Here & Now

Ron Kind Reacts to Tomah VA Overprescription Report

Frederica Freyberg:

But first, allegations of over-prescribing of narcotics to veterans at the Tomah VA Medical Center are detailed in a bombshell report just made public. Included in the story from the Center for Investigative Reporting, some patients there called one doctor the “candy man.” And prescriptions for opiates more than quintupled between 2004 and 2012, even as the number of veterans cared for at the center declined. The reporting also detailed the death of a 35-year-old veteran who overdosed while in the in-patient psychiatric unit. The controversy prompted several of Wisconsin’s congressional delegation to call for an immediate investigation. The first to do so was La Crosse Democrat, Congressman Ron Kind, who joins us now from La Crosse. And thanks very much for being here.

Ron Kind:

My pleasure.

Frederica Freyberg:

Well, so now you’ve been aware of these allegations since 2011, I read in this reporting, and yourself referred them onto the VA inspector general back then. So how blindsided were you to read details of the alleged continuing situation at Tomah, including the overdose death in August?

Ron Kind:

Well, these are very serious allegations. And that’s why earlier this week Senator Baldwin and I immediately got in touch with the VA secretary, Bob McDonald, asking for them to conduct their own formal investigation. And on a phone call with him yesterday, along with the undersecretary for health, Dr. Clancy, they agreed to do so. Because they’re viewing these allegations very seriously, too, about the pain management practice that’s occurring at Tomah, but also about a potential culture of intimidation and coercion that needs to be addressed as well. So we’re looking forward to working with the VA as they move forward on this investigation, and hopefully find out if there is a problem and what we need to do to fix it now so we stay focused on good, quality care for all of our veterans.

Frederica Freyberg:

Well, how was it that your initial contact with VA brass and subsequent contact did not result in changes, and we find ourselves here today?

Ron Kind:

Well, I was just there at Tomah VA yesterday, sat down with the management team to find out if they are implementing the recommendations that came from the office of inspector general. They had concluded about a 2.5 years comprehensive investigation, and at the conclusion of that they didn’t find any actionable cause against the doctor that’s been the focus of this or otherwise. But they did come forward with a list of recommendations to be implemented. Tomah has been doing that throughout the course of the last year, such as an opiate management team and a separate pain management department within the VA at Tomah, and a more collaborative, multi-disciplinary approach to patient files, so that it’s not just an opinion of one doctor and the dosage that they set, but a wider peer review process. I also expect, Fred, that this is more than just Tomah. This could be system-wide, that we’ve got to look at the practice of pain management for our veterans within the VA system. And there again, the inspector general’s office released a separate report dealing with systemwide reforms of how we can manage pain at a much more effective rate throughout the entire VA system.

Frederica Freyberg:

And so the original kind of investigation made these recommendations and they were being implemented at Tomah, but is it your sense that some very big problems persisted right up until very recent weeks?

Ron Kind:

Well, fortunately, because of the investigative report that came out, more individuals have been contacting me who work at Tomah VA, talking about their firsthand experience and what they’ve been encountering. I’ve been following up with them and also seeing if they’re willing to cooperate now with the VA investigations, so I can direct those investigators to more people with firsthand knowledge. I’m not limiting myself to just conversations with management team at Tomah. I’m meeting with a lot of the staff and a lot of the people who do have firsthand knowledge, so I’m given a wider picture of what in fact is taking place. And at the conclusion of this investigation, if people need to be held accountable, I want to make sure that happens, but also that the changes are occurring immediately in order to enhance the quality of care for our veterans there.

Frederica Freyberg:

Can you confirm that Tomah’s chief of staff and psychiatrist has just been reassigned away from the Tomah center?

Ron Kind:

Yeah, not only has he been reassigned, but he’s been suspended from dispensing any pain medication pending the outcome of this investigation. And I think that’s an appropriate step at this time. But as you can imagine, there’s always two sides to a story. And you get he said/they said and that. Trying to weed through all of that is what will be the task of the VA in the coming weeks. Pain management is not an exact science, but we have made a decision, right or wrong, in this country that we don’t want to see our veterans in pain. And sometimes doctors get criticized for too low a dose, for sometimes for too high a dose. And trying to strike that right balance is where I think the collaborative process and peer review can come in. So, again, it’s not just one person’s opinion in this.

Frederica Freyberg:

Very, very briefly, what message do you have for veterans at Tomah and their families?

Ron Kind:

I want to emphasize, too, that we’ve gotten reports dealing with a particular doctor and some specific cases, but there’s also a lot of good-quality work being done. At the same time, I’m receiving contact from a lot of veterans who are very happy with the care and the attention and the outcome of care that they are getting at the Tomah Medical Center. So I don’t want to paint too wide a brush on all this, a lot of dedicated professionals doing a good job at Tomah VA. But if there is a problem, we need to be aware of it and be able to take action immediately so we fix it for veterans.

Frederica Freyberg:

Congressman Ron Kind, thanks very much.

Ron Kind:

Thank you.