VA accused of bad pain-management practices

In an emotional, sometimes tearful hearing before members of Congress Thursday,  widows of veterans and others blamed the Department of Veterans Affairs' Veterans Health Administration for improperly treating chronic pain, occasionally with fatal results.

In addition to the two widows, lawmakers heard from two veterans who describe themselves as victims of VA medical malpractice and former VA doctors who reported instances of personal abuse, alteration of medical records by VA staff, “bullying” of well-meaning physicians and other offenses. One witness characterized some practitioners of VA medicine as favoring “quick and cheap over good and thorough.”

“No one who watched today’s testimony could help but be moved and profoundly angered,” said Daniel M. Dellinger, national commander of The American Legion, which submitted written testimony for the hearing. “If there is even a modicum of truth in the accusations leveled today, VA has much to explain. Whether these problems are contained within certain facilities or wider in scope, they are inexcusable and must be corrected.”

The Thursday morning hearing before the House Committee on Veterans Affairs' Subcommittee on Health Care was titled “Between Peril and Promise: Facing the Dangers of VA’s Skyrocketing Use of Prescription Painkillers to Treat Veterans.” It opened with an emotional statement by Heather McDonald, widow of Army Spec. Scott McDonald, who she found dead in their home, she explained, after a deadly cocktail of painkillers and psychotropic drugs prescribed by VA to help McDonald cope with severe, chronic physical and emotional wounds related to combat.

A fellow service widow and 21-year Air Force veteran, Kimberly Green, told how her Army veteran husband, Ricky, died as the result “mixed-drug intoxication… because of the prescription pain and sleeping medications that the VA and its doctors prescribed for him and dispensed for him out of the VA pharmacy.”

Both widows accused VA of uneven, sometimes-contradictory methods of pain treatment marked by frequent changes of doctors and an over-reliance on opiates – narcotics – while ignoring less dangerous, alternative medical methods.

Two former servicemembers then told of their own struggles with service-connected chronic pain and what they consider outmoded and harmful methods of pain treatment employed by at least some VA medical facilities.

VA offered rebuttal arguments, pointing to the complexity of the medical issues involved in pain management with its mix of severe and individualized physical and psychological factors. VA’s witnesses also told of VHA’s continuously evolving and increasingly effective program of chronic pain treatment with an emphasis on quality, safety and proper training of practitioners. VA offered no explanations about the cases cited in the hearing testimony. 

The three-hour session ended with agreements between VHA officials and members of Congress to follow up on the issue and track progress carefully.

In its written testimony submitted to the congressional subcommittee prior to the hearing, The American Legion noted that it has long been concerned about the negative aspects of exclusive, drug-based therapies for severe, chronic pain, and its related psychological and emotional effects. In 2010, Legion leadership commissioned an ad hoc committee to investigate existing and alternative methods of treating traumatic brain injury and post-traumatic stress disorder – conditions often accompanied by chronic physical pain. During the three-year study, the Legion committee held six meetings and met with leading authorities in VA and the Department of Defense (DoD), and interviewed a number of stricken veterans. As a result, the Legion launched a campaign favoring non-pharmacological treatment modalities for pain management, including the employment of “hyperbaric oxygen therapy, virtual reality therapy and other complementary and alternative medicines.”

The American Legion also mentioned its adoption of a resolution calling for federal funding of pain management research, treatment and therapies at DoD, VA, and at the National Institutes of Health to be increased significantly, and that Congress and the administration re-double their efforts to ensure that an effective pain-management program be uniformly established and implemented.  The resolution also called on DoD and VA to increase their investment in pain-management clinical research by improving and accelerating clinical trials at military and VA treatment facilities, as well as at affiliated university medical centers and research programs.