Secretary McDonald calls for comprehensive review of medication practices in Tomah

TOMAH, Wis. (RELEASE FROM U.S. DEPARTMENT OF VETERAN AFFAIRS)-- Secretary of Veterans Affairs Robert A. McDonald today called for a review of medication practices at the VA medical center in Tomah, Wis., in response to allegations of overuse of opiates and retaliation against employees.

“Thanks to inquiries from Sen. Tammy Baldwin, Rep. Ron Kind and other stakeholders, I have taken additional steps to review medication practices in Tomah by directing Dr. Carolyn Clancy, Interim Under Secretary for Health, to lead a comprehensive review of medication prescription practices in Tomah. The team will begin their work this week and to report back to me in 30 days,” said Secretary of Veterans Affairs Robert A. McDonald. “While important changes are being made to improve services to Wisconsin Veterans immediately, we must ensure that we fully investigate the issues surrounding the possible overuse of powerful medicines and to share these lessons learned throughout our health care system. Ultimately, this is about improving the service we provide to America’s Veterans and providing them with the high quality health care they have earned and deserve.”

The Department of Veterans Affairs is actively reviewing allegations of retaliatory behavior and over-medication at Tomah VA Medical Center and has already taken administrative action:

• In addition to the clinical team that will be in Tomah this week, VA will also be sending representatives from the Office of Accountability Review (OAR) to look into allegations of retaliatory behavior against employees.

• The Tomah VAMC chief of staff has been temporarily reassigned to a position outside of the medical center, and an additional employee has been temporarily reassigned to non-clinical duties pending the outcome of the investigation. These employees will not see patients or prescribe medication while assigned to non-clinical duties.
Important changes are already underway to improve care for Wisconsin Veterans including:

• Targeted training has been made available to health care providers on the following critical issues: management of chronic pain with multiple modalities, the safe use of opioids, use of Informed Consent for Long-term Opioid Therapy for Pain, and the Wisconsin State Prescription Drug Monitoring Program.

• A Chronic Pain Care Consultative Group for outpatient pain management was created as were provider peer support groups so that providers can share best practices and improve patient care. In addition, monthly calls have been instituted with all VA facilities across the health care network to discuss progress and action plans amongst facilities throughout the Great Lakes region.

• A Psychiatric Nurse Practitioner was assigned to a primary care Patient-Aligned Care Team to focus on evaluation and management of patients with significant interacting medical and psychiatric disorders.

• The Tomah VA Medical Center is more closely tracking clinical data to better review and monitor opioid prescribing.

Additional actions have been taken in response to the March 2014 Office of Inspector General report including:

• Important structural changes have been made. For example, Pharmacy Service has been realigned to report to the Associate Director rather than the Chief of Staff to allow the Pharmacy an avenue to appeal clinical decisions without the potential for conflict of interest.

• A pain control physician has been designated to oversee pain management care for high dose pain patients—separating out their pain care from their psychiatric care.

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