For 1 veteran at Tomah, even high doses didn’t end the pain

MADISON, Wis. (AP) — Like flashes of lightning, sharp pains strike 39-year-old Jason Bishop’s left arm several times a day, causing him to writhe in agony.

Frustrated by his chronic suffering, Bishop has struggled to find relief at several Department of Veterans Affairs hospitals, including an embattled medical center in Tomah. He said the VA hospitals have offered him treatment, including prescriptions for narcotics, but few long-term solutions.

“They don’t fix you. They’re not trying to find an answer,” Bishop said. “They just control you with medication.”

The hospital is at the center of multiple probes after reports of narcotic overprescribing practices and retaliatory behavior surfaced in January — allegations already affirmed by a preliminary report. The facility was known to some in the community as “Candy Land” because of the prescriptions of narcotics coming from physicians there. Former Marine Jason Simcakoski, 35, died of an overdose in the hospital’s inpatient care unit. U.S. House and Senate committees are to hold a joint field hearing Monday in Tomah.

Bishop served as a transport plane loadmaster in the Air Force in Kosovo and Bosnia between 1996 and 1999. He said at an appointment to check on intestinal problems in 1999, doctors found Bishop had sick sinus syndrome — a condition that prevents the heart from pumping properly. Surgeons at a Little Rock military base implanted a pacemaker to help Bishop’s heart, but he was left with chronic pain that lingers more than a decade later. Physicians at multiple VA hospitals prescribed narcotics, but none gave him consistent care plans, he said, until he met Tomah VA Chief of Staff David Houlihan.

“He said I’d been medically mismanaged,” Bishop said. “To hear that from the chief of staff, that’s like the golden ticket.”

Like other physicians, Houlihan prescribed Bishop an opioid, morphine sulfate, for the pain. Over almost three years Houlihan and other physicians at Tomah prescribed Bishop doses that at their peak were three to four times higher than the 70 to 100 milligrams that experts recommend per day, according to Bishop’s medical records.

“Those are phenomenally high doses,” said G. Caleb Alexander, co-director of the Johns Hopkins center for Drug Safety and Effectiveness, after reviewing records of Bishop’s prescriptions. “It’s hard to imagine the conversations that took place that led to dosages that high.”

Bishop said the drugs caused him to feel like a zombie — zoning out, forgetful — and still didn’t do away with his pain.

Bishop was one of thousands of veterans to receive the narcotic as well as a prescription for a benzodiazepine, a class of psychoactive drugs that act as a tranquilizer. Alexander said combining the two raises risk of injury and death.

While Bishop said he would have liked to try alternative treatments for pain like aquatic therapy, acupuncture, massage or non-narcotic medications, none were offered by VA physicians. And he said he can’t afford the treatments offered by other medical centers.

Houlihan did not respond to a request for comment. Stephanie McCrobie, a spokeswoman for the hospital, said she could not comment because of patient privacy and because investigations continue.

A VA probe earlier this month found that patients at the Tomah center were more likely to get high doses of opioids and more likely to get a combination of opioids and benzodiazepines. And retaliatory behavior among staff members created a culture of fear that hurt patient care, the report said.

The problem is one that Paul Rieckhoff, president of Iraq and Afghanistan Veterans of America, says he sees often with the VA system. He said many hospitals prescribe pills for chronic pain problems rather than providing long-term care solutions.

“Narcotic prescriptions can be part of a care regimen for managing chronic pain, however, narcotic medications are just one tool out of many,” Rieckhoff said.

Rollin Gallagher, national program director for pain management with the VA, said the VA is trying to treat chronic pain with alternative care solutions but there’s still a gap in education. And for some physicians it can be easier to prescribe painkillers than seek out alternative treatments like massage or acupuncture, he said.

“One of the things we have in our brains is empathy. It’s really the core of physician or clinician to ease suffering. So it’s very hard when someone is suffering in front of you … If they haven’t had the training they will use what they have available,” Gallagher said.

VA Undersecretary for Health Carolyn Clancy hit the same note at a U.S. Senate hearing Thursday.

“We don’t have easy alternatives,” Clancy said. “We don’t have a good answer to chronic pain that fits everyone.”

Until a solution emerges some of these prescribing problems will continue, Alexander said. He said as opioid prescriptions continue to increase so will bad effects.

“This is a problem far beyond an occasional rogue prescriber and a few doctor shoppers,” Alexander said. “There’s no question that we need more effective treatments.”

Bishop, unhappy with how the medications made him feel, said he weaned himself off of many of the pills. He said without the prescriptions he’s better able to care for his 9-year-old daughter Chloë.

“So I live in pain all the time,” Bishop said as he started to cry, “but I have a high pain tolerance. I’m just trying to find a solution that’s not medicating.”

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