MARION, Ind. – A VA hospital once investigated for giving out too many opioids, is now cracking down hard on opiate prescriptions.
But are they going too far?
According to a number of veterans, the answer is yes. They say their opiate prescriptions were cut off, with no warning and no communication from doctors. Many of them rely on the Marion VA.
Three, who agreed to be identified on camera—Josh Keller, Rae Ann Panther and John Nelson—call the VA’s response to the opioid abuse epidemic “irresponsible” and “dangerous.”
“They’re treating us like we’re addicts, selling our prescriptions on the street,” said Nelson.
Nelson, along with the three others, acknowledges that some of their fellow veterans are addicts and may be selling their opiate prescriptions or otherwise abusing them. Their concern is that providers are now assuming everyone is an addict and treating them poorly because of that.
“None of us wants the drugs for the high,” said Panther. “We just want to live again.”
All three were left to struggle with pain and some even withdrawal symptoms, after they say their daily doses of Oxycontin, Lortab and Tramadol were suddenly cut off.
“I called back several times and finally got a nurse to say, ‘They’re not giving you any of your medication. I am extremely sorry,’” said Keller as he recounted the day he found out his prescription would not be refilled. “And she was very upset on the line and it sounded like she was in tears. She said, ‘They’ve done it to not just you, but everybody. They’ve done this to everybody.’”
Panther had a similar experience. As a former nurse herself, she says the most unnerving part was not getting any prior communication from her doctor.
“They never contacted me to say, 'Hey, we’re thinking about doing something, what’s your idea?'” recalled Rae Ann. “No plan of action. Cut you off, never talk with you about it.”
They say the cutoffs came just a day or two before their prescriptions ran out. They say they received no help tapering off the heavy-duty narcotics and no relief for chronic back and knee pain they spent years trying to leave behind.
For Nelson, who’s self-employed, that meant sometimes not being able to work and falling behind. For Keller, it meant using his vacation days because he was in too much pain to even get out of bed.
“I have to weigh my options,” said Keller. “Am I going to be sick? Can I call in sick today or is it going to be worse tomorrow?”
For Rae Ann, whose husband had to quit his job to care for her due to numerous illnesses years ago, the pain made her bad situation much worse.
“There’s no quality of life for people like us!” exclaimed Panther. “When they say, your pain level from 1-10. Dear God, what’s a one? We live, probably at a 4.”
They claim the doctors not only brushed off their concerns at being so abruptly cut off, but were quick to point the finger at one person, Dr. Lori Drumm, they say is making the decisions.
Dr. Drumm is not these vets' primary physician. In fact, they say she never treated them at all.
Drumm wouldn't speak on camera with CBS4, but her boss, Chief of Staff, Dr. Wayne McBride did.
“Dr. Drumm is a very experienced primary care provider and she is our service chief for the primary care service line,” said McBride.
He says part of Drumm's job is to make sure providers are aligning their care with the national VA Opioid Safety Initiative. She’s also responsible for recommending changes to prescriptions.
There are two main reasons Drumm might suggest a change.
Sometimes, Dr. McBride says she might be looking through records and find that a veteran has violated what is known as a “pain contract” by taking opiates improperly. A veterans’ urinalysis that comes back negative when they’re supposed to be on an opiate might indicate they’re diverting their drugs and giving or selling them to someone else.
Dr. Drumm can also recommend changes when she believes the prescribed dose is too high.
“There have been times, I believe, when some of the providers and physicians have sought her assistance and she has then indicated to them, a certain course of action,” said Dr. McBride.
When asked why veterans are hearing these recommendations or orders from Dr. Drumm and not their own provider, McBride sympathized with the vets.
“I’m concerned, when the veteran has not received the communication from the assigned provider and Dr. Drumm is scripting this care or making those determinations,” said Dr. McBride.
With Panther’s permission, we showed Dr. McBride two My HealthyVet messages from the two times doctors said they were taking her Tramadol away.
In June of last year, a nurse tells Panther, “Dr. Drumm is not going to order additional opiates” and “Dr. Drumm is concerned about unintentional overdose.”
Panther replies, stating she’s “never been seen by Dr. Drumm.”
At the time, Dr. Drumm was covering for Panthers’ normal provider who was out on leave. But still, McBride says that doesn’t absolve her of all responsibility for what he considers proper communication with a patient.
“In this particular case, she was covering for another provider, but as I’ve acknowledged, I think it could’ve been handled better,” said McBride.
After Panther gets a nurse to help intervene, her prescription is renewed. But then in October, her nurse practitioner tries to cut her off this time.
Dr. McBride read where Panther relays to a nurse that she was told by a third party that her nurse practitioner would not refill her script.
That is not the way McBride wants these conversations to happen.
“It’s disturbing that she wouldn’t say, ‘Come in let`s talk about this,’” said Dr. McBride. “I don’t think you need this, why and have a conversation. So it’s concerning.”
Dr. McBride says his intent is for opiate reductions at the Marion VA hospital to always comply with the Opioid Safety Initiative.
“In many chronic pain conditions, opioid medications are now not thought to be the standard of care,” said McBride. “It is our intent, before we reduce the medication or even start to lower it or discontinue it, our intent is to make sure they have pain management from other sources, non-narcotic sources, where they will have access to chiropractic or physical therapy.”
Those alternative pain management sources can also include an acupuncturist or even a psychiatrist, as they’re slowly taken off opiates. But that doesn’t match the accounts from these three veterans or the many others.
“I’ve spent almost $1,200 of my own money using a doctor for acupuncture and chiropractic,” said Panther. “We ask them about it and they say, 'Oh no you don’t need that.' I’ve had a doctor say to me, I don’t believe in that stuff. I would believe in anything that helps me!”
McBride says he doesn’t want to see veterans spending their own money on care they should be able to receive through the VA or CHOICE program. Yet he admitted alternative pain care appointments aren’t always available quickly.
He also acknowledged that some doctors haven’t been following orders to wean veterans off their opiates.
“We have had accounts that have arisen in our healthcare system, where veterans have been removed from their opioid medications, perhaps a little bit aggressively,” said McBride.
McBride believes fear may be motivating some providers to move too swiftly.
“Concern is growing, that they may be subject to a review or their license, if they’re giving too many opioids, may be in some jeopardy,” said McBride.
But the veterans feel some primary care providers are putting their and other veterans’ lives in jeopardy.
“That’s why there’s 22 veterans committing suicide every single day,” said Panther. “Chronic pain is a killer. And in my opinion, these programs where they`re just abruptly taking medication from patients that absolutely need it, this is the cause.”
Dr. McBride’s point about the pressure doctors are feeling to cut the number of opiates they prescribe is key to why some doctors may be acting the way they are.
Under the new Comprehensive Addiction Recovery Act authored by Indiana representative Jackie Walorski, the number of opiate prescriptions provided by doctors and at VA facilities will be under review each year, starting with a report set to be filed this summer. These doctors’ prescription numbers will be under a microscope, in an attempt to keep veterans from getting hooked on the drugs in the first place.
The law clearly requires safe weaning from opiates, no matter the reason for stopping the prescription.
Her office says they’re concerned about reports of abrupt cutoffs throughout the Northern Indiana VA system. They plan to make sure a recently requested report from the system addresses potential issues at the Marion facility, as well as the Peru clinic also now under scrutiny since this investigation started.
They say they will also take into consideration that CBS4 received complaints from all over Indiana, as well as across the country, to make sure this isn’t a nationwide problem.