VA Illegally Substituted Cheaper Drugs in Psychiatric Care

Substituting one drug for another – say, a generic version for a brand name – often is perfectly fine in terms of what’s best for the patient. But when a Veterans Affairs hospital in West Virginia replaced certain psychotropic drugs with older versions, it put patients at risk, because the priority wasn’t good care, it was cheaper care.

As told by the Washington Post, a federal investigation last month concluded that the drug switch was a violation of VA policy, and that it resulted in a “substantial and specific danger to public health and safety,” according to the VA’s Office of Medical Inspector. The probe was aided by a whistle-blower within the department.

The U.S. special counsel acknowledged the important role of the whistle-blower, which is doubly interesting, given that so often, as we wrote recently, people working in military medicine who identify its shortcomings often are ignored at best, and suffer retribution at worst.

“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,” the counsel said in a statement.

The Department of Veterans Affairs is not allowed to restrict drugs based solely on how much they cost, The Post story said. It’s required to supply certain medications when they are necessary for a patient’s health.

But that’s not what happened at a VA clinic in Beckley, W.Va. It had established what the investigation called a “blanket restriction” on administering two antipsychotic drugs, aripiprazole and ziprasidone, to help meet its cost-saving goals for fiscal 2013.

Aripiprazole is the generic name for the brand drug Abilify. It’s prescribed for schizophrenia, bipolar disorder and depression. Ziprasidone, which also can treat those disorders, is known by the brand name Geodon. Drugs in this class alter the activity of certain substances in the brain.

The West Virginia clinic’s pharmacy committee, which makes decisions about what drugs may be used, restricted the use of those two without allowing doctors to make a clinical determination about potential health effects on their patients. The sole reason the panel said “no” was to help meet cost-saving goals for its fiscal year (2013). To add insult to arrogant injury, when the committee made the decision, its chair wasn’t even a physician.

According to The Post, the Office of Medical Inspector “recommended” that the clinic study how the drug substitutions affected patients’ health. Wouldn’t you expect the adults in the room to demand such analysis?

The inspector also sought discipline of the pharmacy committee’s leadership, and installation of a physician as its leader. That seems to be the least anyone could do to rectify such a breach of medical ethics and patient safety.

The U.S. special counsel called these recommendations “immediate and appropriate measures” for resolving the drug-substitution problem, but also said that the whistle-blower has claimed that wrongdoing might be ongoing at the clinic.

The VA said it has initiated an investigation based on the findings and recommendations of the medical inspector’s report. In a statement, it said, “We will immediately take action where it is warranted to ensure the most current medical standards are strictly followed. We applaud the VA employee who contacted the OSC on this matter. [VA] Secretary [Robert A.] McDonald has made clear that employees who step forward to raise concerns have a direct bearing on the veteran outcomes we deliver, and this is an example of why that is important.”

The special counsel has closed the case “conditionally,” pending a follow-up report to address the allegations of continued wrongdoing. The analysis is due to be completed by May 11.

Wow, that’s fast even for a balky, bureaucratic federal agency that’s responsible, responsive and efficient (are there any?), so let’s hope this glass is half full and will be topped off this month not only with problem resolution, but by sending a strong message throughout the system of military medicine that such serious issues of patient safety will not go unnoticed or unpunished.

Learn more about military malpractice here.

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