VA doctors renewed opioids without seeing patients

A new government report found evidence of Veterans Affairs doctors at one California hospital renewing highly addictive narcotic painkillers for patients they had never seen.

At the San Francisco Veterans Affairs Medical Center, healthcare providers did not properly document patients’ opioid prescription renewals in the electronic health record (EHR), according to the Department of Veterans Affairs’ Office of Inspector General. In fact, after reviewing 264 opiate prescription renewals, the VA OIG found that doctors had not seen the patients or spoken to them in 53% of cases.

“The providers did not consistently document an assessment for adherence with appropriate use of opioids and monitor patients for misuse, abuse, or addiction,” the VA OIG wrote in a report about the San Francisco VA Medical Center. “While we recognize that the clinical pharmacists perform a comprehensive review of the EHR, VHA policy requires documentation of all elements of pain management, including adherence. In addition, we determined that the PCPs [primary care providers] did not consistently monitor patients for misuse.”

At a congressional subcommittee hearing, VA physicians told lawmakers that hospital administrators regularly pressured them to prescribe opiates to patients they had not examined personally, the San DiegoUnion-Tribune reported.

Meanwhile, the VA Office of Inspector General found that the clinic uses a paper prescription request form to communicate the status of the renewal requests among clinic staff. However, the form is shredded and does not become a permanent part of the patient’s EHR.