PERU – An investigation by the Department of Veterans Affairs has revealed employees at the Peru VA outpatient clinic changed veterans’ pain medication without doing physical assessments and scheduled appointments with patients’ knowledge.
A report documenting the findings of the investigation was published March 22 after a team made onsite visits to the clinic from Dec. 19-21.
The investigation found one employee at the Peru clinic had tapered opioid pain medication for at least six veterans without a face-to-face clinical appointment or physical assessment, which violates both Indiana state law and VA policy.
The employee remotely managed patients’ opioid medication from a worksite at the Marion clinic while covering for an absent provider, according to the report obtained by the Kokomo Tribune.
An employee confirmed to investigators that veterans had complained that their narcotic prescriptions were tapered without their knowledge.
The VA was unable to substantiate whether a veteran died as a result of having their medication changed. An autopsy revealed the veteran died from severe coronary artery disease, but the report recommended an external peer review to determine whether the death was related to tapering opioid medication.
The VA team also determined patients were being scheduled without their knowledge and often cancelled by the clinic on the day of the appointment. Policy prohibits scheduling an appointment without negotiating the date and time with the patient.
The report says some employees also created “placeholder appointments,” which is an appointment scheduled with a veteran who is not expected to attend. From October 2014 to December 2016, 56 appointment slots were filled by placeholder veterans.
The report states the practice could result in missed opportunities for eligible veterans to be treated.
Employees at the clinic told investigators they created the placeholder appointments to save time slots for veterans who may need an urgent appointment.
The clinic was also alleged to have prescribed high doses of narcotics without a proper diagnosis, but the report determined these claims were unsubstantiated.
The investigation into the Peru clinic was initiated by VA Under Secretary for Health David Shulkin after allegations of improper care and scheduling improprieties were forwarded to his office by U.S. Rep. Jackie Walorski, R-2, and former Congressman Jeff Miller.
The two forwarded the complaints on behalf of the U.S. House of Representatives Veterans’ Affairs Committee.
In a statement to the Kokomo Tribune, Walorski said “The investigation I requested has confirmed disturbing allegations made by Hoosier veterans and whistleblowers at the Peru VA clinic about inadequate care and improper scheduling manipulations.”
“Adjusting veterans’ pain medications without face-to-face examination by a doctor falls unacceptably short of the level of care our veterans expect and deserve,” she said. “It has already taken far too long for the VA to address these failures, and I will be keeping a close eye on the VA’s progress in implementing the report’s recommendations so Hoosier veterans never again face such mistreatment at the Peru clinic or any other VA facility.”
Teresa Calhoun, health systems specialist for the VA’s Northern Indiana Health Care System, which operates the Peru clinic, said reports like this one will be used to improve the process for veteran care.
She was unable to comment any disciplinary action the VA might take against the clinic employees accused of violations. The employees’ names were redacted from the report.
But Miami County Veterans Service Officer Jay Kendall, who works closely with the clinic, said the Peru facility isn’t to blame for the issues unearthed by the investigation.
He said the problem largely stems from the fact that the clinic is understaffed and overbooked with patients, and employees can’t keep up with the load.
“These people are doing more than they possibly could do,” Kendall said. “I will vouch that their true desire is to help veterans.”
The VA report does note that substantial staffing challenges have occurred at the Peru clinic since May 2016 that have had a significant impact on veterans’ access to care.
Kendall said at one point last year, the clinic had only one nurse practitioner and no doctors. It’s also been nearly two years since the facility had a permanent, full-time manger to oversee day-to-day operations.
Since then, one full-time and one part-time doctor have been added, and the VA is in the process of hiring a full-time manager, he said.
“Their hair was on fire there for a while, but we’re getting things built back up again finally,” Kendall said.
In the end, he said, VA administrators are responsible for ensuring the Peru clinic is properly staffed and managed and veterans are receiving quality healthcare.
“It was wrong what (the employees in the report) did, but it was not out of malice,” Kendall said. “It came down to the fact that they were too busy. They tried to make things work without any supervision, and this is what happens.”