JOSH RENSCHLER, SERGEANT US ARMY (RET.)
SUBCOMMITTEE ON HEALTH
COMMITTEE ON VETERANS AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
Between Peril and Promise: Facing the Dangers of VA’s Skyrocketing Use of Prescription Painkillers to Treat Veterans
OCTOBER 10, 2013
Chairman Benishek, Ranking Member Brownley, and members of the Subcommittee, I am honored to have the opportunity to speak to you today regarding my experiences with Pain Management treatment from the Department of Veterans Affairs. I proudly served in the United States Army as an Infantryman for 5 1/2 years. I am now the director of men’s programming for a non-profit organization that assists service members, veterans and their families; who are struggling due to deployment related trauma. Based on my own experiences with the VA, and having witnessed first-hand the experiences of other veterans whom I have mentored; it is my belief that the VA has continually fallen short of providing veteran-centered care; the VA has completely missed the mark of meeting veteran’s needs on an individual case by case basis as well as employing best practices to care for common injuries/illnesses. Pertaining to the VA’s increasing use of opioids in pain management it is my belief that current practices are reckless and irresponsible at best. It is my intention to bring these issues into the light before this committee so they may be addressed by the VA in order to affect changes in policies and practices in order to improve care for all Veterans.
I was medically retired from the Army due to severe injuries from a mortar blast in Iraq and entered into the VA system in 2008. I was assigned to the Deployment Health Team at American Lake VA Hospital in Lakewood, WA and to the PolyTrauma Team from the Seattle VA Medical Center. At the time, I was on approximately 8 medications which treated me for sleep, migraines, pain, seizures and anxiety. It had taken Army doctors 3 years to discover and balance an effective, safe medication mix. My VA primary care doctor told me that several of those medications were not on the VA formulary and that VA would not pay for them. My primary care provider at American Lake began experimenting with different medications on me, despite the urging of my wife due to the failure of these medications in the past. The side effects caused me so much difficulty that I began to backslide in my recovery. I was soon on 13 medications (some to simply counter the effects of others); and soon all my conditions worsened and I had a severe panic attack at work. As a result, I lost my job, costing my family our home and vehicle. As my back pain continued to worsen, my primary care provider simply increased the dose of Percocet until it was no longer effective even at the extreme dosing of 12-15 5mg tablets a day. Soon I was issued methadone and eventually morphine tablets to take in between dosing of Percocet. By mid-2009, these ridiculous dosages kept me from working. Though the pain was wildly out of control, visits to my primary care provider were- 3 months apart and at each appointment I would beg for anything other than more meds. PolyTrauma finally granted a referral to see a Physical Therapist at American Lake; I was very excited to do something proactive. But the Physical Therapist simply asked me questions about my pain as he sat at a computer, and did nothing more than give me pages of instructions on stretching exercises to try at home and follow up with him in two weeks. As I then required the support of a cane just to walk, this left me feeling nearly hopeless. A little over a month later, an appointment with Neurosurgery finally led to an order for an MRI and EMG, which showed severe nerve damage and disc deterioration, and eventually a referral to a private Neurosurgeon. He was amazed that I was still walking and infuriated with the VA for allowing this to go on so long, and scheduled an urgent surgery 3 days later. By then (March 2010), due to the length of time the problems went unresolved; the nerve damage had become permanent. I still have no feeling in my left leg to this day.
From 2008-2011, I continued to take the “cocktail” of medications prescribed through the VA. I had never heard of a pain clinic and was never offered alternative therapies despite my pleading. (I did pay out of pocket as I could for Chiropractic care and massage therapy for some minor relief.) Over the course of these years, I was not once monitored for effects on Liver or Kidneys despite the high occurrence of Liver and Kidney issues with several of my medications. Finally, in early 2011 a new VA primary care doctor at the American Lake VA became very concerned and ordered a blood test that revealed extremely elevated Liver enzymes in dangerous levels. With a doubling of those levels over the next two months, I was referred to a Hematologist, who conducted a Liver biopsy. At this point my wife and I were very worried, so we began to slowly stop taking all but my seizure medications within 2 weeks; as we awaited my biopsy. Life became very difficult, but I didn’t wish to die. The biopsy showed minor scarring of the Liver; the problem was diagnosed as Non-Alcoholic Steatohepatitis. This led me to get off all but one of my medications; a subsequent blood test showed a drastic drop in my Liver enzymes to near safe levels (and they continued to drop over the next 6 months until reaching “high normal”).
By mid 2011, the nerve pain I’d experienced before the surgery began to come back, and the frustrating cycle all began over again with the unhelpful, uncaring Physical Therapy, and being sent to Occupational Therapy where I was given a “wedge pillow” to elevate my legs at bedtime and a device to help me put my socks on. My primary care doctor began treating my pain with oxycodone; I was now very restricted on what I could take due to my Liver issues. I demanded to see Neurosurgery and was given a referral to see the department head of Neurosurgery at the Seattle VA hospital. She informed me of a non-opiate medication called Lyrica that could drastically reduce my nerve pain and that had very few side-effects, but it was a non-formulary (expensive) medication. As she had anticipated, the pharmacy denied her request for the drug. Despite her subsequently getting recommendations from two other department heads in support of her resubmitted request, the VA pharmacy again denied it. Unwilling to go down the road of dangerous medications again, I spent $12,000 for a therapeutic hot tub, $3,000 for a massage chair, and began seeing a chiropractor regularly. This account has no happy ending. I am currently taking (6) 5mg oxycodone tablets daily, and I find no relief from pain laying, sitting, or standing and I have been begging and pleading with the VA to help me to little avail. Late in 2012, I did have the opportunity to try acupuncture through the VA; it was a 6-month wait for 6 appointments spread over 6 weeks. But as it was only available in Seattle, the hour long car ride defeated the minimal relief it provided. I still have not been offered a pain management clinic, though what I really need is a “hands-on” physical therapist, or a referral to a private hospital for another surgery.
Let me emphasize that I made this trip not to gain advantage for myself, but because I hope my testimony will help lead to changes in the way VA facilities handle pain-management. I hope that focusing on cases like mine will end irresponsible practices like prescribing medications that have potentially dangerous side effects with limited to no oversight of those medications. I hope it will result in much greater emphasis on pain-management and on improving overall quality of life, to include use of alternative therapies. And I hope that combat veterans experiencing chronic pain won’t ever again be denied potentially helpful drugs simply because of their cost. I thank you for your time and for your careful oversight on this matter.