By Sandra Basu
In addition, the agency is working to ensure that drug checks at medical facilities are performed and follow all requirements, according to VHA Deputy Undersecretary for Health for Organizational Excellence Carolyn Clancy, MD.
Clancy made her comments at a hearing held by a House Committee on Veterans’ Affairs subcommittee in late February that assessed VA’s risks for drug diversion.
The hearing was held in the wake of a Government Accountability Office (GAO) report that found a failure by the VA to conduct required monthly inspections of facilities that house controlled substances and to always follow VHA inspection requirements when the inspections are performed.
Referring to recent news reports, Subcommittee Chairman Rep. Jack Bergman (R-MI) said “in case after case, what we see are examples of drugs being diverted for personal use or personal gain, yet there does not seem to be much progress being made by VA to correct the glaring problems that allow it to happen.”
Bergman said that issues of drug diversion “are in part a result of VA having inadequate procedures in place to safeguard against theft and diversion of controlled substances.”
GAO Director of Healthcare Randall Williamson told lawmakers that VHA requires medical facilities to conduct monthly inspections that follow procedures outlined by VA. GAO found in a review of four medical facilities it conducted from January 2015 to February 2016, however, that the oversight was inconsistent.
Williamson told lawmakers that he estimated that, overall, as few as 10% to 15% of VA facilities nationwide are following agency inspection procedures, making them vulnerable to drug diversion.
Meanwhile, Nicholas Dahl, VA OIG Deputy Assistant Inspector General for Audits and Evaluations, explained that, in recent years, his department has reported that VA facilities did not always comply with its own policy to drug-test applicants prior to appointment.
While VA’s policy states that every individual tentatively selected for employment in a Testing Designated Position (TDP) is subject to a drug test before appointment, the OIG found that this had been interpreted by human resources as meaning only some finalists for TDPs needed to undergo those tests before being appointed.
As a result, the OIG estimated that prehire drug tests were not performed for about 15,800 of the nearly 22,600 individuals who were appointed into VA positions, including physicians, nurses, senior executives, police office and motor vehicle operators during fiscal year FY 2013.
That year, according to the OIG, VA achieved a national employee random drug testing rate of 68% of the 3,420 employees selected for that program in FY 2013.
More recently, the VA OIG issued a report in January on delays in the processing of certain human resources functions at the Atlanta VAMC, noting that mandatory drug testing for new hires did not occur for a period of at least six months between 2014 and 2015 because of an open facility coordinator’s position.
“Because no drug testing occurred, the Atlanta VAMC lacked assurance that employees who should have been subject to drug testing remained suitable for employment,” Dahl said.
Keith Berge, MD, who chairs Mayo Clinic’s Enterprise-wide Medication Diversion Prevention Committee, told lawmakers the consequence of lapses in drug testing is that you might “be letting someone who would test positive, and is in fact an addict, into an area where they could get their hands on drugs.”
Clancy said the recent GAO report received a “swift response” by VA in addressing the concerns outlined. She also said that, while GAO and the VA OIG have identified “select instances” of noncompliance with VA’s “robust controls,” she believed the system is working “as designed to make it difficult for VA staff to divert drugs, and most importantly to give us the tools to be able to detect diversion rapidly.”
Lawmakers also questioned VA’s drug diversion data during the hearing. The VA reported that data from Jan. 2, 2014, through March 11, 2016, show that VA had 2,405 reports of internal and external losses, some of which were due to diversion. The agency said data also indicates that approximately 92% of the controlled substances losses occur in the mailing system during shipping to veterans, with only 1.5% due to diversion by VA staff.
Skeptical of VA’s data on the large percentage of losses in the mail system, Rep. Neal Dunn (R-FL), MD, said he “has never seen anything like the report.”
“This is perilously close to the old excuse: the dog ate my homework,” he said.
When asked to explain about the drug losses in the mail system Clancy said that “between the time that prescriptions are put in the envelope, and — understand we have a central mail order pharmacy, which for most prescriptions works extraordinarily well — somewhere between there and the veterans’ home where it was supposed to go, is where it is diverted.”
Dunn said he was “flabbergasted” by those numbers.
“In 35 years, I have never heard this kind of accusation that 90% are in the postal system,” he said.
Williamson said he also would be “suspicious” of those numbers because “VA doesn’t have a very good reporting system for drug diversion cases.”
Legislation that would streamline VA’s community care programs into one program and expand VA’s caregiver program to veterans of all eras was signed into law earlier this month..
The good news from a recent consultant study is that, overall, the VA healthcare system is generally equal or better than others when inpatient and outpatient quality is measured.