Healthcare Inspection Prescribing Practices in the Pain Management Clinic, John D. Dingell VA Medical Center, Detroit, Michigan

The VA Office of Inspector General Office of Healthcare Inspections evaluated allegations of poor prescribing practices for controlled substances in the Pain Management Clinic (PMC) at the John D. Dingell VA Medical Center, Detroit, MI. A complainant alleged that: PMC physicians prescribed controlled substances without adequate evaluation of patients. Supervisors coerced PMC providers to write controlled substance prescriptions for patients not under their care. Patient injuries and deaths occurred as a result of PMC providers prescribing practices. We substantiated that providers were prescribing controlled substances without adequate evaluation of patients and found that the facility did not have a policy outlining requirements for the ongoing assessment of patients treated with opioid (narcotic) medications. We did not substantiate the allegation that supervisors coerced providers to write controlled substance prescriptions for patients they had not evaluated. We also did not substantiate that injuries or deaths resulted from the prescribing practices of PMC providers. We recommended that the Medical Center Director ensure that managers define the expected frequency of provider evaluations for patients treated with opioid medications and ensure peer review of the PMC physician responsible for opioid prescriptions without adequate patient evaluation. The VISN and Medical Center Directors concurred with the inspection results. We will follow up on the planned actions until they are complete.