Golden Living Executive Testifies About DEA Policies and Tactics in Skilled Nursing Facilities
Washington, DC, March 24, 2010 — In a testimony before the U.S. Senate Special Committee on Aging today, Robert Warnock, D.Ph., Vice President of Pharmacy Services at Golden Living, stated that well-intentioned Drug Enforcement Agency (DEA) policies can inhibit the ability of skilled nursing facilities (SNFs) in meeting the pain-relief and medical-care needs of patients.
The hearing, titled “The War on Drugs Meets the War on Pain: Nursing Home Residents Caught in the Crossfire,” was called to examine regulations, policies and tactics of the Drug Enforcement Agency as they apply to skilled nursing facilities.
The focus of Dr. Warnock’s testimony was on the process and procedures by which SNFs dispense controlled medications such as morphine, oxycodone, and dextroamphetamine.
“This is, essentially, a collision of good intentions,” said Dr. Warnock. “The DEA works to protect the public against the diversion of harmful drugs. But the agency’s regulations concerning the dispensing of Schedule II drugs can cause needless suffering for patients with legitimate medical needs for these medications.”
In the skilled nursing facility setting, DEA policies can be at odds with regulations by the Centers for Medicare and Medicaid Services (CMS) under which SNFs must operate. CMS regulations cover the safe and effective handling of medications — including controlled substances. They also require SNFs to ease the suffering of patients and provide pain relief in a timely manner when needed.
Because SNFs do not have on-site 24-hour physician staffs, obtaining a written prescription and other necessary approvals for a controlled drug can be a lengthy process — especially after hours and on weekends. The medication cannot be given to the patient until the process is completed, even though the SNF has the drug on hand and available. Patients may needlessly suffer as a result.
Dr. Warnock recommended that SNFs be allowed to follow the same procedures that are practiced in hospitals regarding the dispensing of controlled drugs.
In hospitals, a physician’s order on a patient’s chart serves as the legal order and prescription for the pharmacy to fill the controlled substance. Also, in a hospital setting, a nurse is allowed to serve as a physician’s agent, and can order the pharmacy to fill a prescription for the controlled substance.
Dr. Warnock said, “These two provisions help hospital staff and pharmacies meet the immediate needs of their acute-care patients for controlled medications. We believe similar provisions for SNFs would enable us to better meet the needs of residents and patients who become acutely ill in our facilities. In many cases, we would be able to help patients in severe discomfort faster than we can under current regulations.”