Alleged Interference and Failure to Comply with the Pain Management Directive and the Opioid Safety Initiative at the VA Northern Indiana Health Care System, Fort Wayne, Indiana

The VA Office of Inspector General (OIG) conducted a healthcare inspection to determine the validity of confidential allegations that system leaders interfered with primary care providers’ opioid prescribing practices; requirements specified in Veterans Health Administration’s (VHA) Pain Management directive were not followed; and system leaders failed to meet all the goals of VHA’s Opioid Safety Initiative Update. The OIG substantiated that on four occasions the Chief of Staff interfered with primary care providers’ opioid prescribing practices. The OIG determined that patients did not have identifiable adverse clinical outcomes; however, the continuation of patients’ opioids may have prolonged their dependence on opioids. Providers also reported experiencing pressure by the Chief of Staff related to opioid prescribing practices. The OIG substantiated that the system did not follow all requirements in VHA Directive 2009-053, Pain Management. Further, not all providers used the required opioid risk assessment tools for patients on long-term opioid therapy. The OIG found that system leaders were not in compliance with the system’s policy related to veteran requests to change providers. The system met six out of nine goals outlined in VHA’s Opioid Safety Initiative Update. The OIG made one recommendation to the VISN 10 Director related to the ethics of a system leader interfering with the opioid prescribing practices of primary care providers and 11 recommendations to the System Director related to the Pain Management Committee, pain assessments, annual evaluation of compliance with the Pain Management Strategy, tertiary pain rehabilitation programs, stepped care education and training, the pain management team, opioid risk assessment tools, veteran requests to change providers, prescription drug monitoring program reports, and opioid and benzodiazepine tapering protocols.