Ex-VA Doctor Says She Was Forced Out After Limiting Opiate Prescriptions

February 25, 2014

(CIRONLINE) – On the eve of a congressional hearing about the Department of Veterans Affairs’ skyrocketing use of narcotic painkillers, a former VA doctor has stepped forward with new allegations about the agency’s prescription practices.

basimah-khulusiIn an exclusive interview with The Center for Investigative Reporting and ABC News, Dr. Basimah Khulusi said she was forced out last year after patients complained that she would not prescribe high doses of opiates.

Dr. Basimah Khulusi says she was forced out of her job as a rehabilitation specialist at the Department of Veterans Affairs hospital in Kansas City, Mo., after patients complained that she would not prescribe high doses of opiates. She says many of her patients had been addicted to opiates for years yet received escalating doses from VA doctors as their tolerance built.

“I had to do something about it. And I tried,” said Khulusi, a rehabilitation specialist who worked at the VA hospital in Kansas City, Mo., for five and a half years. “And then, you know, I was let go.”

In September, CIR revealed that VA prescriptions for four opiates – hydrocodone, oxycodone, methadone and morphine – surged by 270 percent between 2001 and 2012. That far outpaced the increase in VA patients and contributed to a fatal overdose rate of nearly double the national average, the agency’s own scientists found. CIR’s report helped spark a congressional hearing. At that hearing in October, VA officials promised to present a plan to address problems with opiate prescriptions within 30 days. A follow-up oversight hearing is scheduled for Wednesday.

Khulusi said the majority of veterans she saw in the pain clinic already were addicted to prescription opiates – receiving doses as high as 900 narcotic pain pills a month and 1,000 milligrams of morphine a day, 10 times the level she considered safe.

Internal VA data obtained by CIR show the number of opiate prescriptions at the Kansas City VA grew by 173 percent between 2001 and 2012.

Nationally, CIR found that opiate prescription levels varied wildly depending on where veterans lived, with physicians at VA hospitals in Oregon and Oklahoma writing eight times as many narcotic prescriptions as those in New York City.

The VA says it is aware of the problem. Today, the agency announced a new Opioid Safety Initiative, designed to reduce the volume of narcotic painkiller prescriptions.  In an interview with Byron Pitts of ABC News, Dr. Gavin West, acting chief medical officer of the Salt Lake City VA, said his agency was

at the forefront, developing evidenced-based safe opiate prescribing practices.”

In the coming months, West said, the VA will increase physician education and patient monitoring, and expand across the country pilot programs that treat pain through alternative therapies such as acupuncture and yoga.

“The VA has promised to limit opiate prescriptions before,” Pitts responded. “So why should the American people be confident that you’ll get it right this time?”

West, a special assistant to the agency undersecretary for clinical operations, said: “We’ve been very careful. This is a very serious thing.”

For her part, Khulusi is adopting a wait-and-see attitude.  She said many of her patients had been addicted to opiates for years yet received escalating doses from VA doctors as their tolerance built. As a result, many were “lethargic, not functional.” Some had not been able to drive for 10 years, she said, or erroneously thought they had Alzheimer’s disease.

Khulusi said she tried to wean her patients off high doses of painkillers and most appreciated the help. But others would threaten her, “cussing, cursing, lashing out, complaining to the administration, complaining to the (medical) board to try to take my license away from me,” Khulusi said.

Internal VA emails show the hospital administration tired of complaints from angry veterans.

In November 2012, a supervisor at the Kansas City VA wrote in an email to Khulusi that the agency planned to “terminate your fee appointment” so she could be replaced with a new doctor who would work in a VA clinic that specialized in giving injections for pain.

The VA declined to comment on Khulusi’s dismissal. But West said the agency is trying to

get the message out there that more drugs is not always the answer.”