El Paso VA temporarily extends IV Ketamine Infusions; veterans battle for transparency
EL PASO, Texas (KFOX14) — KFOX14 is learning the El Paso VA has decided to continue a controversial treatment for veterans after the VA claimed it was being misused.
The contract for IV Ketamine Infusions between VA and Donya Pain and Wellness Center in east El Paso is active once again.
It was renewed in the two weeks after KFOX14 Reporter Lianna Golden's first report digging into why they suddenly pulled it.
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However, the extension is temporary.
The veterans who spoke to KFOX14 on the topic believe it's just a band-aid to a much bigger problem.
When Golden asked to sit down with a VA representative for an on-camera interview, the request was denied.
The veterans who receive the infusions said it's changed their lives for the better and are the ones fighting the VA to keep it around.
"The VA finally reactivated the whole program," said Dr. Ali Ibrahim, owner of Donya Pain and Wellness. "However, time is ticking. December 31st is around the corner."
The treatment will still end at the end of the year for the vets who don't follow the VA's new criteria very closely.
That criteria were explained in a letter sent to the veterans, and the VA sent it to Golden as well.
The Veterans Care Agreement (VCA) for Donya Pain and Wellness Center was reactivated on October 2, 2023, after the El Paso VA Medical Center Chief of Staff and Chief Psychiatrist established and implemented a plan in concurrence with their Community Care Department, to approve referrals for Veterans with diagnoses of Treatment-Resistant Depression (TRD) and Active Suicidal Ideations (ASI) that met criteria for continuation of care for IV Ketamine in alignment with VA policy. In early October, letters were also mailed out to each Veteran who did not meet criteria for IV Ketamine with clear guidance on the actual criteria. Guidance was included in the letter for Veterans interested in a behavioral health clinical evaluation (example below).
Ibrahim and the vets say it's not that easy.
"My patients, they are getting this letter in the mail from the VA directly... but the main complaint I'm getting is a lot of veterans, when they called this number, different times - morning, afternoon, nobody picks up the phone. When they leave a voicemail, nobody calls them back," said Ibrahim.
Golden filed a formal request for an on-camera interview with the VA, asking the following questions, among others:
1. Previously, you all told KFOX14 a "review" found misuse of the Ketamine therapy at the provider. However, we have yet to hear specific details of this review. Can you please list what specific steps were taken to determine this provider was allegedly misusing the treatment and how you can prove it is being used for pain and not mental health?
2. We are hearing allegations of mistakes and miscommunications made in the mental health department at the VA. Veterans not being able to schedule appointments, phone calls unanswered, possibly a coding error which led to the decision to pull the treatment. Can you please address those concerns? How can you prove they are true or false?
3. Is the VA possibly pulling the treatment due to lack of funding?
4. Ketamine is inarguably a controversial treatment. Is this about politics for the VA? You have veterans claiming to rely on this treatment. What is more important to the VA?
5. The letter attached references exploring the possibility of using Ketamine to treat pain complex syndromes. Doesn't this contradict what you've said all along? Please clarify what this means and how it will affect the VCA for Donya Pain and Wellness.
A spokesperson replied, denying the request: "At this time, El Paso is declining your request for an on-camera interview and is providing the following statement in response to your query."
All VA medical decisions are made with the best possible outcomes for Veterans in mind. As previously stated, VA supports the evidence-based use of ketamine infusions for treatment-resistant depression and severe suicidal ideation. Many Veterans with these mental health conditions are treated with IV Ketamine annually both at VA facilities and by community providers.
Generally, Veterans can be referred for treatment with IV Ketamine for these mental health diagnoses in the community through a Veteran Care Agreement (VCA) between individual community providers and VA facilities.
While ketamine infusions are considered an evidence-based, guideline concordant treatment for treatment-resistant depression and severe suicidal ideation, the use of ketamine infusions for chronic pain conditions, such as certain neuropathic and central pain conditions, is not considered standard of care, and any such use would be experimental. Studies demonstrate conflicting evidence and limited efficacy for chronic pain. Commercial insurances will generally not cover this treatment for chronic pain conditions.
The VCA Donya Anesthesiology and Pain (Donya) was placed under review after VA, while conducting a routine audit of VCA payments, identified provider referrals that were inconsistent with VA policy. Specifically, we found indications that some providers from Donya were authorizing IV Ketamine treatment for pain management. The VCA with Donya Anesthesiology and Pain approved IV Ketamine use only for mental health care, not for pain management.
The Veterans Care Agreement (VCA) for Donya Pain and Wellness Center was reactivated on October 2, 2023, after the El Paso VA Medical Center Chief of Staff and Chief Psychiatrist established and implemented a plan in concurrence with their Community Care Department, to approve referrals for Veterans with diagnoses of Treatment-Resistant Depression (TRD) and Active Suicidal Ideations (ASI) that met criteria for continuation of care for IV Ketamine in alignment with VA policy. In early October, letters were also mailed out to each Veteran who did not meet criteria for IV Ketamine with clear guidance on the actual criteria. Guidance was included in the letter for Veterans interested in a behavioral health clinical evaluation (example below).
VA is committed to same day mental health services to ensure that Veterans in crisis receive immediate assistance and same-day access for initial screening when a Veteran requests mental health assistance. The El Paso VA Behavioral Health team is reporting zero issues with incoming phone calls, zero issues with scheduling requests, and wait times have improved dramatically over the last 12 months. Additionally, VA continues to focus on improving access for mental health services and offers Veterans the option of referral to community care when VA wait times or drive time for Veterans meets community care eligibility criteria established by the MISSION Act.
When Golden followed up, asking why her request was denied, she was told:
Thank you for the opportunity to respond to your questions, we refer you to our statement below.
"We're glad that they reactivated the whole program, that's a good step from the VA," said Ibrahim. However, what's the benefit of reactivating something if you don't have the tools to make it successful?"
Those tools, Ibrahim said, are the staff and commitment to making the treatment work.
Golden also spoke with local mental health expert Alfredo Arellano, who has practiced for 33 years, specializing in advanced treatments for all types of mental health conditions, to learn more about the infusions.
"Ketamine, although helpful, also has some drawbacks," Arellano said.
He said Ketamine has risks, like dissociation, high blood pressure, and hallucinations, among others.
"Ketamine is not the first go-to medication to manage pain, and it's not the first medication to manage depression," Arellano said.
Arellano said it can also be habit-forming.
"Ketamine works on the opioid receptors in our brain. It's not an opioid, but we have to be careful there's not a dependence on it," said Arellano. "S as long as the person's on IV Ketamine, they might be feeling very good, but the moment they stop a week or two weeks later, they might fall back into their depression."
"I personally am rated 100% for my PTSD, TRD, and anxiety," said Omar Savage, a veteran who chose to speak with KFOX14.
The veterans are still committed to fighting for the treatment they say actually works for them, compared to years of other failed methods.
That includes Savage, who has had a closer look into VA operations.
I worked with the VA shortly in the audiology department, and it’s always politics. It was always about funding in this and that," said Savage. "Even at work, I would have these cognitive dissociative episodes. Basically, it’s flashbacks. I had them in the short time that I worked there. I had them at work, and they just looked at me like I was crazy. They’re like, 'What’s going on?'... Even with that even in my records and everything, they still want to get rid of the treatment. It doesn’t make sense.
The unknown of what will happen come December 31st, and what the veterans said is a continued lack of transparency from the VA, leaves them with more questions than answers.
"I have a VA doctor, mental health doctor that's been there for over 20 years," said veteran Steven Washington. "He's never heard of Ketamine. Don't have any idea what they're actually doing down there. It's supposed to be for mental health. Well, how's that supposed to be for mental health when the VA mental health doctor doesn’t have a clue what's going on?"
"Nobody ever asks me about, 'Does the treatment help?' You would think you would ask the actual veteran who goes for the treatment. Not one time," Washington added.
One of the veterans who mentioned he was having trouble getting a hold of the mental health department over the phone went down in person.
He had to wait a few hours but said he was able to get a hold of someone to talk options.
He recommends his fellow veterans to go and wait as long as it takes to talk to someone face to face.
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