Based on those findings, the OIG made eight recommendations.
John J. Pershing VAMC responded to those recommendations:
"At the time of the introduction of the 2014 OSI into VA Healthcare, John J. Pershing VAMC provided opiate therapy to approximately 1500 Veterans annually; in January 2014, very few had UDS performed or consents obtained. By the time of the OIG visit in January 2016, the facility already achieved remarkable results which reflect the performance of all Veterans receiving opiate therapy, not just 10 specific, pre-selected Veterans."
According to John J. Pershing, those results include:
Increase of veterans who had a urine drug screen from 38.7 percent to 90.2 percent
Increase of veterans with documented consent from 23.6 percent to 92.3 percent
Reduction of veterans on percentage of opioid/benzodiazepine combination from 19 percent to 16.5 percent
Reduction of veterans dispensed opioids from 16.6 percent to 14.2 percent
Reduction of almost 200 veterans on long-term opioid therapy
The John J. Pershing VAMC also provided a status update on those eight recommendations and requested they be "closed."
The facility strengthened communication from non-VA hospitals and providers so that VA providers get timely notification of clinically significant changes impacting on a patient’s opioid prescription. Opioid risk stratification tools are available for all providers to use.
Providers received education. In addition, a Pain Management Clinical Pharmacy Specialist provides continuing education and consultation.
The facility established a process for dual short-acting opioids; pharmacy alerts the provider and clarifies the order. The Pain Management Clinical Pharmacy Specialist assists providers with tapering of opioids.
Providers prescribing opioids received education on opioid risk tools.
The facility developed and implemented a UDS clinical reminder to help providers in obtaining UDS. The facility provided education on interpreting UDS to those prescribing opioids. The Pain Management Committee regularly reviews UDS completion rates.
Along with the education and tools, the facility developed an audit process. The most recent audit demonstrated 100 percent (4 of 4) patients requiring confirmatory UDS testing had that test completed.
Urine creatinine tests are now completed on all UDS. Providers received guidance on urine creatinine levels that may raise suspicion of testing and tampering.
In addition to education of providers, the Pain Management Committee monitors completion of informed consents.
He was set to be terminated, but as of May 15, he reported back to work. According to his attorney, Natalie Khawam, the hospital sent him a letter saying he could go back to work and start seeing patients.
Khawam says Klein did report to work, but continues to not see patients.
Khawam says Klein doesn't feel it is in the veterans best interest until the hospital can show it has made corrections, and is willing to get him the training he needs after not practicing medicine for more than a year.
Klein is also seeking a financial settlement from the John J. Pershing VA Medical Center. The details of that settlement are not being released.