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The Journal Gazette

Wednesday, May 10, 2017 1:00 am

Issues found at Peru VA clinic

Opioid doses, 'fake appointments' cited

BRIAN FRANCISCO | The Journal Gazette

The U.S. Department of Veterans Affairs found patient care and access improprieties at a Peru outpatient clinic operated by the Fort Wayne-based VA Medical Center.

A VA on-site investigation conducted in December determined that a clinic employee had reduced doses of opioid pain medications for at least six patients without examining or meeting with them.

A veteran died “shortly after the (employee) began tapering his medications,” according to a Veterans Health Administration report obtained by The Journal Gazette. The March 22 report said VA could not substantiate that the death was the result of the dosage change and noted that an autopsy found the veteran had died from severe coronary artery disease.

VA also discovered that another Peru clinic employee was scheduling appointments for veterans without their knowledge and canceling them on the day of the appointment. The employee allegedly was “padding her schedule with fake appointments to fill her clinic schedule,” the report said.

A review of records from Oct. 1, 2014, through Dec. 21, 2016, uncovered 56 such “placeholder” appointments made by clinic staff, VA said. The practice could have denied veterans the opportunity to receive medical treatment, according to the report.

The report redacted the names of the employees in question.

Michael Hershman, director of the VA Northern Indiana Health Care System, which oversees the Fort Wayne medical center and the Peru outpatient clinic, said Tuesday in a telephone interview he has not received a copy of the report.

Hershman said he became aware of “scheduling irregularities” in Peru within a month after he joined the Northern Indiana system in September and appointed an administrative investigation board.

After receiving findings from the internal investigation, “we are taking administrative actions as a result of the AIB, but they're still a work in progress right now. … It's a quite lengthy process,” Hershman said.

Rep. Jackie Walorski, R-2nd, who said she sought the VA investigation after receiving complaints from patients, called the scheduling and opioid prescribing infractions “reprehensible.” She said veterans across the nation “are still dealing with this stuff” despite federal laws, VA leadership shake-ups and media scrutiny related to patient treatment delays and manipulated appointment records at VA hospitals and clinics in recent years.

“The VA system is broken, and it really cannot help itself internally. … It really takes a lot of outside interference and a lot of outside pressure to get change,” Walorski said Tuesday in a phone interview. 

VA has recommended that the Fort Wayne medical center determine educational, administrative or disciplinary remedies at the Peru clinic. VA directed the center to ensure “sufficient qualified provider staffing” at the clinic for opioid management and implement training for staff on patient appointment scheduling.

Walorski said employees who committed the improprieties should be removed from their jobs.

“Fire them,” Walorski urged. “They couldn't do the job. If they knowingly and willingly cooked books (on patient appointments), fire them. If the doctors knowingly and willingly jeopardized somebody's life, and never even looking at somebody? Fire 'em. Get 'em out of the system. Clean the system up.”

VA officials “have had four years just since the crackdown on VA really happened to educate people, and obviously it's not working,” she said. “It shouldn't come to this kind of abuse and neglect of veterans.”

Walorski was a member of the House Veterans' Affairs Committee when she and the committee chairman at the time, former Republican Rep. Jeff Miller of Florida, asked VA to investigate the Peru clinic. That site and VA Northern Indiana outpatient clinics in South Bend and Goshen are in her district.

“I'm going to continue to fight for veterans every day,” Walorski said. She also vowed to “get to the bottom” of the death of the patient whose medications had been tapered.

Rep. Jim Banks, R-3rd, joined the House VA Committee this year. His office confirmed the VA's investigation of the Peru clinic and said he “is concerned about this situation and working with the VA Committee to learn more.”

The VA report stated that it did not substantiate an allegation that Peru clinic patients have been prescribed high doses of narcotics without proper diagnosis.

The report did confirm that the clinic employee who scheduled placeholder appointments also brought to an August 2016 office party a cake “in the shape of a male body part” that offended another worker. Administrative action was pending when the report was issued in March.

“It's part of the action we're reviewing,” Hershman said. “Administrative actions are quite detailed and quite lengthy to protect everybody involved, and employees have rights under the process.”

bfrancisco@jg.net