Review of Opioid Monitoring and Allegations Related to Opioid Prescribing Practices and Other Concerns at the Tomah VA Medical Center

In response to a request from Senator Tammy Baldwin, the VA Office of Inspector General (OIG) conducted a healthcare inspection to assess 12 allegations regarding opioid monitoring, prescribing practices, and other concerns at the Tomah VA Medical Center, Wisconsin. The OIG found the facility had an opioid monitoring program and processes were in place to follow up on outliers or other concerns. The OIG’s electronic health record review revealed opportunities to improve compliance with risk mitigation strategies, but it appeared that the facility was attempting to comply. The OIG did not substantiate that temporary or covering providers’ opioid prescriptions were not monitored; facility managers failed to provide adequate guidance and support regarding opioid prescribing; opioids were being handed out “like candy;” pain management consults were not available; or that facility leaders failed to impose restrictions on the number of times a patient on opioids could change providers. Further, the OIG did not substantiate that physician assistants were forced to write opioid prescriptions or were being harassed such that the work environment was psychologically unsafe, or that patients were endangered because of these practices. Interviewees reported that leaders were supportive of tapering opioids and non-opioid pain management resources were available and encouraged. The OIG was unable to determine whether mental health providers were combining benzodiazepine and opioid prescriptions for patients after another provider would discontinue them. The OIG substantiated that a physician was not consistently on-site at the Wausau Community Based Outpatient Clinic (CBOC) during fiscal year 2018; however, a permanent physician started at the CBOC in early spring 2018. The facility was recruiting for additional primary care providers in several of its locations. Environment of care deficiencies at the Wausau CBOC had largely been addressed. The OIG recommended the facility continue provider education efforts and comply with risk mitigation strategies.