LaCrosse Tribune
Medical center director: ‘We had already taken steps’
By Chris Hubbuch
January 27, 2015

Psychiatrist David Houlihan

Psychiatrist David Houlihan

TOMAH, Wis. — As the VA launches an investigation into media reports of overmedication of patients at the Tomah VA, the director of the medical center says he wouldn’t have done anything differently.

Director Mario DeSanctis said in an interview Monday that his staff began looking into an unusually high rate of opiate prescriptions by providers at the Tomah VA in 2012, two years before an internal investigation said the practice “raised potentially serious concerns.”

“We had already taken steps to institute solutions to the problems that were identified,” DeSanctis said.

Secretary of Veterans Affairs Robert McDonald on Monday said his second in command will lead “a comprehensive review of medication prescription practices in Tomah.”

The announcement comes after calls by members of Congress in response to a recent report by the nonprofit Center for Investigative Reporting, which said opiate prescriptions had become so common that patients nicknamed the hospital “Candy Land.”

One veteran died in the hospital as a result of opiate overdose, according to the CIR report.

DeSanctis, a retired Air Force colonel who took over the Tomah facility in 2012, said his staff formed study committees, appointed an “opioid safety champion” and began educating providers about alternative treatments even before the VA’s Office of Inspector General began looking into complaints of overmedication.

According to the CIR report, the number of opiates prescribed at the Tomah VA quintupled between 2004 and 2012, even as the number of patients declined.

The CIR also brought to light the unpublished OIG report, which showed Tomah dispensed more opiates per patient than any other facility in the Great Lakes network, which serves more than 220,000 veterans in three states. One provider dispensed more than twice as many opiates as the 10th highest provider in the network, despite seeing few patients. Two others were among the top 10.

DeSanctis said opiate prescription rates “have at least leveled off if not been reduced,” since 2012 and that drug screening rates – used to ensure patients are taking medications as prescribed – are up, though the VA did not provide data.

“This is a work in progress,” DeSanctis said. “You just can’t take veterans off of pain meds cold turkey.”

DeSanctis also added that Tomah is a referral site for the most complex mental health cases in the region.

“We’re treating veterans that no other facility can treat – or will treat,” he said.

Still, DeSanctis said he welcomes the new investigation.

“What else can we do to improve the care we’re providing,” he said. “We take the allegations seriously.”
Report ‘not releasable’

Records show problems at the Tomah VA were reported as early as 2011, when an anonymous complaint to Rep. Ron Kind and the OIG alleged heavy opiate prescription by Dr. David Houlihan, a psychiatrist and chief of staff for the hospital.

It detailed the case of one veteran with a history of drug abuse who spent a month in the hospital for detoxification only to be prescribed oxycodone on release. He returned a few days later after a drug binge, according to the letter, which went on to outline a pattern of intimidation by Houlihan.

That complaint, in part, sparked the two-year OIG investigation.

Kind and others in Congress have criticized the OIG for not publishing the report or notifying the appropriate oversight committees of its existence. Kind also criticized DeSanctis for failing to alert him to the investigation.

DeSanctis said the report was “not releasable,” meaning he was not allowed to share it with anyone, including Kind.

Kind said OIG staff admitted they “dropped the ball” by not notifying Congress of the report.
Second investigation to examine culture

Since the initial publication of the CIR report Jan. 9, the Department of Veterans Affairs has come under increasing scrutiny, with calls for hearings in both the House and Senate oversight committees.

Houlihan was temporarily reassigned after the publication and will not see patients or prescribe medication during the VA investigation.

The VA said it will launch a second investigation into claims that senior medical personnel created an atmosphere of intimidation and retaliation.

DeSanctis said those allegations were not substantiated by the OIG investigation, though it made recommendations that resulted in removing the pharmacy from Houlihan’s supervision.

“I took those recommendations to heart,” he said.

David Houlihan, Wisconsin VA psychiatrist