices led to the August 2014 death of 35-year-old veteran Marine Jason Simcakoski, according to multiple federal investigations into the hospital.
Dr. David Houlihan, the facility’s chief of staff, was fired in late 2015 following investigative reports and whistleblower accounts of painkiller addiction abuse and retaliation against employees who dared bring the problems to light. Last month, a state board stripped Houlihan of his medical license and declared the physician referred to as the “Candy Man” ineligible to practice medicine in Wisconsin.
Also last month, the VA named Victoria Brahm to lead the troubled medical center. Brahm has served as acting director since October 2015.
While VA officials are praising Brahm for her leadership and celebrating her appointment, sources inside the medical center say prescription drug abuse and other health care delivery concerns remain a problem.
“While this has changed some ways drugs are processed, the problem with over-prescribing and veterans’ abuse of medication still lingers,” a source who works at the hospital told Wisconsin Watchdog. The source asked not to be identified for fear of retaliation.
“We have many veterans who lash out at the pharmacy and pharmacist and technicians who see the dispensing practices as insane,” the source added.
In December, an employee who works in medicine at the veterans hospital said the amount of painkillers still being prescribed is “insane.”
“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,” the insider said. “They took away the Candy Man, but other providers still are pushing medications.
Last month, Gowan said the VA’s Opioid Safety Initiative has been very successful, although hospital officials hear criticism on “both ends of the spectrum.”
“We have some who say, ‘You’re just stoning veterans out of their minds over here,’ and then you have others who say, ‘You’re just taking needed medications away from veterans,’” Gowan said. “It’s really more something in the middle. Each veteran is being looked at by multiple teams. We’re talking about prescription practices attempting to deal with people suffering with chronic pain plus mental health issues.”
Nationally, the number of risky dosages of opioids prescribed to veterans has dropped by double digits, according to a study published in the Journal of Pain.
As the University of Michigan Institute for Healthcare Policy and Innovation reported last month, “Over a two-year period, high-dose opioid prescribing declined by 16 percent, and very-high-dose opioid prescribing dropped by 24 percent.”
“The number of patients receiving both opioids and sedatives, which can be lethal when combined, dropped by 21 percent,” the institute reported.
The study examined the Opioid Safety Initiative across all of the nation’s 141 VA hospitals.
Gowan noted other quality data since October 2015:
- More than 90 percent of veterans at the Tomah VA hospital report they were “completely satisfied” or “satisfied” with the timeliness of their appointments.
- In 2016, 98.5 percent of completed appointments were within 30 days of the veteran’s preferred date, 90.3 percent were within 7 days and 17.2 percent were same-day appointments. During the same time frame, average wait times for completed appointments were 2.4 days for primary care, 5.7 days for specialty care and 1.8 days for mental health care.
- In fiscal year 2016, Tomah improved its quality ranking from 77 to 41.
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