The DEA Continues Its War On Nursing Home Residents

Under Administrator Michele Leonhart, the Drug Enforcement Administration has been engaged in a three-years long war against longterm care facilities that allow nursing staff, at the behest of doctors, to submit pain prescriptions for patients.

The reasoning for this practice that a doctor isn't always around when a patient—say, an 87-year-old dementia patient who has just undergone major surgery—needs more painkiller medicine. So, historically, when a doctor hasn't been able to call in a prescription personally, nursing home staff have done so on the doctor's behalf. 

On the grounds that prescriptions may be called in, collected, and resold by nurses (but never by doctors), Leonhart and the DEA have been trying to put a stop to this practice since at least October 2009, when the Washington Post first reported that the administration was "denying some hospice and elderly patients needed pain medication." 

That year, pharmacists and geriatric care groups sounded the alarm about the drug war's mission creep, and the Senate Committee on Aging accused the DEA of contributing to "adverse health outcomes and unnecessary rehospitalizations, not to mention needless suffering."

After almost two years of back-and-forth with Leonhart and Attorney General Eric Holder, the Senate Committee on Aging told Reason that it was close to a solution. That was in May 2011. It's now May 2012, and the DEA has just won a $50 million settlement against a pharmacy that violated the administration's rules in order to help nursing home patients:

Pharmaceutical company Omnicare, Inc. (NYSE:OCR), the nation’s largest pharmacy for long-term care facilities, must pay the U.S. government $50 million in a settlement over complaints it dispensed painkillers to nursing homes and other senior care facilities across the country without proper prescriptions or authorization.

The Covington, Ky.-based company’s settlement with the Department of Justice is the second-largest civil settlement in history of the Controlled Substances Act, and follows a Drug Enforcement Administration investigation of “alleged errors and deficiencies” in how certain Omnicare pharmacies distributed controlled substances.

“While DEA regulations specifically address retail and hospital pharmacy operations, long-term pharmacies have historically operated in a less defined middle ground, dispensing controlled substances on instructions from long-term care facility staff after the staff’s consultation with the ordering authorized prescriber,” said Omnicare in a statement about the settlement. “This civil settlement makes it clear that DEA interprets its regulations to require the ordering authorized prescriber to either sign an order containing all of the elements of a valid prescription prior to dispensing, or in limited emergency circumstances for Schedule II controlled substances to speak directly with the pharmacy prior to dispensing.”

Omnicare’s CEO, John Figueroa, said the pharmaceutical company “understands and accepts” the DEA’s efforts to make sure appropriate procedures are followed when distributing drugs. “While requiring authorized prescribers to communicate directly with the pharmacy can potentially cause delay, we have committed ourselves to shortening the time in which nursing home residents receive required medication,” he said. 

The wrongdoer here isn't Omnicare, which has agreed to pay the settlement immediately in order to continue doing business uninterrupted, but the DEA, which Sen. Herb Kohl accused two years ago of "putting paperwork before pain relief.” 

To get a sense of how, exactly, the DEA's rules against nurses ordering pain prescriptions affects longterm care residents, take a look at this 2009 testimony from Cheryl Phillips, then president of the American Geriatrics Society: 

Mrs. M is an 87 year old female with advanced dementia and a recent hip fracture and subsequent surgery. She has been at the nursing home for the past three days. Prior to her transfer from the hospital her pain meds were decreased because her orthopedic surgeon was worried about confusion. Since then, the family has been concerned that she has been in pain that is not managed with the non-narcotic meds prescribed. On the fourth day of her nursing home stay physical therapists worked “a bit harder” to get her moving more and out of bed. By that evening she was tearful and refusing to eat. When the family arrived they recognized she was in pain and requested something stronger to treat her.  

After a call to her attending physician which resulted in an order for morphine sulfate the nurse requested from the pharmacist that she be able to access the emergency drug kit and administer the ordered medication. However, because the physician was not able to provide an after-hours signature the pharmacist said she was not able to release the medication. The family became incensed and threatened to “sue the nursing home." At that point, the nurse called the physician back and the order was given to send the patient, via ambulance, to the emergency room for pain management. 

Meanwhile, the legislation that Kohl proposed to reign in the DEA, titled "The Nursing Home Resident Pain Relief Act of 2011," is gathering dust

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  • sarcasmic||

    "adverse health outcomes and unnecessary rehospitalizations, not to mention needless suffering."

    When you work for an agency like the DEA, causing suffering is the name of the game!

  • ||

    "adverse health outcomes and unnecessary rehospitalizations, not to mention needless suffering."

    How else are they going to measure success?

  • sarcasmic||

    How else are they going to measure success?

    Number of people they put in prison.

    That is the mark of a free society.

    The more people per capita caged by the government, the freer the society is.

  • Lord Humungus||

    So now the aged can suffer in pain. Back to the medieval ages we go - a drug war and needless bureaucracy MUST COME FIRST!

  • Brandon||

    Please. Even in the middle ages, substances weren't criminalized.

  • Kwanzaa Cake||

    Rest assured, this same government will be able to run the entire health care system without a hitch.

  • Wavy Gravy||

    We must be in Heaven, man!

  • Fist of Etiquette||

    ...the Senate Committee on Aging told Reason that it was close to a solution.

    Those dipshits have six-year terms, so anything around that time frame is considered "close" to them.

  • ||

    the Senate Committee on Aging--

    Doesn't the very existence of such an entity tell us everything we need to know about how far we've sunk?

  • ||

    +100,000^19.

  • Invisible Finger||

    You know what the Senate Committee On Aging says about aging in pain?

    It's against it.

  • The Unknown Pundit||

    Is is just me, or does it seem that many of our legislators are scared of these giant agencies they've created?

  • Mr. FIFY||

    "You can't professionalize unless you federalize" - Tom Daschle, (D)ouchebag

    I know, it doesn't quite fit... but in a way, it does.

  • ||

    I gotta make sure to keep my connections strong in the advanced years. Have some streetwise kid help me out for a cut.

  • ||

    Where the fuck is the AARP in all this? You'd think that useless group might be good for something, you know, actually good for once.

  • daveInAustin||

    Yeah, the AARP says "government, keep your hands off our medicare". Why can't they say keep your DEA out of our nursing homes.

  • Scruffy Nerfherder||

    Because they're on the government tit. They just want that money to flow.

  • sarcasmic||

    If so she'll have access to all the pain medication she needs.

    Remember that the rules do not apply to those who enforce them.

  • sarcasmic||

    squirrels - that was in response to John below.

  • Hugh Akston||

    Dementia patients can't vote or pay dues. They're like cordwood to the AARP.

  • Bryan C||

    The AARP is an insurance brokerage that sell endorsements. No one's paying them to care about old people in pain. And they certainly don't want to end up on the executive branch's enemies list.

  • ||

    I remember my 99-year-old great-grandma, who had Alzheimer's and cancer, being curled up into a ball in her bed in the nursing home. And they still wouldn't give her opiates. These people are pure scum.

  • BikeRider||

    My father-in-law died a few weeks ago in a nursing home. Due to advanced Parkinson's he had significant dementia but knew he was dying. He was scared, angry and in pain all at the same time. Thankfully the staff had permission to give him morphine to calm him down for his last few hours.

    I'm really sorry to hear what your great-grandma went through. Perhaps someday those people will find themselves in intense pain with no one willing to help. Then they'll understand.

  • fried wylie||

    Perhaps someday those people will find themselves in intense pain with no one willing to help.

    I start everyday with a prayer that they will.

  • croaker||

    Doctors should ban all pain killers to drug warriors an their families. "Sorry, but I don't want to go to jail, so you'll just have to take Advil and suck it up. Asstard."

  • Scruffy Nerfherder||

    What is the rationale for this? It doesn't make any damn sense whatsoever.

  • John||

    If they let nurses do their jobs, some of them might sell the pain meds to someone who doesn't have a prescription. And that would be bad. So in the DEA's mind it is better to let thousands of innocent old people suffer so that a few addicts might have to go somewhere else to get their opiates.

    Yeah, they really are that fucking stupid and evil.

  • Scruffy Nerfherder||

    It's shit like this that makes you hate people in general.

  • AlmightyJB||

    Yep. With all the baby boomers getting older, I am seeing a business opportunity here though.

  • perlhaqr||

    And DEA fuckbuckets in particular.

  • John||

    Is it bad that I sincerely hope Ms. Leonhart develops chronic and debilitating pain some time soon?

  • ||

    nope. petards and hoists and all that

  • Mr. FIFY||

    You'll have to deal with the Petard-Hoisters Local union rep on that.

  • sarcasmic||

    If so she'll have access to all the pain medication she needs.

    Remember that the rules do not apply to those who enforce them.

  • Drake||

    "As part of the settlement, Omnicare has agreed to make the payment within the next few days in exchange for being able to continue dispensing medication."

    No need for a Judge or jury. If Omnicare didn't immediately kowtow to the DEA, they would have had their business destroyed.

    I hope they all die painfully in shitty nursing homes. Sic semper tyrannis.

  • ||

    This reminds me of the super-legal activities of the EPA in fining or seizing lands from people who don't follow their edicts. The Institute for Justice could probably make some noise about this as well.

  • ||

    its a nice racket

  • croaker||

    Cordless drill. Tungsten drill bits. Kneecaps. Some assembly required.

  • AlmightyJB||

    Related: Cardinal Health facility suspended for two years for not doing the DEA's job for them.

    http://www.dispatch.com/conten.....ended.html

  • Scruffy Nerfherder||

    Big health business that thrives on regulations to stifle competition feels pain from those regulations. It's hard to feel sorry for Cardinal. Now if they stood up and told the DEA to go fuck itself, it would be a different story.

  • AlmightyJB||

    I fail to see how arguing against the regulations makes them culpable in having those regulations applied against them?

  • Scruffy Nerfherder||

    Overall, Cardinal profits from a severe regulatory environment. They perform regulatory consulting, they sell regulatory compliance software, they acquire smaller businesses that don't have the means to comply with the phenomenal levels of paperwork. They are a classic example of big business in bed with big government in a heavily regulated sector.

    I have a hard time feeling sorry for them when they run afoul of the system that they actively participate in and profit from.

  • AlmightyJB||

    The qeustion is do they lobby for the regulations? If they actively lobby for those regulations then I would agree with you. Just profiting from them them doesn't make them the bad guy though. That would make every accountant and business consultant culpable for helping people navigate tax regulation.

  • Robert||

    Rather ridiculous, isn't it, suspending a given facility of a company? They're xferring the drugs to another facility in the same company, which will distribute them from there. All it looks like is a way to consolidate jobs.

  • Mr. FIFY||

    Remember, Democrats:

    This is happening with YOUR Team in charge.

    No remorse, I suspect.

  • Brandon||

    Democrats: But Republicans, car, ditch, economy, fair share, greed, wall street, dog on a roof!

  • T||

    This is the kind of shit that leads me to go off on spittle-flecked rants against the drug war. I've taken to asking people who support it 'stupid or evil?' because it has to be one or the other.

  • John||

    Mostly stupid and uninformed. Most people who support the drug war have no idea about its excesses. It is not like this stuff gets much press outside of Reason. If we had anything but a state run media, that might change. But we don't so it doesn't.

  • T||

    In my conversations on the subject, they don't care. They don't give a shit that people are dying or that people spend years in pain until they committ suicide. They accept the collateral damage because drugs are bad, mmkay? They're perfectly willing to rationalize the damage away because DRUGS! CHILDREN! BAD!

    This is usually the point where I say 'Okay, so the answer is evil. Good to know. Get the fuck away from me.'

  • John||

    That is what you say T. But you will think differently once you have kids!!

    ;-)

  • T||

    God, I hope not. If that happens I may have to lobotomize myself with a fucking cocktail fork.

  • John||

    That is by far and away the most annoying response people give. As if having kids renders you incapable of rational thought.

  • T||

    Based on my experience at POA meetings, it must. People will demand the dumbest shit because OMG there exists a one in a million chance little Bratley might be exposed to a risk.

  • ||

    Haha, Bratley, I like that.

  • The Unknown Pundit||

    Problem: I don't want Billy to do drugs.

    Solution: I'll support laws that punish strangers that want to use drugs in order to be able tell Billy drugs are against the law and he could get arrested and could be punished if he breaks the law.

    Moral: Evidently the ends do justify the means.

    Some sort of moral thought from parents would be nice, let alone rational thought.

  • JW||

    If that happens I may have to lobotomize myself with a fucking cocktail fork.

    Not to worry. Having kids will do that.

  • Whahappan?||

    I know you're just being facetious, but I've got a 7 year old daughter, and if anything I've gotten more adamant in my opposition to the drug war. I know the odds of her being addicted are vanishing small, however her life is much more likely to be fucked up by the shitstains running the drug war.

  • tommyboy||

    John,

    This is the most condecending comment I have ever seen. I have four children and teach them to avoid drugs, alcohol and tobacco, but I hate the war on drugs. I want my kids to live with more freedom and less government safety nets.

    Maybe you have 12 kids and know more than I do, but I'll assume you are just a self righteous jerk.

  • Robert||

    It is not like this stuff gets much press outside of Reason. If we had anything but a state run media, that might change. But we don't so it doesn't.


    I see no evidence that the media are "state run", nor that state involvement makes them any less likely to expose such stories. In fact, it's those media that get gov't grants that most frequently emit material critical of gov't, in my experience. Why that is, I don't know, but that's the pattern. Don't go by a priori reasoning where there's actual evidence.

  • John||

    Robert,

    If the media covered the drug war the way it covers race relations, the drug war would end in less than a decade. As someone once said, this isn't your father's liberal media. The media loves cops and loves the government line on the drug war.

  • Drake||

    They do cover the drug war the same way they cover race relations - with extreme bias and incompetence.

    When was the last time you heard about a black on white hate crime in the national news?
    http://hamptonroads.com/2012/0.....-reporters
    Would we have even heard about this in the local news if the attack wasn't actual on reporters?

  • ||

    I've taken to asking people who support it 'stupid or evil?' because it has to be one or the other.

    Why do you pose it as an either/or question?

  • T||

    Shorter and simpler. The correct question is actually 'Stupid, evil, or both?' but the short version usually throws people enough and doesn't give them any wiggle room.

  • Wavy Gravy||

    As do you, RingoHungo. As do you.

  • R C Dean||

    Take a close look at that picture of Ms. Leonhart. Next time somebody refers to "dead eyes", you'll know exactly what they mean.

  • AlmightyJB||

    Maybe Obama has her on Scopolamine along witht e rest of his administration.

  • Lord at War||

    Caption: "Fuck you, that's why!"

  • ||

    Sweet mother of God, I eagerly await the day DEA headquarters is burned to the ground by some half-decent President (like Ron Paul, for instance). One day soon, I hope, Administrator Leoncunt. One day soon.

  • Ken Shultz||

    The administration was "denying some hospice and elderly patients needed pain medication."

    The extent to which the Obama Administration is willing to go to push its agenda is frightening.

    Denying pain medication to hospice patients?!

    How much lower can they get?

  • Ken Shultz||

    Gotta save the terminally ill from drug addiction, too, I guess.

  • fried wylie||

    *insert spittle-flecked rage here*

  • ant1sthenes||

    Hey, maybe they should take a page from the insurance premium debacle. Next time grandma wants some pain meds but can't, let her know that the Obama administration has prevented her from getting them.

  • Brandybuck||

    Democrats: STILL better than Republicans when it comes to drugs. Praise Holy Obama!

  • Ken Shultz||

    They always seem to feel like they gotta try harder to prove that they're just as tough on [insert whatever] as the Republican alternative.

    It's like that time Bill Clinton executed a functionally retarded guy just to prove that he was tough on crime.

    Gee, we're so impressed, Obama! You won't even let terminally ill patients in hospice off the hook. Wow.

  • ||

    [T]he Drug Enforcement Administration has been engaged in a three-years long war against LTC facilities that allow nursing staff, at the behest of doctors, to submit pain prescriptions for patients.

    This is somewhat of a misnomer, as we can write scripts for a certain amount of refills and nursing staff simply calls in and faxes a current, valid script for a refill of meds until the script number of script refills has expired. Nursing staff, barring an ARNP or DRNP as per state regs, cannot write RX's.

    The reasoning for this practice that a doctor isn't always around when a patient—say, an 87-year-old dementia patient who has just undergone major surgery—needs more painkiller medicine. So, historically, when a doctor hasn't been able to call in a prescription personally, nursing home staff have done so on the doctor's behalf.

    Scheduled drugs, as per the State of OK and DEA, require an original RX be submitted (colloquially called a "hard script") in order for the RX to be filled. I can call them in, but there must be a hard script within 24 hrs of the meds being dispensed by pharmacy, or it's my ass in a sling. And you can be damn sure this will be scrutinized, as the pharmacy is required to notify the DEA otherwise.

    I cannot write a standing order for Scheduled PX meds; however for this type of patient, I would write the RX for as much as I could possibly allow for proper PX mgmt (and it would be probably quite a bit).

  • ||

    After a call to her attending physician which resulted in an order for morphine sulfate the nurse requested from the pharmacist that she be able to access the emergency drug kit and administer the ordered medication. However, because the physician was not able to provide an after-hours signature the pharmacist said she was not able to release the medication.

    Also, ARNP's can't write Schedule II's RX's. Why, is beyond me. I supervised them either way. What I don't understand here is why, in 2009, why the dispensary wouldn't release the meds in lieu of the 24 hour provision, unless there are other circumstances here of which I am not aware.

  • The Unknown Pundit||

    Tyranny.

    The only word for all of this. And the men and women who carry out this tyranny should be ashamed.

  • John C. Randolph||

    The DEA's existence is unconstitutional. Everything that sadistic bitch does is a usurpation.

    -jcr

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