The OIG conducted an inspection of the VAMC the week of January 11, 2016 on an anonymous complainant’s allegation regarding opioid management practices at the facility.
At the time of the complaint, John J. Pershing provided long-term opioid therapy to more than 1,300 veterans.
The OIG focused its inspection on 10 veterans specifically selected by the complainant and given to the OIG.
Among those 10 veterans receiving opiate prescriptions, the OIG concluded:
- Six did not have a urine drug screen performed as recommended
- Five patients did not have signed informed consents prior to initiating long-term opiate therapy
- Providers prescribed opiates without documenting risk through use of a risk stratification toolAccording to John J. Pershing, those results include:
- Increase of veterans who had a urine drug screen from 38.7 percent to 90.2 percent
- Increase of veterans with documented consent from 23.6 percent to 92.3 percent
- Reduction of veterans on percentage of opioid/benzodiazepine combination from 19 percent to 16.5 percent
- Reduction of veterans dispensed opioids from 16.6 percent to 14.2 percent
- Reduction of almost 200 veterans on long-term opioid therapy
The John J. Pershing VAMC also provided a status update on those eight recommendations and requested they be “closed.”
- The facility strengthened communication from non-VA hospitals and providers so that VA providers get timely notification of clinically significant changes impacting on a patient’s opioid prescription. Opioid risk stratification tools are available for all providers to use.
- Providers received education. In addition, a Pain Management Clinical Pharmacy Specialist provides continuing education and consultation.
- The facility established a process for dual short-acting opioids; pharmacy alerts the provider and clarifies the order. The Pain Management Clinical Pharmacy Specialist assists providers with tapering of opioids.
- Providers prescribing opioids received education on opioid risk tools.
- The facility developed and implemented a UDS clinical reminder to help providers in obtaining UDS. The facility provided education on interpreting UDS to those prescribing opioids. The Pain Management Committee regularly reviews UDS completion rates.
- Along with the education and tools, the facility developed an audit process. The most recent audit demonstrated 100 percent (4 of 4) patients requiring confirmatory UDS testing had that test completed.
- Urine creatinine tests are now completed on all UDS. Providers received guidance on urine creatinine levels that may raise suspicion of testing and tampering.
- In addition to education of providers, the Pain Management Committee monitors completion of informed consents.
Early in May, we told you about a doctor at John J. Pershing who claimed veterans weren’t getting the care they deserve at the VA medical center. Dr. Dale Klein said he was “banished to an empty room,” while still collecting a salary, after he voiced his concerns.
He was set to be terminated, but as of May 15, he reported back to work. According to his attorney, Natalie Khawam, the hospital sent him a letter saying he could go back to work and start seeing patients.
Khawam says Klein did report to work, but continues to not see patients.
Khawam says Klein doesn’t feel it is in the veterans best interest until the hospital can show it has made corrections, and is willing to get him the training he needs after not practicing medicine for more than a year.
Klein is also seeking a financial settlement from the John J. Pershing VA Medical Center. The details of that settlement are not being released.
U.S. Senator Claire McCaskill of Missouri joined U.S. Senator Ron Johnson of Wisconsin in calling on the Department of Veterans Affairs Secretary David Shulkin to fully investigate the claims.