February 23, 2017

Report finds massive spike in missing drugs at VA, other federal hospitals

Daily Briefing

    Opioid theft, missing prescriptions, and unauthorized drug use by staff at federal hospitals has increased sharply since 2009, according to a recent investigation by the Associated Press.

    For its investigation, the AP reviewed data from the Drug Enforcement Administration (DEA) on incidents of drug losses or theft at federal hospitals, which include:

    • More than 1,100 Veterans Affairs (VA) facilities;
    • About 20 Indian Health Service hospitals; and
    • Seven correctional hospitals.

    AP also reviewed past Government Accountability Office reports and spoke with officials from GAO and the VA Office of Inspector General (OIG). According to AP, VA officials at the time of publication had not responded to a three-week-old request for "a list of VA facilities where drugs had been reported missing or disciplinary action was taken, saying it was still compiling the information."

    Findings

    The DEA data reviewed by AP showed that reported incidents of drug loss or theft at federal hospitals increased from 272 in 2009 to 2,926 in 2015. That number dropped last year, however, to 2,457.

    The AP found that nurses, pharmacy staff, and physicians at federal hospitals in some cases diverted controlled substances for personal use or street sales. In other instances, AP stated that drugs intended for patients "simply disappeared."

    The AP highlighted several "notable" incidents it discovered during its investigation. For instance, the AP found that three VA employees this month were charged with conspiring to steal prescription medications from the John L. McClellan Memorial Veterans Hospital in Little Rock, Arkansas. A 2016 OIG investigation alleged that a pharmacy technician used his VA access to a suppliers' web portal to order and divert 4,000 oxycodone pills, 3,300 hydrocodone pills, and other substances. The VA employees also were charged with conspiring to distribute the drugs.

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    In a separate instance, an associate chief of pharmacy at the VA medical center in Salt Lake City recently pleaded guilty to acquiring possession of a controlled substance by fraud, according to OIG. Between October 2011 and March 2015, the employee diverted roughly 25,000 pills—including Adderall, buprenorphine, hydromorphone, oxycodone, and Ritalin—from the inpatient pharmacy. 

    AP also highlighted a case at Providence VA Medical Center, Rhode Island last year in which a former registered nurse pleaded guilty to stealing prescription drugs by overriding the center's medication dispensation system. The nurse obtained hundreds of controlled substance pills, such as oxycodone and morphine, which were not prescribed for or provided to patients.

    According to AP, lax protocol regarding prescription drugs at VA hospitals led officials to overlook missing drugs. Spot checks at four VA hospitals during a GAO review conducted between January 2015 and February 2016 found that the hospitals had skipped monthly checks of drug stocks or failed to complete other requirements.

    VA's response

    VA acknowledged that hospitals in the department sometimes miss monthly inspections. The department said it is requiring hospitals to comply with inspection protocols and develop plans for improvement.

    Senate confirms Shulkin as VA secretary

    Recently confirmed VA Secretary David Shulkin in an interview called VA employees the "best in health care" but vowed to remove bad actors in the department. "When you have one or two or three people [who] really aren't doing their job, they bring everybody down," Shulkin said.

    Veterans groups, lawmakers respond

    Garry Augustine, executive director of Disabled American Veterans' Washington headquarters, said, "Medical practitioners at the VA have a responsibility to provide the best care for the injured and ill veterans in their charge, and these actions are contradictory to the very nature of their professional obligations."

    Joe Davis, a spokesperson for Veterans of Foreign Wars, said, "VA employees who are entrusted with serving our nation's wounded, ill, and injured veterans must be held to a higher standard."

    House Veterans Affairs Committee Chair Phil Roe (R-Tenn.) on Tuesday said the committee has scheduled a hearing on the issue for Monday. Roe said he would ask VA officials to discuss efforts to improve internal controls and hold employees accountable for missing drugs. "The fact that drugs are going missing from VA facilities further underscores the importance of oversight," Roe said.

    Senate Homeland Security Committee Chair Ron Johnson (R-Wis.) called the increase in drug loss and theft at federal hospitals concerning. According to the AP/Minneapolis Star Tribune, Johnson last year flagged issues related to possible unauthorized use of drugs at a VA medical center in Milwaukee. Johnson's' office said the committee still is reviewing that matter (Yen, Associated Press, 2/20; Yen, AP/Minneapolis Star Tribune, 2/21; AP/Sacramento Bee, 2/21).

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