A house panel looks at efforts to curb abuse on the Health Care Facilities. The Veterans Affairs subcommittee also heard about the sale of drugs by pa employees. Congressman jack berkman of michigan chairs to hearing. Good afternoon. The hearing will come to order. I want to welcome everyone who has joined us today. Today we will address the lack of oversight and internal controls regarding substances in the Veterans Health administration that leave facilities open in veteran harm. The diversion of drugs from the Va Health Care facilities is an incredible Patient Safety issue that pits veterans, va employees and the public at a tremendous risk. Unfortunately, the news has recently been filled with the story within the va. In little rock arkansas a technician reportedly used his access to medical supplies, websites to order and biggert 4,000 oxycodone pills over 3,000 hydrocodone and more than 14,000 viagra andsign alice pills at the cost of more than 70,000. This technician was allegedly selling these drugs on thes street where they had a value of more than 160,000. Aat a bj facility in florida for a registered nurse. The stealing oxycodone andsteelg hydro morpheme to feed her addiction. Keep in mind these are occasions that should have been going to veterans for their care. These issues are in part a result of the va having ang adequate procedures in place to safeguard against that and diversion of controlled substances. A recent Government Accountability office audit requested by the committee founn one va medical cente center mis of the required monthly inspections must be in Critical Care areas such as the operating room and the intensive care unit. In addition, three other facilities dont follow all of the requirements for controlled substances. This is not the first instance where weaknesses were identified in the controlled substancee idi Inspection Program. In 2009 and 2014, the va office of Inspector General found some medical facilities were not conducting monthly inspections and some inspections were incomplete. The va has been given multiple opportunities to address these concerns. This leaves me wondering what they are doing to repair the oversight and apparent abuse and absence of accountability regarding these issues within the bha. To make matters worse, there are also issues with drug testing employees to ensure they are suitable to provide care. In 2015 the office of Inspector General report found that Medical Centers were not conducting preemployment and random drug tests for testing designated positions in manysti instances across the bha that amounted to tens of thousands of employees not receiving drug tests required by the Drugfree Workplace Program. Most recently in january of 2017, they found high backlogs and background checks to include testing for highrisk positions medihe atlanta Va Medical Center. It is precisely these tools that have been put into place to help protect patients and Healthcare Organizations from Drug Diversions and harm. However, the va doesnt seem to be taking them seriously as it should. Based on the oversight reports and numerous incidents we will discuss today, im concerned that the controlled substance Oversight Program is not workink and that the staff that failed to follow proper procedures are not being held accountable for violations. In case after case with vcr examples of drugs being diverted from personal use or personal gain but there doesnt seem to be much progress made by the va to protect the growing problems that allow it to happen. What is even more concerning is the programs that help deter thc diversion are identified as divi illegal employee use not being consistently in the va Health System. We are in the midst of an Opioid Epidemic and its time for the va to start making effective changechangeis to avoid puttingd the employees that serve them at risk. With that i recognize the Ranking Member for her opening statement. Thank you mr. Chairman and thank you for choosing this topic. I am particularly interested as the cochair of the Congressional Task force to combat theta epidemic and i appreciate this testimony. We are again examining the role ensuring that Prescription Drugs are safely controlled in the va medical facilities. Ti i spent a year ago the former chairman and i held a hearing of the subcommittee on this very issue in colorado because the b Drug Enforcement agency found several violations. We continue to hear disturbing reports in hospitals and clinics in the communities that some healthcarHealth Care Employeese stealing controlled substances for their own personal use or personal gain. We know the cases are on the rise throughout the country. One Health Care Employees diverging the substances can be a Public Health risk and can cause significant harm to many patients. We learned this lesson the hard way in New Hampshire with a technician who was injecting himself at a hospital in New Hampshire but it turned out this started at the Baltimore Va Medical Center and continued at more than a dozen hospitals in other states infecting up to 50 patients in the community with hepatitis c and some of the patients were veterans. From this example it is clear the nationwide trend alsoso impacts the va. The whole system is one of the leading prescribers of opioid medication. The diversion threatens the safety of the veterans and hampers efforts to address the Opioid Epidemic in the communities. I find them particularly troublesome. Some of the facilities are not conducting routine inspections to prevent and identify drugent diversion. Background investigations that could potentially identify finding employees who have diverted drugs or who may have a Substance Abuse problem or backlogs in atlanta. Employees at the atlanta Medical Center were not subject to drug testing for six months, which could identify the diversion of Prescription Drugs. We need to get to the bottom of why the safeguards and processes are not being followed. I want to know if the procedure is what worked to prevent the diversion and i want to know if they have the resources it needs to conduct the end actions and administer it drugfreekground Workplace Program. M. I am also concerned about the vr hiring freeze thats currently in place and that the employees are not exempt. The identified with the staff need more personnel and training to properly conduct these inspections. They also identified the need for more personnel to address the background check backlog inl atlanta. Without adequate support staff in place, the va medical facilities would continue to struggle to comply with the procedures and programs thatog they must follow to ensure that our veterans receive safe care. Finally, i look forward to learning about progress at the va with regards to the Opioid Safety Initiative that we passed within the comprehensive Addiction Recovery program just last year to bring down the rate of prescriptions for all of our veterans. We must do everything we can to help the veterans suffering from chronic pain and to help veterans struggling with Substance Abuse and addiction. The Opioid Epidemic is destroying the lives of veterans and their families and communities across New Hampshire and all across the country and we need to Work Together to find Innovative Solutions to end this epidemic. As i say to my colleagues, they do not choose ours and peace. We can Work Together and we are proud champions of the comprehensive Addiction Recovery act that we passed last congress did i look forward to hearing about the compliance. Thank you, mr. Tremaine and i cd i yield back. You and thank you. I would ask all members waved her opening remarks per the committees custom. With that i would welcome the first and only panel that is now seated at the witness table. On the panel, we have Carolyn Clancy the deputy undersecretary for health organizational excellence. She is accompanied by doctor michael valentino, chief consultant for the Pharmacy Benefits Management Services of the Veterans Health administration. Em we also have the Deputy AssistantInspector General for audits and evaluations. He is accompanied by a unique about the Health System specialist for the office of healthcare inspections and office of the Inspector General. Finally, mr. Randall williamson, the director of the Health Care Team for the Government Accountability office and keith, consultant and anesthesiology chairman of the mayo clinic enterprise medication diversion prevention committee. I ask that th the witnesses plee stand and raise your right hand. Do you solemnly swear under penalty of perjury testimony yot are about to provide us the truth, the whole truth and nothing but the truth . Please be seated. Let the record reflect all witnesses answered in the affirmative. You are now recognized for five minutes. Afternoon chairman, Ranking Member and members of theafterno subcommittee thank you for the opportunity to discuss oversight of the substances and Drugfree Workplace Program of the facilities. For the selected employees and a commitment to accountability for employees who do not live up to the core values and then accompanied as you mentioned by mike valentino. We recently released a report on the medical facility substanceom programs and floor of thero facilities prompted a swift response. We concurred with the six recommendations and are now implementing them and expect them to be fully implemented by october of this year. We conducted a Conference Call last week with over 450 failed the staff to launch the plans and to provide tools that support that effort followed bya distribution of written instructions. Additional dissemination efforts are planned over the next two weeks. Although the gao and vaar Inspector General identified the selected instances of noncompliance in these robust controls, i believe the system is working as designed to make it difficult for the va staff today for drugs and most importantly, to give us the tools to be able to detect it rapidly and take action when it does occur. We implemented robust controlled substance internal controls in the early 1980s and in many cases, these measures exceed those required by the controlled substance act and we believe they aligned closely with the mayo clinics recommended best practices. Data from january 22014 through march 11 to 2016 show the va report of the controlled substances loss rate is. 008 or eight per 100,000. It is the va internal controls that lead to the vast majority of diversion cases being identified. The use of Illegal Drugs by the employees is inconsistent with the special trust placed in those that care for veterans. The Inspector General recently reviewed allegations of the atlanta Va Medical Center of a backlog of the background investigations and found that mandatory drug testing of new hires did not occur over a sixmonth period resulting in a backlog of about 200 background investigations. Bo it was also found the Drugfree Workplace Program was not administered from november 2014 through may 2015. Atlanta va leadership implemented a number of changese in 2016 in response to these ofn recommendations, such as moving the Human Resources department under the direct supervision of the Medical Center director and developing a secondary database for the staffing and tracking of the health backgroundatabase investigations. We expect that backlog will be cleared by the end of this thish and if not, we will keep you informed. In addition theyve made Great Strides towards improving the Drugfree Workplace Program and in october of 2015, drug Program Coordinators began certifying on a monthly basis that employees selected for the random drug testing were tested when they were tested or why they were not tested. The va is also developing procedures to ensure the drug testing coding is approximately with 180,000 testing designated positions as accurate and complete. On march 1 of 20 team, the assistant secretary for Human Resources and administration published a memorandum stating that 100 of all applicants tentatively selected for the appointment of a testing position be drug tested prior to appointment. The va works closely with local, state and federal s lawenforcement entities to identify specific geographic areas with recorded losses and the identification lead to successful arrests, prosecutions and convictions. Theyve developed a culture of controlled substance reporting and adopted a practice of over rather than under reporting suspected cases of diversion. Mr. Chairman, im proud of the Health Care Facilities provided to the veterans includingng Prescription Drug services. The issues we are discussing here today are closely related to the nations overarching struggle with opioid use. As a whole, the nation needs to come up with a better alternative to the Pain Management and opioids. The va is at the forefront with the Safety Initiative that wevl pioneered in august of 2013. We are active in reducing the number to the number of the veterans receiving these prescriptions. Instead, we are offering a variety of complementary and Integrative Medicine treatments for chronic pain such as chiropractic and acupuncture among many other options. Initiatives like these will reduce the number of controlled substances prescribed making it easier to maintain the oversight. With support from congress we look forward to continuing to improve the oversight of Drugfree Workplace Programs which will further improve the care of our veterans and the care that they deserve. Thank you for the opportunity to testify and i look forward to your questions. You are now recognized for five minutes. Mr. Chairman, Ranking Member and members of the subcommitteet thank you for the opportunity to testify on the office of Inspector Generals work related to Drugfree Workplace Programs at the oversight of the controlled substances and va facilities. I am accompanied by a member off the healthcare inspections staff who is also a former va pharmacist. A the federal Drugfree Workplace Program was initiated with the goal of establishing a drugfree federal workplace. The program made it a condition of employment for all federalac. Employees to refrain from using Illegal Drugs on or off duty. The va has designated occupational series as testing designated positions including positions such as positions, nurses, Police Officers and Motor Vehicle operators. In recent years, the oig completed two projects that assist the aspects of a Drugfree Workplace Program. In march, 2015, the oig issued a report detailing the results of an audit of the program. We identified the program a weaknesses in three areas. Ograme first, preemployment drug testing. If a tested applicant has a verified positive test result, the va should decline a final offer of employment however, we reported they did not ensure compliance with policy to drug test all applicants selected for a testing designated physician prior to employment. Instead, they selected only about three of every ten applicants for testing. Second, employee random drug testing. We estimated they achieved a National Drug testing rate of 68 of employees selected f