VA Hospital Improperly Substituted Mental Health Drugs to Save Money
April 22, 2015
OSC informed the White House hat a VA Medical Center in West Virginia put patients at medical risk by substituting prescribed medications with older drugs in order to cut costs.
The U.S. Office of Special Counsel (OSC) informed the White House and Congress today that the Beckley, West Virginia, Veterans Affairs Medical Center (VAMC) put patients at medical risk and violated VA policy by substituting prescribed antipsychotic medications with older drugs in order to cut costs. A VA whistleblower disclosed these allegations to OSC, which were confirmed by the VA’s Office of Medical Inspector (OMI). OMI’s report of investigation found that the VAMC’s actions posed “a substantial and specific danger to public health and safety.” OMI recommended that the Beckley VAMC immediately stop switching patients from their prescribed drugs without a legitimate clinical need. The OMI investigation also found that, in a departure from standard VA practice, the Beckley VAMC Pharmacy and Therapeutics Committee (PTC) was chaired by a non-physician, and recommended this practice be changed.
“At a time when many veterans are grappling with mental health issues, this VA facility was cutting corners on needed drug therapy to save money in violation of VA policy,” said Special Counsel Carolyn Lerner. “We only know this was happening because an employee had the courage to blow the whistle on this dangerous practice.”
The OMI report found that the PTC restricted providers from administering aripiprazole or ziprasidone to meet a cost savings goal. VA policy bars VA hospitals from withholding prescribed drugs from veterans solely to save money.
A mental health unit representative to the PTC voiced concerns about the proposed restriction on continued therapy with these two drugs, but these concerns were not documented. Other mental health providers told OMI they had little to no input on the PTC’s clinical guidelines. There was a process for doctors to appeal a pharmacy decision to use cheaper, older drugs, but “they did not submit appeal requests because of what they felt was a foregone conclusion,” according to the OMI report. OMI’s report also stated that while each veteran had their medications reviewed before any adjustment took place, “many providers felt that they had no option other than to prescribe some other medication in place of the originally prescribed ariprazole or ziprasidone. They followed this guidance, despite their disagreement with the change in treatment,” citing potential side effects of weight gain and sedation associated with the older drugs.
The OMI report called for a clinical care review of the medical records and condition of all patients who were discontinued from aripirazole or ziprasidone and whether there were any adverse patient outcomes as a result. The report recommended that Beckley VAMC and PTC leadership be disciplined for approving actions that violated VA policy and could pose a substantial and specific danger to public health. OSC will follow-up with the VA to ensure that the Beckley VAMC implements these recommendations. The whistleblower did not consent to release of their name.