Department of Veterans Affairs physicians told a House subcommittee today that hospital administrators regularly pressured them to prescribe highly addictive narcotic painkillers to patients, even those they had not personally examined.
The hearing marked the first time VA officials have spoken publicly about the skyrocketing number of painkiller prescriptions since The Center for Investigative Reporting revealed the trend last month.
“There are multiple instances when I have been coerced or even ordered to write for Schedule II narcotics when it was against my medical judgment,” said Dr. Pamela Gray, a physician who formerly worked at the VA hospital in Hampton, Va.
Primary care doctors who don’t want to prescribe large amounts of opiates may resign, do as they are told or be terminated, Gray said. Gray was fired.
In his testimony before the health subcommittee of the House Committee on Veterans’ Affairs, the VA’s principal deputy undersecretary for health, Dr. Robert Jesse, said the large amounts of opiates prescribed at VA hospitals and clinics are part of a national crisis that extends beyond the agency.
Jesse said that if physicians feel pressured by their superiors to prescribe, that is “absolutely indefensible” and they “should feel absolutely that they can refuse to do that.”
But lawmakers were not convinced. “The system appears to be broken,” said Rep. Julia Brownley, D-Calif., the subcommittee’s ranking Democrat. “How do you respond to the comments that we have a system of quick and cheap over good and thorough?”
Jesse responded: “I don’t believe that is the case systemwide.”
CIR disclosed that prescriptions for four highly addictive opiates – hydrocodone, oxycodone, methadone and morphine – have increased by 270 percent since the war in Afghanistan began, far outstripping the increase in the number of patients.
In its analysis, CIR also found extreme variation in the rate at which agency doctors prescribed these opiates around the country. Last year, for instance, doctors at the VA hospital in Roseburg, Ore., wrote eight times as many opiate prescriptions per patient as did their colleagues at the VA hospital in Manhattan.
“Veterans depend upon VA to uphold its mission of restoring the health of those who have borne the burdens of battle,” Rep. Jeff Miller, R-Fla., chairman of the House Committee on Veterans’ Affairs, said in his opening statement.
“But instead of helping them manage their battles with pain in a healthy manner, VA has opted instead to use treatment that has the power to destroy, rather than restore their lives,” Miller said.
Veterans and survivors of former servicemen who had died of opiate overdoses testified at the hearing.
Iraq and Afghanistan war veteran Scott Alan McDonald died of an overdose of Percocet on Sept. 13, 2012. His widow, Heather McDonald, who was featured in a CBS News report on painkillers last month, told the lawmakers that families can accept a soldier’s death on the battlefield but cannot accept “when they come home and die in front of their children and their loved ones.”
“This has got to stop,” she said.
CIR found that VA scientists have known for two years that the fatal overdose rate among the agency’s patients is nearly double the national average. Since then, CIR’s analysis showed, the rate of opiate prescriptions has continued to rise.
During the hearing, Jesse, the VA health official, did not directly address the escalating prescription rate.
His written testimony emphasized the challenges for agency physicians who treat veterans with bodies savaged by war. More than half of the 5.7 million veterans who received care from the agency last year were affected by chronic pain, Jesse said – a far greater proportion than in the general adult population.
Jesse argued that the agency used a “multimodality, team-based, stepped-care model” designed to de-emphasize the use of strong drugs in favor of more holistic treatment like physical therapy and acupuncture. In his written testimony, he reported that the agency has 115 pain specialists on staff nationally – about one for every 50,000 patients.
Veterans told lawmakers that alternative treatments to opiates existed only on paper and that they find it very difficult to get medical care that goes beyond powerful medication.
Joshua Renschler, a former U.S. Army sergeant who was medically retired after surviving a mortar blast in Iraq in 2008, told lawmakers that he had difficulty obtaining primary care appointments at the VA in Lakewood, Wash., within three months of his previous appointment.
But that didn’t stop the agency’s doctors from putting him on 13 medications, including a cocktail of painkillers such as Percocet, which contains the opiate oxycodone.
“As my back pain continued to worsen, my primary care provider simply increased the dose of Percocet until it was no longer effective even at the extreme dosing of 12 to 15 5-milligram tablets a day,” he said. When that didn’t work, the VA put him on methadone and eventually morphine. By the middle of 2009, he said, he was so doped up that he couldn’t work.
This story was edited by Amy Pyle and copy edited by Nikki Frick and Christine Lee.
Correction: An earlier version of this story misstated when veteran Scott Alan McDonald died.