Politicians from both parties and government bureaucrats are rushing to look into allegations of rampant overmedication, retaliatory management practices and preventable overdose deaths at the U.S. Department of Veterans Affairs Medical Center in Tomah, Wisconsin, that The Center for Investigative Reporting revealed last week.
In the story’s wake, the VA has begun “actively reviewing allegations of retaliatory behavior and overmedication at the Tomah VA Medical Center,” said agency spokesman James Hutton. He said the facility’s chief of staff, psychiatrist Dr. David Houlihan, has been temporarily reassigned to the VA regional office while an internal investigation takes place.
But the problems disclosed should not have surprised politicians or federal officials: Health care professionals at the hospital have complained for at least five years about Houlihan’s prescription practices and his retaliatory management style – filing numerous reports with those in charge of oversight.
“It’s about time,” said Robin Weeth, a former social worker at the hospital who wrote to the VA inspector general in 2012 with a long list of allegations, including that “veterans are overmedicated and have been driving while impaired, fallen asleep while smoking and set themselves on fire.”
Today, Weeth reports that he never heard back from the inspector general.
The CIR story reported that the number of opiates prescribed at the Tomah VA had more than quintupled between 2004 and 2012, even as the number of veterans seeking care at the hospital declined. It included details of the August death of a 35-year-old Marine Corps veteran, who overdosed while in the hospital’s inpatient psychiatric ward.
U.S. Rep. Ron Kind, the Wisconsin Democrat whose district includes the hospital, issued a news release Monday saying, “The allegations made in this report are extremely serious and require immediate action,” and scheduled a tour of the hospital today.
Documents show Kind first heard about the problems in August 2011, when his office received an anonymous letter from a VA employee.
“The use of narcotics is escalating at such a high rate that it is scary,” the employee wrote. “We are losing great professionals who want to help these veterans and we are losing hope for change unless someone looks into the matter. Houlihan is dangerous and needs to be stopped.”
Kind’s spokesman, Peter Knudsen, told CIR that the congressman had referred it to the VA inspector general on Sept. 29, 2011. Asked what the congressman had done since, Knudsen said Kind was “disappointed that it’s taken this long,” but “he is in contact with officials at the VA and also people with knowledge of the situation in Tomah.”
Like Kind, U.S. Sen. Tammy Baldwin, another Wisconsin Democrat, fired off a letter Tuesday to VA Secretary Robert McDonald, demanding an investigation.
“I am writing to request that you take immediate action to address extremely troubling reports of improper opiate prescribing practices and abuse of administrative authority at the Tomah VA Medical Center,” she wrote.
The problems were old news to Baldwin as well. In her letter to McDonald, Baldwin notes that she had referred complaints to the Tomah VA and the Office of Inspector General in April and June last year.
The VA inspector general had closed an investigation into the Tomah VA before Baldwin even got in touch, in March 2014. The inspector general’s report noted that Houlihan’s narcotic prescriptions were “at considerable variance compared to most opioid prescribers” and “raised potentially serious concerns” that should be brought to the attention of the federal agency’s leadership. But the report suggested no punishment.
Weeth said he believed that Jason Simcakoski, the 35-year-old former Marine who fatally overdosed in the Tomah VA psychiatric ward in August, still would be alive today if the inspector general had come down harder on Houlihan.
“It hit me in the heart and I was just shaking my head,” said Weeth, who also served in the Marine Corps. “It’s ridiculous, senseless, preventable. It didn’t need to happen.”
In Washington, U.S. Rep. Jeff Miller, R-Fla., chairman of the House Committee on Veterans’ Affairs, said he also was upset because the inspector general’s report was not published for the public to see or shared with the House or Senate committees that oversee the VA.
“VA’s problems often go unsolved if they are kept a secret,” Miller said, alluding to hidden hospital waiting lists and undisclosed patient deaths that prompted the resignation of the previous secretary of veterans affairs, Eric Shinseki, last May.
“It looks as if there is another scandal brewing at OIG – one that involves secret reports,” Miller added. “As the old saying goes, ‘Sunlight is the best disinfectant.’ ”
In an email exchange with committee staff, Cathy Gromek, the inspector general’s spokeswoman, acknowledged that auditors had not shared their report with the House or Senate committees, but she said Baldwin’s office had been briefed in July, three months after the senator reached out.
“We are not hiding our work,” Gromek said in the email. “We did brief congressional staff on this matter.”
On Wednesday, U.S. Sen. Ron Johnson, R-Wis., chairman of the Senate Committee on Homeland Security and Governmental Affairs, sent a letter to the VA’s deputy inspector general, saying he was “deeply troubled by reports” that veterans “continue to receive questionable care” at the Tomah VA.
He asked auditors to conduct a fresh investigation of the facility. Like Baldwin and Kind, Johnson has been aware of the problems for a while.
In October, Johnson’s veterans services staffer, Mark Nielsen, responded to a slew of emails from Ryan Honl, a former secretary in the Tomah VA’s mental health department.
“We have forwarded your information and explanation to the DC office and they will be sharing with the committee that overseas (sic) jurisdiction of the VA,” Nielsen wrote.
Honl said he never heard back. Johnson’s spokeswoman, Melinda Schnell, said the senator’s office “prides itself on being efficient and responsive with constituent casework,” and Johnson had referred the matter to staff at a Senate subcommittee.
“Senator Johnson is proud that one of his first acts as chairman of the Committee on Homeland Security and Governmental Affairs was to direct the acting inspector general of the VA to launch a full investigation into disturbing reports concerning the VA medical center in Tomah,” she said.
Over the last five years, a large number of employees at the Tomah VA have filed whistleblower complaints with Office of Special Counsel, an independent federal agency.
Sally Stix, a Madison, Wisconsin-based attorney, told CIR that she has represented six employees who’ve filed whistleblower complaints about Houlihan, including a physician assistant, a social worker and a pharmacist.
The pharmacist’s concerns were among the first: In 2009, she alleged she was fired after refusing to fill some of Houlihan’s prescriptions for narcotics and taking her complaints to the Drug Enforcement Administration. DEA spokeswoman Barbara Carreno would not confirm whether it had investigated Houlihan or whether it was currently investigating him, but the DEA’s inquiry is noted in the VA inspector general’s report.
The Office of Special Counsel denied the pharmacist’s complaint, saying that, while questionable, Houlihan’s prescriptions were not illegal.
“You have not provided information showing that prescriptions written by Dr. Houlihan, treating physician, were in violation of any law, rule, or regulation. Rather, it appears that the prescriptions were improper in your judgment,” agency attorney Martha Sheth wrote.
Stix said the pharmacist eventually received a $60,000 settlement from the VA, the terms of which bar her from speaking about the case.
Nick Schwellenbach, a spokesman for the Office of Special Counsel, declined to comment on current conditions at the Tomah VA.