By David Esteppe
The U.S. Office of Special Council (OSC) informed the White House and Congress on Apr. 22 that the Veterans Affairs Medical Center (VAMC) in Beckley put patients at medical risk and violated VA policy by substituting prescribed antipsychotic medications with older drugs in order to cut costs.
A VA whistleblower disclosed these allegations to OSC. The allegations were confirmed by the VA’s Office of Medical Inspector (OMI). OMI’s report of investigation found that the VAMC’s actions posed “a substantial and specific danger to public health and safety.”
The OMI recommended that the Beckley VAMC immediately stop switching patients from their prescribed drugs without a legitimate clinical need. Additionally, the OMI found that the chair of the Beckley VAMC Pharmacy and Therapeutics Committee (PTC) is not a physician. This is a departure from standard VA practice and the OMI recommended that this be changed.
“At a time when many veterans are grappling with mental health issues, this VA facility was cutting corners on needed drug therapy to save money in violation of VA policy,” said Special Counsel Carolyn Lerner. “We only know this was happening because an employee had the courage to blow the whistle on this dangerous practice.”
The OMI report found that the PTC restricted providers from administering aripiprazole or ziprasidone to meet a cost savings goal. VA policy bars VA hospitals from withholding prescribed drugs from veterans solely to save money.
A mental health unit representative to the PTC voiced concerns about the proposed restriction on continued therapy with these two drugs, but these concerns were not documented. Other mental health providers told OMI they had little to no input on the PTC’s clinical guidelines. There is a process for doctors to appeal a pharmacy decision to use cheaper, older drugs, but “they did not submit appeal requests because of what they felt was a foregone conclusion,” according to the OMI report.
OMI’s report also stated that while each veteran had their medications reviewed before any adjustment took place, “many providers felt that they had no option other than to prescribe some other medication in place of the originally prescribed aripiprazole or ziprasidone. They followed this guidance despite their disagreement with the change in treatment,” citing potential side effects of weight gain and sedation associated with the older drugs.
The OMI called for a clinical review of the medical records and conditions of all patients who were discontinued from aripiprazole or ziprasidone and whether there were any adverse patient outcomes as a result. OMI also recommended that Beckley VAMC and PTC leadership be disciplined for approving actions that violated VA policy and could pose a substantial and specific danger to public health.
The OSC will follow up with the VA to ensure that the Beckley VAMC implements these recommendations.
“The Department of Veterans Affairs appreciates the work of the Office of Special Counsel and takes its report and findings on the Beckley, WV, VAMC seriously,” said Debbie Voloski, the Beckley VAMC public affairs officer. “The VA Office of Accountability Review has begun an investigation based on the report’s substantial findings and recommendations. The safety of the nation’s veterans is foremost in our mission, and we are committed to providing them the care they deserve at every facility nationwide. We will immediately take action where it is warranted to ensure the most current medical standards are strictly followed. We applaud the VA employee who contacted the OSC on this matter. Secretary McDonald has made clear that employees who step forward to raise concerns have a direct bearing on the veteran outcomes we deliver, and this is an example of why this is important.”
Voloski told the Mountain Messenger that the investigative team is at the medical center this week, and she is hopeful for a positive outcome.
The whistleblower did not consent to the release of their name.