The VA Inspector General's office on Thursday strongly refuted congressional criticism of its investigation into prescribing practices at the Tomah Wisconsin VA Medical Center.
The IG drafted a vitriolic missive to the Senate Committee on Homeland Security and Governmental Affairs that takes lawmakers to task for not requesting personal briefings on the initial allegations, the investigation and the IG's findings.
Deputy Inspector General Richard Griffin led the release of an 11-page rebuttal with a quote from John Adams: "Facts are stubborn things; and whatever may be our wishes, our inclinations or the dictates of our passion, they cannot alter the state of facts and evidence."
He then ripped into criticism of the investigation, refuting reports that his office hid its results, dismissing testimony from former Tomah employees for lacking personal knowledge of the facts and saying that a staff psychologist who committed suicide in 2009 after he was fired from the medical center was a drug dealer.
The response was among 13,949 pages provided to the Senate committee in response to a subpoena issued April 29.
In a document summation, Griffin addressed the major concerns surrounding the Tomah scandal, including allegations that providers overprescribed opioids and other painkillers, charges of whistleblower retaliation and a reputation that a "culture of fear" exists among employees at the medical facility.
Griffin said the VA OIG first received a complaint about prescribing practices at Tomah in March 2011. The office investigated and substantiated the allegations, but because the Veterans Health Administration had embarked on an action plan to solve the problem, the IG closed the case.
In August 2011, it received another complaint and launched a full investigation into practices at the hospital as well as two providers, Chief of Staff Dr. David Houlihan, and an unnamed nurse practitioner.
That review, however, "found largely that analyses of prescription data from Tomah and other VA medical centers and among various providers failed to support many of the allegations," according to Griffin.
Among VA prescribers in the region, Houlihan ranked fourth among 10 of the highest and the nurse in question was a "distant second" behind the highest provider, whom the report did not name.
The IG noted that part of the perception that the two prescribed too many painkillers may be attributable to "inexperienced" pharmacists, whom, they found, complained about Houlihan and others' prescribing practices but "had no experience working with complex medical psychiatric issues facing the veterans of Tomah."
On the allegations of whistleblower retaliation, the IG pointed out that one pharmacist who testified at a March 30 field hearing in Wisconsin, Ryan Honl, did not have personal knowledge of the things he spoke about in the hearing because was not employed at VA at the time of the investigation or some of the events, such as the death of clinical psychologist Christopher Kirkpatrick.
The families of both Honl and Kirkpatrick told lawmakers and the media that they believe the the clinician's suicide was tied to expressing concerns that his patients were overmedicated.
But Griffin said evidence found at Kirkpatrick's home, as well as large amounts of medication not prescribed to Kirkpatrick, indicates he was "distributing marijuana and other illegal substances."
The report also dismissed allegations made by another pharmacist at the hearing who testified she was fired for refusing to fill a prescription. Instead, Griffin said, Noelle Johnson was dismissed before her probationary period ended because she was not a "team player" and had poor "interpersonal skills and was caustic to physicians."
"The evidence we found during the inspection does not support her assertion that that she was fired as result of whistleblower retaliation," Griffin wrote.
Acknowledging that any culture of fear is detrimental to workplace morale, Griffin said the OIG staff did find the pharmacists were reluctant to question prescriptions ordered by Houlihan and would not raise concerns of aberrant behavior by his patients. "But most could not give first-hand accounts of any negative action toward them," the IG staff concluded.
In January, the Center for Investigative Reporting released an article on the problems at the Tomah facility, finding that the number of opiate prescriptions quintupled from 2004 to 2012, with rates rising sharply after Houlihan, a psychiatrist, was hired as chief of staff.
When pharmacists raised questions about the high number of prescriptions, they faced retaliation, were fired or resigned in protest, according to interviews with the media as well as congressional testimony.
At least six deaths at the facility have been tied to medications or considered suspicious at the facility, according to witness testimony.
The IG currently has an active investigation into one of the deaths, that of former Marine Jason Simcakoski, who died in August while an inpatient in the psychiatric ward.
On Thursday, the VA inspector general released the results of an investigation into another death, that of Thomas Baer, a veteran who suffered a stroke while waiting for a mental health appointment at a Tomah urgent care clinic.
Family members had charged that staff at the facility ignored the 74-year-old's symptoms and then failed to treat them once they realized the severity of his neurological event.
The VA OIG concluded that the staff acted appropriately in transferring the patient to a civilian medical facility after he had the stroke.
"The urgent care facility is being used by patients as an emergency department when, in fact, it is not. The Tomah facility has no operating room, no intensive care unit, no surgeon on staff, and lacks the infrastructure of an emergency department," the IG wrote.
Griffin said his staff is willing to sit down with lawmakers to discuss the voluminous documents provided them in response to the subpoena, and in fact, welcomes the interaction.
While noting that Sen. Ron Johnson, R-Wis., Homeland Security Committee chairman, and his staff have publicy criticized the VA OIG's findings, "neither he nor any member of the oversight committee has requested to be personally briefed regarding the allegations, our inspection, our findings and supporting evidence," Griffin said.
The original Tomah investigations were carried out by two board-certified psychiatrists, two board-certified internists, a physical medicine and rehabilitation doctor, a pharmacist and a special agent.
Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.
