Doctors at the Department of Veterans Affairs hospital in San Francisco routinely renewed prescriptions for narcotic painkillers for patients they had never seen, according to a report from the agency's inspector general.
The IG also found sloppy record-keeping and failure to follow protocols to ensure the highly addictive drugs were not being abused.
Seven patients tracked by the IG overdosed on prescription narcotics, though none died, the IG found.
A Center for Investigative Reporting investigation published in September showed VA prescriptions for opiates increased 270 percent between 2001 and 2012, a rate that greatly exceeded the increase in patients.
The rate of fatal overdoses among VA patients is nearly double the national average, according to CIR.
The IG investigation resulted from a tip in October 2012 claiming doctors at the San Francisco facility were writing prescriptions for addictive painkillers to patients they were not treating.
VA procedures require prescriptions for certain opioid drugs, which are similar to morphine, to be renewed every 30 days. That is supposed to be done by the patient’s primary care physician.
But, if the regular doctor is not available, VA policy allows another physician to renew the prescription without performing a face-to-face evaluation.
However, the patient’s request is supposed to be screened to ensure it is time for the renewal and the patient is not abusing the drugs. The IG found that 53 percent of the renewals it reviewed had no documentation of a provider assessment.
Prescription renewal forms that should have been maintained in patient records were routinely shredded, the IG found.
Of the seven hospital patients who overdosed on prescription opioids, three attempted suicide, three took more than the prescribed dose and one took the opioids with illicit drugs.
Bonnie Graham, director of the San Francisco VA Medical Center, agreed with the IG's findings and implemented changes that will make the primary care physician responsible issuing and documenting prescription renewals.