Medical Reports, Veterans' Families Suggest VA Is Overmedicating Vets

Family members, veterans and physicians tell of dangerous drug cocktails being administered to injured soldiers.

Jesus Bocanegra, an Iraq War veteran, drinks water to wash down one of four anti-depression and anxiety drugs he takes July 21, 2006, in McAllen, Texas.
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But Petit says doctors didn't properly weigh the side effects for her brother. "He begged them to get him on something that didn't give him suicidal thoughts," she says.

If doctors aren't weighing the side effects, it may be due in part to the VA's severe lack of resources. VA Healthcare has remained fully operational during the government shutdown this month, but reserves are slim under normal circumstances. According to a VA report on pain management in 2012, which was obtained by U.S. News, only two VA physicians who provide pain clinic services are available to every 100,000 patients.

The consequences of constrained resources became painfully clear for a VA hospital in Jackson, Miss., where a recent internal investigation found that the lack of doctors in its primary care unit led nurse practitioners to see too many patients and to write narcotics prescriptions without the needed federal certification. It also led the hospital to ask doctors to write prescriptions for patients they had not met.

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"In the VA system you'll find that nurse practitioners can write prescriptions at a level that is not done anywhere in the civilian practice," says W. Robb Graham, a Philadelphia-based attorney who represents veterans with malpractice cases against the VA.

"I've had clients that have just gotten tremendous amount of medications. Part of it is also the VA's mail order pharmacy system that just sends this stuff out in droves. Part of it is that a variety of [VA] providers ... will just prescribe and prescribe and prescribe."

In its statement, the VA said it had uniform guidelines and procedures for prescribing medication, and that those guidelines were in accordance with "generally accepted pain management standards of care."

Veterans groups say another factor is that the VA is still coming to terms with how to treat soldiers who go to war today. A new age of chemical warfare, coupled with new kinds of injuries, such as post traumatic stress disorder and traumatic brain injury, have presented new problems for VA doctors., these groups say. Better medicine and better armor have also kept more soldiers from dying, but they are coming to the VA with more damage doctors can't see.

"You've got a lot of people with multiple, complicated wounds that we've never seen before in combat," says Tom Tarantino, chief policy officer at the Iraq and Afghanistan Veterans of America. "And so in an honest desire to alleviate pain, you have an overmedication of soldiers."

The breadth of these mental wounds is, as is now quite well-known, astounding. Some 30 percent of vets treated by the VA have been diagnosed with PTSD, according to the agency. More than 280,000 veterans have been diagnosed with traumatic brain injury since the year 2000, the Department of Defense reports.

Medication may simply be the VA's first impulse to get these suffering veterans back on track, according to Tarantino. "On the battlefield you hand out medication like crazy, just trying to get someone stable and back out in the fight. That ethos has translated back home."

Handing out "medication like crazy" is what so many find problematic.

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In testimony Thursday, military spouse Heather McDonald described how her husband would come home from every VA appointment with new and different medications -- until the day he did not wake up. Scott McDonald, who was discharged in 2011 after 15 years in the Army, was initially given basic drugs, like ibuprofen, and then put on a seizure drug, gabapentin. He was later prescribed anti-depression and anxiety medications, including zoloft and valium, and finally a powerful narcotic, percocet, according to his widow.

On Sept. 17, a VA Office of the Inspector General report detailed a lethal cocktail given to a veteran who died unexpectedly in a mental health rehab program at the VA campus in Lyons, N.J. He died, the report found, of "acute intoxication due to the combined effects of cyclobenzaprine, tramadol, gabapentin, sertraline, hydroxyzine, and amlodipine."