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In a special program Drugging America, America Tonight investigates the overprescription of powerful medication, the harm it's causing and who's benefiting from it. Tune in Friday at 10 p.m. ET/7 PT.
TOMAH, Wis. – When Marv Simcakoski visited his son Jason at the Tomah VA Medical Center in Central Wisconsin, he never suspected it would be the last time he would see the 35-year-old former Marine alive.
That day, Aug. 30, Jason Simcakoski’s speech was so slurred that his father couldn't understand him. Marv Simcakoski said he went to the nurses' station to ask what was wrong.
“I said, ‘He can’t even talk.’" Simcakoski recalled. "And she said, ‘Well, we gave him some medication for the migraine. He’ll be all right in a couple hours.'”
A few hours later, Jason Simcakoski stopped breathing. Efforts to revive him failed.
Jason Simcakoski had been receiving treatment at Tomah for several years, but his parents had grown increasing concerned that his growing list of medications was having dire, unintended consequences.
“At the end, they had him so drugged up, he took a drug to get up in the morning and keep him going, and then he had to take many drugs to knock him out at night cause he couldn’t sleep,” said his mother Linda Simcakoski. “And it was just a vicious circle.”
The Tomah VA told the family that their son’s death had been caused by an aneurysm, but after a state autopsy, the official cause of death was ruled as “mixed drug toxicity.” All told, the medical examiner found 13 different medications in Jason Simcakoski’s system. His parents reported he was actually taking 14 or 15 medications, all prescribed by the VA.
His parents say VA doctors had told them their son was prescribed drugs for bipolar disorder and attention deficit disorder, and that surprised them, since they say he'd never received those diagnoses before or showed any symptoms.
Some patients referred to the Tomah VA as "Candy Land," and its chief of staff, Dr. David Houlihan, as the "Candy Man," based on what they considered to be a tendency to prescribe high doses of opiates.
“Jacob called it Candy Land. And he called Dr. Houlihan, the Candy Man,” said Lorraine Ward, whose son, Jacob Ward, was treated at the Tomah VA. Ward said her son, an Army veteran who returned from Iraq with PTSD and a substance abuse problem, would always come home from the facility with a bag of pills.
"I just heard all the time that Houlihan was giving this stuff out all the time like candy," said Kristen Fuehrer, a former Tomah VA housekeeper, in her first interview about what she witnessed as both an employee and as a patient.
A lot of them were just walking around like zombies.
former Tomah VA employee
A Navy veteran, Fuehrer received substance abuse treatment in the same ward as Jason Simcakoski several years earlier. She recently resigned from the Tomah VA under pressure from her supervisors, part of what she described as a climate of intimidation against anyone speaking out. As a patient, she had felt that she and her fellow veterans were forced to take medications, like sleeping pills, that worsened their substance abuse problems.
"I really wanted to fix my life, get better,” she said. "I made a decision that I needed to get off of those pills that they wanted me to take before I go to bed. And I eventually stopped, because I knew I would be addicted."
As member of the cleaning staff, Fuehrer observed that many veterans seemed heavily medicated.
“A lot of them were just walking around like zombies,” she said. “I couldn’t understand why there were so many patients that would just be in there, in their bed all day long. And sometimes, ones were really loud. And so they would hush them by giving them more meds.”
On Tuesday, the VA announced the results of a preliminary clinical review of Tomah, ordered in the wake of Simcakoski's death and a damning report from the Center for Investigative Reporting. The VA’s clinical review found unsafe practices in pain management and psychiatric care, high dose opiates being prescribed at two and a half times the national average and a culture of fear that compromised patient care.
At a news conference Tuesday, VA Deputy Secretary Sloan Gibson said that there would be a second, independent review of the facility. Dr. Houlihan, who had been moved to non-clinical duties pending the outcome of the first investigation, was placed on administrative leave along with another staff member. Gibson said the move wasn't disciplinary.
"I can't take disciplinary action without evidence," he said. "But [the action] is being undertaken given the context here, given the allegations here, to ensure that there is no interference whatsoever with patient care or with the process of the investigation."
He liked Dr. Houlihan. He liked him. He liked drugs.
mother of former Tomah VA patient
According to data obtained by the Center for Investigative Reporting, since 2004, the year before Dr. Houlihan became chief of staff, the number of opiate prescriptions handed out at the Tomah VA increased by five times – despite the fact that fewer veterans were seeking care at the facility.
Lorraine Ward said her son Jacob Ward would get so groggy from his prescriptions that he couldn't even keep his eyes open when she visited. At times, she said he didn't even recognize her.
“He liked Dr. Houlihan," Ward said. "He liked him. He liked drugs.”
Concerned that her son was being overmedicated, Ward once called Dr. Houlihan directly.
"He didn't talk to me long," she said. "He was pretty short with me. Basically said that he was a doctor and that's how he did things."
The VA had already looked into allegations about Dr. Houlihan months before Simcakoski’s death. Complaints from employees about overmedication, intimidation and retaliation prompted an investigation by the VA’s Office of the Inspector General. In March 2014, it found that Dr. Houlihan and one of his nurse practitioners had been prescribing high levels of opiates to their patients, but it didn't uncover any conclusive evidence of wrongdoing, clinical incompetence or negligence.
Dr. Houlihan's attorney said all interview requests had to go through the Tomah VA, but the Tomah VA told America Tonight that any interview decisions would be up to the doctor himself.
The facility's spokeswoman Stephanie McCrobie told America Tonight that the facility had made changes since the inspector general’s report a year ago. For example, she said the Tomah VA had appointed a pain management physician to “oversee the patients with the highest opiate usage at the facility” and ensure that their psychiatric care is separated from their pain care.
“I think we’ve seen tremendous strides in how the facility’s addressing opiate usage with our veteran patients,” McCrobie told us before the release of the VA's latest review.
The VA's clinical review from earlier this month examined the medical records of 18 patients and discovered in a third of those cases there had been incidents of "patient harm," such as falls, "that could be at least partially attributable to prescribing practices.” In half the cases, the team of experts found that practitioners at Tomah didn't adjust treatment plans even when patients displayed "aberrant behaviors."
The Simcakoskis say they repeatedly urged the facility to cut back on their son's prescriptions.
"I always fought for reduction in meds," said Marv Simcakoskis. "But it seemed like I always lost."