Theft and sale of drugs by agency workers. The House Veterans AffairsCommittee Held this hearing late last month. Good afternoon. This hearing will come to order. I want to welcome everyone who has joined us today. Today we will address the lack of oversight in internal controls regarding controlled substances within the Veterans Health administration that leave facilities open to Drug Diversion and veteran harm. The diversion of drugs from v. A. Health care facilities is an incredible Patient Safety issue that puts veterans, v. A. Employees and the public at tremendous risk. Unfortunately the news has recently been filled with story after story of Drug Diversions within v. A. In little rock, arkansas, v. A. Pharmacy technician reportedly used his access to medical supplies, websites to order and divert 4,000 oxycodone pills over 3,000 hydrocodone pills and more than 14,000 viagra and cialis pills at the cost of the v. A. Of more than 70,000. This technician was allegedly selling these drugs on the street where they had a value of more than 160,000. At a v. A. Facility in florida, a registered nurse was apparently stealing oxycodone and hydromorphone from the hospital to feed her addiction. Keep in mind, these are medications that should have been going to veterans for their care. These issues are in part a result of v. A. Having an adequate procedures in place to safeguard against theft and diversion of controlled substances. A recent Government Accountability office audit requested by this Committee Found that one v. A. Medical center missed 43 of the required monthly inspections, mostly in Critical Care areas such as the operating room and the intensive care unit. In addition, three other facilities did not follow all of vhas requirements for inspections of controlled substances. This is not the first instance where weaknesses were identified in v. A. s controlled substance Inspection Program. In 2009 and 2014, the v. A. Office of Inspector General found that some medical facilities were not conducting monthly inspections, and some inspections were incomplete. V. A. Has been given multiple opportunities to address these concerns. This leaves me wondering what v. A. Is doing to repair the lax oversight and apparent abuse absence of accountability regarding these issues within vha. To make matters worse, there are also issues with drug testing employees to ensure they are suitable to provide care to our veterans. A 2015 office of Inspector General report found that v. A. Medical centers were not conducting preemployment and random drug tests for testing designated positions in many instances across vha which amounted to tens of thousands of employees not receiving drug tests required by the drugfree Workplace Program. Most recently in january, 2017, the oig found high backlogs and background checks to include drug testing for high risk positions at the atlanta v. A. Medical center. It is precisely these tools that had been put into place to help protect patients and Health Care Organizations from Drug Diversions and harm. However, v. A. Does not seem to be taking them seriously as it should. Based on the oversight reports and numerous diversion incidents, we will discuss today, im concerned that v. A. s controlled substance Oversight Program is not working and that staff who fail to follow proper procedures are not being held accountable for violations. In case after case, what we see are examples of drugs being diverted for personal use or personal gain, yet there does not seem to be much progress made by the v. A. To correct the glaring problems that allow it to happen. By what is more concerning is that the programs to help deter diversion are not being implemented consistently within the v. A. Health system. We are in the midst of an Opioid Epidemic and its time for the v. A. To start making effective changes to avoid putting veterans and the employees who serve them at risk. With that, i recognize Ranking Member kuster for her opening statement. Thank you, mr. Chairman. And thank you for choosing this topic. Im particularly interested as the cochair, the founding cochair of our Congressional Task force to combat the heroin epidemic, and i appreciate this testimony. This afternoon, we are again examining v. A. s role in ensuring that the Prescription Drugs are safely controlled in v. A. Medical facilities. Less than a year ago, former chairman kaufman and i held a hearing of the oni subcommittee on this very issue in colorado, because the Drug Enforcement agency, dea, found several violations in the denver vamc. We continue to hear disturbing reports in hospitals and clinics and in our communities that some Health Care Employees are stealing controlled substances for their own personal use or personal gain. We know that these cases are on the rise throughout the country. One Health Care Employee diverting controlled substances can be a Serious Public Health risk and can cause significant harm to many patients. We learned this lesson the hard way in New Hampshire with the technician who was injecting himself with fentanyl at a hospital in New Hampshire but it turned out this started at the baltimore v. A. Medical center and continued in more than a dozen hospitals in other states. Infecting up to 50 patients in our community with hepatitis c and some of these patients were veterans. From this example, it is clear that the nationwide trend of opioid diversion also impacts our v. A. The v. A. Health system is one of the nations leading prescribers of opioid medication. Diversion in the v. A. Threatens the safety of veterans and hampers efforts to address the Opioid Epidemic in our communities, preventing diversions of these substances should be a paramount concern. Thats why i find the gao and igs findings particularly troublesome. Its unacceptable that some v. A. Medical facilities are not conducting routine inspections to prevent and identify Drug Diversion. Background investigations that could potentially identify finding employees who have diverted drugs or who may have a drug Substance Use problem were backlogged in atlanta. Health care employees at the Atlanta Health care center were not subject to drug testing for six months, which could identify diversion of Prescription Drugs. We need to get to the bottom of why these safeguards and processes are not being followed. I want to know if the procedures when followed would work to prevent Drug Diversion and i want to know if v. A. Has the resources it needs to conduct the inspections, the background checks and to administer its drug fee Workplace Program. Im also concerned about the v. A. Hiring freeze thats currently in place and that v. A. Hr employees are not exempt. The gao and ig identified that staff need more personnel and more training to properly conduct these inspections. They also identified the need for more hr personnel to address the background check backlog in lean. Without adequate support staff in place, v. A. Medical facilities will continue to struggle to comply with the procedures and programs that they must follow to ensure that our veterans receive safe care. Finally, i look forward to learning about progress at the v. A. With regard to the Opioid Safety Initiative that we passed within cara just last year to bring down the rate of opioid prescriptions for all of our veterans. We must do everything we can to help 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 in 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, the heroin does not choose rs and ds. We can Work Together. We are proud champions of the comprehensive Addiction Recovery act that we passed last congress. I look forward to hearing about v. A. Compliance. Thank you, chairman bergman, and i yield back. Thank you. Thank you, Ranking Member kuster. I ask all members waive their opening remarks as per this committees custom. With that, i welcome our first and only panel who is now seated at the witness table. On the panel, we have dr. Carolyn clancy, deputy undersecretary for health for organizational excellence. She is accompanied by dr. Michael valentino. Chief consultant for the Pharmacy Benefits Management Services of the Veterans Health administration. We also have mr. Nick dahl, Deputy AssistantInspector General for audits and evaluations. He is accompanied by miss amy valcanos, Health Care Systems for the office of Health Care Inspections in the office of Inspector General. Finally, we have mr. Randall williamson, director of the Health Care Team for the Government Accountability office and dr. Keith berg, consultant in anesthesiology and chairman of the mayo clinic enterprise wide medication diversion prevention committee. I ask that the witnesses please stand and raise your right hand. Do you solemnly swear under penalty of perjury that the testimony you are about to provide is the truth, the whole truth and nothing but the truth . Please be seated. Let the record reflect that all witnesses have answered in the affirmative. Dr. Clancy, you are now recognized for five minutes. Good afternoon, chairman bergman. Ranking member kuster and members of the subcommittee. Thank you for the opportunity to discuss oversight of controlled substances in Drug Free Workplace Program at v. A. Facilities. I will address inspections to minimize diversion, drug testing for selected employees, and our commitment to accountability for employees who do not live up to our core values. Im accompanied today as you mentioned by Mike Valentino from pharmacy benefits. Gaos recently released report on facility controlled Inspection Programs in four of our facilities has prompted a swift response. We concurred with gaos six recommendations and are now implementing them. Expect them to be fully implemented by october of this year. We conducted a Conference Call last week with over 450 field base staff to provide tools that support the effort, followed by distribution of written instructions. Additional dissemination efforts are planned over the next two weeks. Other gao and v. A. Inspector general identified selected instances of noncompliance with these robust controls. I believe the system is working as designed to make it difficult for v. A. Staff to divert drugs, and most importantly, to give us the tools to be able to detect diversion rapidly and take action when it does occur. Vha implemented robust controlled substance internal controls in the early 1980s. In many cases these measures exceed those required by the controlled substances act, and we believe they align closely with mayo clinics recommended best practices. Data from january 2nd of 2014 through march 11th of 2016 show that v. A. s reported controlled substances loss rate is. 008 , or 8 per 100,000. And it is v. A. s very own internal controls that lead to the vast majority of diversion cases being identified. The use of Illegal Drugs by v. A. Employees is inconsistent with the special trust placed in those who care for veterans. The Inspector General recently reviewed allegations at the atlanta v. A. Medical center of a backlog of background investigations and found mandatory drug testing of new hires did not occur over a sixmonth period, resulting in a backlog of about 200 background investigations. It was also found that the drugfree Workplace Program was not administered from november of 2014 to may of 2015. Atlanta v. A. Leadership implemented a number of changes in 2016 in response to these recommendations, such as moving the Human Resources department under the direct inspection of background investigations, we expect that that backlog will be cleared by the end of this march and if not well keep you informed. In addition, v. A. Has made Great Strides towards improving the Drug Free Workplace Program. In october of 2015, drug Program Coordinators began certifying on a monthly basis employees selected for random drug testing were tested when they were tested or why they were not tested. V. A. Is also developing procedures to ensure the drug testing coding of employees in approximately 180,000 testing designated positions is accurate and complete. On march 1st of 2016, the assistant secretary for Human Resources and administration published a memorandum stating 100 of all applicants tentatively scheduled for appointment to a drug tested position be drug tested prior to appointment. V. A. Works closely with local, state and federal Law Enforcement entities to identify specific geographic areas with reported male losses and lost clusters has led to successful arrests, prosecutions and convictions. V. A. Has developed a culture of controlled substance loss reporting and has adopted a practice of over rather than underreporting suspected cases of diversion. Mr. Chairman, im proud of the health care our facilities provide to our veterans, including Prescription Drug services. The issues were discussing here today are closely related to our nations overarching struggle with opioid use. As a whole, our nation needs to come up with a better alternative to Pain Management than opioids. V. A. Is at the forefront with our Opioid Safety Initiative which we pioneered in august of 2013. Were actively reducing the number of opioids we prescribe and the number of veterans receiving these prescriptions. Instead were offering a variety of complementary and integrative treatments for chronic pain such as chiropractic and acupuncture among many others. Initiatives like these will reduce the number of controlled substances v. A. Prescribes making it easier to maintain their oversight. With support from congress, we look forward to continuing to improve our oversight of controlled substances and Drug Free Workplace Programs which will further improve the care of our veterans and the care they deserve. Thank you for the opportunity to testify and i look forward to your questions. Thank you, dr. Clancy. Mr. Dahl, you are now recognized for five minutes. Mr. Chairman, Ranking Member kuster and members of the subcommittee, thank you for the opportunity to testify today on the office of Inspector Generals work related to Drug Free Workplace Programs and the oversight of controlled substances at v. A. Facilities. I am accompanied by a member of the oig health care inspection staff in manchester, New Hampshire, and is also a former v. A. Pharmacist. The federal Drug Free Workplace Program was initiated with the goal of establishing a drug free federal workplace. The program made it a condition of employment for all federal employees to refrain from using Illegal Drugs on or off duty. V. A. Has designated safety sensitive occupational series as testing designated positions including positions such as physicians, nurses, Police Officers and Motor Vehicle operators. In recent years, the oig has completed two projects that assessed aspects of the Drug Free Workplace Program. In march, 2015, the oig issued a report detailing the results of an audit of v. A. s program. We identified Program Weaknesses in three areas. First, preemployment applicant drug testing. If a