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Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

Deadly VA Clinic Lapses

Poor mental healthcare at one Veterans Affairs clinic in Chico, California played a role in violence that shattered two veterans' families, reported.

These incidents are just a few examples of what found in a larger review of all of the reports published by the VA Office of Inspector General since 2020, which concluded, "Over and over, the hospitals and clinics in the VA's sprawling healthcare network have fallen short when it comes to treating people with mental illness."

One former Air Force veteran, Andrew Iles, began experiencing paranoia while travelling the world working on planes, and moved back home with his parents. His delusions grew, leading him to lock himself in a room, suspicious of even his strongest supporters. Ultimately, the delusions grew so bad that he shot and killed his mother, convinced she was poisoning him.

Iles had sought help at the Chico VA clinic -- which served more than 500 mental health patients -- but the lone psychiatrist there had retired. His new provider gave him medications, but Andrew wanted to talk to someone routinely. The VA did not replace the psychiatrist, instead relying on visiting doctors and telepsychiatrists.

Julia Larsen enlisted in the Navy and became a flight deck firefighter. On assignment on an aircraft carrier, she was sexually assaulted by a supervisor, but was offered no mental health services. Over the next 4 years, she grew increasingly paranoid. When a loud noise triggered her PTSD one day, she beat her father with a handgun and shot her mother, ultimately killing her.

Larsen, who was diagnosed with PTSD, was seeing a telemedicine provider at the Chico VA clinic. There wasn't always one available, however, to refill medications or see patients in crisis. The focus, Larsen told ProPublica, was more on medication and less on talk therapy, and she was passed from provider to provider, one of whom prescribed her two drugs that together can trigger psychotic or manic symptoms.

Larsen had gone to the VA the same day she shot her mother, feeling unstable, but the clinic was too busy to see her and she was sent away.

The clinic's site manager had complained about the lack of on-site mental health providers, and tried to find workarounds. After the shootings, she sent a tip to the agency's inspector general's office, and was later fired. The inspector general's office ultimately found multiple problems with how Larsen's case was handled. For several months, the clinic told ProPublica, the mental health team has been fully staffed.

Asthma Drug Risky in Kids

In 2020, the FDA finally added a warning to the label of the 25-year old asthma drug montelukast (Singulair), alerting users it could cause aggression, agitation and suicidal thoughts, .

In testimonials for a 2022 FDA meeting, some patients and parents recounted hearing voices telling them to hurt themselves. Other testimony included a story about a toddler who banged his head against the wall and hid knives underneath his pillow, and a 7-year old who tried to take his own life.

Few knew about the consequences, the Times reported, noting that 12 million people were still prescribed the drug in 2022 -- including 1.6 million minors.

"Federal regulators in 1998 initially dismissed evidence that emerged during the approval process about the drug's potential to affect the brain and did not revise their assessment until two decades later," the article stated. "The FDA was slow to alert the public as reports of psychiatric problems surfaced, highlighting deficiencies of a drug-monitoring system that puts the onus on drugmakers to report problems."

Meanwhile, the drug's maker, Merck, received thousands of reports nearly a decade ago of side effects from the drug, but the FDA ultimately "stopped short of forcing Merck to conduct more rigorous and expensive studies that could have made clear how common bad reactions were," the Times reported. A whistleblower claimed in a lawsuit that the company paid doctors to prescribe the drug, and earned $50 billion from it.

Also, though the FDA alerted patient and professional groups, they did not require monitoring of side effects or education of doctors, the Times wrote. It is still unclear how widespread the problems are, however, although observational reports have suggested the issues arise in children with no psychiatric history, end when the drug is stopped, and come back if restarted.

Invisible HHS Secretary?

For much of his time as Secretary of the U.S. Department of Health and Human Services, Xavier Becerra has kept a low profile, making infrequent appearances at the White House and abstaining from any aggressive promotion of his own accomplishments. But with a presidential election on the horizon, the legacy he leaves behind may be more consequential than ever, according to a report.

"Certainly from a public profile point of view he's been a major disappointment," Lawrence Gostin, a public health law professor at Georgetown University, told STAT. "He's a very prominent Latino leader, and he was well placed to really shine during COVID, monkeypox, and other health crises. He was very silent during those crises."

Yet his behind-the-scenes work has improved health prices and coverage via the Affordable Care Act, Gostin said.

According to STAT, Becerra skipped an appearance at an event celebrating the drug prices negotiation win, ceded the spotlight on abortion rights to Kamala Harris, and wasn't involved in Biden's new phase of his Cancer Moonshot plan, along with other press opportunities.

After an early, tense exchange with White House Domestic Policy Adviser Susan Rice, "Becerra seemed to fade into the background," according to STAT. He was not a public figure in COVID-19 response, and appeared at a White House press briefing after a full year into his role. Instead, Becerra has travelled extensively to tout President Biden's accomplishments, like capping insulin costs and negotiating Medicare drug prices.

However, lately Becerra has gotten closer to some White House officials, like Rice's replacement Susan Tanden, and White House Chief of Staff Jeff Zients, with whom he meets often. "That's helped change his presence and visibility with the White House," maybe enough to leave a lasting impression, according to STAT.

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