Who’s watching?

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http://www.portlandtribune.com/archview.cgi?id=34132

 

Who’s watching?

The State Board of Nursing hides its program for troubled nurses behind

a shroud of secrecy, and others can only wonder if it works

By PETER KORN Issue date: Fri, Mar 10, 2006

The Tribune

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Maybe Lisa Overton deserved a second chance. And a third chance. And

a fourth. But the patients whom the Oregon nurse cared for as she

suffered through relapse after relapse in her battle against drug

addiction might have another point of view.

Especially since Overton, according to her later confession to

police, was stealing drugs from hospitals and nursing homes where she

worked. On one occasion she stole drugs directly from a patient who

then did not receive her painkilling medication.

Overton was in the Oregon State Board of Nursing’s Nurse Monitoring

Program, which is for nurses suffering addictions or mental health

disorders and which shields them from further discipline as long as

they remain enrolled. Overton continued in the program for at least

four years without board discipline, despite relapses that showed she

was continuing to use drugs.

Critics have raised numerous questions about how the Board of

Nursing disciplines problem nurses. But the most controversial method,

the Nurse Monitoring Program, technically is not discipline at all.

Enrollment in the monitoring program is available to registered and

licensed nurses with drug and alcohol addictions or psychiatric

disorders, but not to the larger numbers of nursing assistants who also

come under the board’s purview.

And enrollment in the program is confidential. Board officials say

it is the nurse’s duty to inform employers that he or she is in the

program. The board releases no information on the identity of current

enrollees to anyone except — according to board officials — supervisors

at facilities where the nurses work.

Public officials interviewed by the Portland Tribune nearly

unanimously support the idea of the monitoring program as a

confidential diversion alternative for addicted nurses. But many who

are familiar with the way the nursing board administers its program

think it is a well-intended failure in terms of keeping the public safe

from nurses who are fighting addictions or mental illness.

The idea behind the monitoring program is to allow nurses to

continue to work while they get help. But Meredith Cote, Oregon’s

long-term care ombudsman, the state official in charge of protecting

public welfare in care facilities such as nursing homes, said she

thinks keeping chemically dependent nurses on the job is a bad idea.

That’s especially the case with nursing facilities, which traditionally

provide less oversight of nurses than hospitals, she said.

“When you are in a position where people’s lives are in your hands,

one has a duty to the patient,” Cote said. “I think that trumps being

in a position where you may be impaired and having access to people who

are vulnerable.”

In Cote’s view, people involved in health care have to be held to a

higher standard than people in other occupations.

“It does not seem reasonable to put people who are actively involved

with an addiction in places where they are caring for vulnerable

people,” she said.

Beyond those concerns, addicted nurses obviously have easy access to

what they’re addicted to: drugs. That is especially true of nurses and

nursing assistants who work in long-term care facilities, said Gail

Albers, who worked for four years as an investigator for Oregon Adult

Protective Services before moving to New Mexico in 2000.

“It’s a perfect job for someone who’s chemically addicted,” Albers

said. “It’s a job where you’re working with such a vulnerable

population, many of whom are not cognizant of what their medications

are, so you could put up a lot of smokescreens.”

But Board of Nursing officials maintain nurses with addictions can

be placed safely back in the workplace.

“The decision to return a Nurse Monitoring Program participant to

work is made collaboratively with the participant’s licensed, certified

treatment counselor, when that counselor deems the participant’s

disease is in remission,” board officials said in an e-mailed response

to Portland Tribune questions. “The level of supervision, access to

narcotics and shift are all considered in making that assignment.”

 

‘Relapse … part of recovery’

 

Lisa Marie Overton has more familiarity with the monitoring program

than most enrollees. Now 44 and living in Eagle Creek, Overton

graduated from Linfield Good Samaritan School of Nursing in 1987 and

began a career working at hospitals and long-term care facilities in

the Portland area. (Overton refused repeated requests for an interview

for this story.)

According to a 1999 nursing board order concerning Overton, she

admitted to a chemical dependency and was enrolled in the board’s Nurse

Monitoring Program in 1993.

In 1994, according to a confession she made to Portland police after

her April 2002 arrest on theft and drug charges, she stole Demerol (a

pain medication) from a nursing facility and was fired from her job. In

that confession Overton, by then a mother of two sons, also made clear

that she wanted help in overcoming her addiction.

According to a later board order, Overton suffered four drug

relapses from 1994 through 1997. Yet she was never brought up on

disciplinary charges and was allowed to keep working as a registered

nurse until after her fourth relapse in 1997.

It might appear the monitoring program did not work for Overton or

her patients.

According to board rules, “Licensees who fail to comply with the

terms of participation (in the Nurse Monitoring Program) shall be

reported to the board for formal disciplinary action.”

But Kimberly Cobrain, the board’s investigative and compliance

program executive, said board officials do not view relapse as failure.

“Relapse behavior is part of the recovery process,” she said.

Cobrain said the monitoring program operates on a “three strikes and

you’re out rule.” Once in the monitoring program, a nurse is allowed

three relapses before being subject to board discipline, Cobrain said.

“I think it’s a humane kind of thing,” said board President Saundra

Theis about the relapse policy. Theis said when nurses relapse, they

usually are required to leave their jobs for a period of time. But when

pressed, Theis said the board does not keep records of how frequently

nurses actually are asked to take time off, or, on average, for how

long.

“We don’t look at it as time,” Cobrain said. “There’s no magic time.

We rely on what experts tell us as far as when they’re stable.”

 

Nurse’s problems continued

 

A week after Portland Tribune interviews with the board, an e-mail

arrived from board spokeswoman Barbara Holtry offering clarification:

“The usual amount of time a nurse in the Nurse Monitoring Program is

away from work (either at the beginning of the program or after a

relapse) is one to two months.”

But the board provided no documentation or information

substantiating the statement, and a Tribune request to interview Dawn

Gordon, who administers the monitoring program, was denied.

In 1997, after suffering a fourth drug relapse, according to the

board order, and leaving a new nursing job at Providence Portland

Medical Center, Overton surrendered her nursing license and entered an

outpatient treatment program. That happened as part of a stipulated

agreement with the board.

Two years later Overton was “clean and sober,” according to board

records, and her license was reinstated. Providence rehired her as a

registered nurse in February 2000.

But just five months later, in July 2000, Overton stole 29

controlled substances from Providence over a period of about four

weeks, according to a later board order.

Overton admitted to board investigators that she took and used the

drugs, according to the order.

Providence fired her, according to Overton’s confession to police.

Yet even then, the Board of Nursing did not suspend or revoke Overton’s

nursing license. She was given another chance: She could keep working

while on probationary status that required she be excluded from contact

with narcotics while on the job, according to a board order.

Relapsing, stealing drugs and being fired from Providence again did

not keep Overton from finding another job. She followed the path of

many troubled nurses after they’ve been fired from hospitals — she went

back to work at nursing facilities.

In January 2002, Overton was terminated from her job at Mountain

View Rehabilitation and Living Center in Oregon City for “theft of

narcotics and falsification of records,” according to an Oregon

Department of Human Services report. Sometime in 2002 she moved on to

Cascade Terrace in Portland, where her behavior worsened.

At Cascade Terrace, Overton was caring for an elderly woman dying of

cancer.

The woman was attached to a device that allowed her to

self-administer morphine for pain relief by pushing on a bedside

button. Overton stole the woman’s morphine from the pump in two

syringes, according to her confession to police. The patient’s family,

however, became suspicious because Cascade Terrace’s medications

records appeared inconsistent with the amount the patient was actually

receiving, according to a Department of Human Services investigation.

Eventually Portland police were called in, and Overton was charged

with possession of a controlled substance, criminal mistreatment and

theft. She entered a drug diversion program, and the charges apparently

were dismissed.

The board accepted Overton’s voluntary surrender of her license in

August 2002.

Judy McFarlane, the Portland police officer who arrested Overton,

questions whom the Board of Nursing thought it was helping when it

allowed Overton to continue nursing after each relapse.

McFarlane interviewed Overton at length after her arrest. Overton,

McFarlane said, admitted her addiction and the thefts she had

committed.

“It’s obvious to me that the monitoring program was not working and

she was asking for help. She knew she had a problem,” McFarlane said.

“Obviously, her being able to work in that field wasn’t helping her,

and it sure as hell wasn’t helping her patients.

“I wouldn’t be so concerned if I saw the monitoring program

working,” McFarlane said. “But I wasn’t seeing that. They (the board)

protect their own. But it’s not really protecting them.”

McFarlane took her concerns to board administrators, but she said

she came away from a meeting with them having gained new insight into

another problem that had been puzzling her — why the board was not

referring cases to the police so they could pursue criminal charges.

“I was led to believe (from board officials) that if the police

found out about it they aren’t able to offer the monitoring program,

and they want to be able to always offer this monitoring program,” she

said. “If they found out about a case first, they did not let the

police know about it.”

In an e-mail, board officials said they knew of no one “currently on

staff” who told McFarlane that the board could not offer a nurse the

monitoring program if police knew about the case.

 

Board: Program is successful

 

The idea of a confidential program that allows nurses to continue

working while undergoing drug diversion is not unique to the Oregon

State Board of Nursing. Many states have similar programs, as do other

Oregon licensing boards such as those for pharmacists, dentists and

doctors.

A recent study in The Journal of the American Medical Association

looked at health professionals enrolled in drug diversion programs and

found the relapse rate to be about 25 percent. And another study found

that nurses who steal drugs while on the job usually take those drugs

while working.

Board officials say the board’s program has a 78 percent success

rate, but they consider nurses still active in the program — even those

who are relapsing — to be part of that success rate.

The board’s own statistics show that of the 968 nurses who have

participated in the Nurse Monitoring Program since its inception in

1991, 414 — or 42 percent — have completed the five-year program.

Twenty-five nurses have died from addiction-related causes while in

the program.

Currently, 299 Oregon nurses are enrolled in the Nurse Monitoring

Program.

But aside from how successful the treatment programs are, critics

worry about the secrecy surrounding Oregon’s program.

The confidential nature of the program can make it difficult for

even well-intentioned, vigilant hospitals to know when a nurse is a

safe hire or not.

Even though Overton stole drugs from facilities where she worked, as

long as she was enrolled in the monitoring program, her record remained

clean — until her two-year suspension for failing the program. Even

after criminal convictions for job-related drug theft, nurses in the

monitoring program have retained completely spotless records.

 

Is ‘confidential’ a cop-out?

 

The Board of Nursing would not reveal if Overton was forced to take

time off after each of her relapses, or for how long. That is part of

the monitoring program’s confidentiality, board officials said.

But Rodney Hopkinson, assistant attorney general for the Oregon

Department of Justice Medicaid Fraud Unit, has investigated other

nurses who were in the monitoring program, and said he thinks the board

may be hiding behind its cloak of confidentiality.

One of the nurses Hopkinson investigated — Tami Monroe Gonroff — was

found to be working without any contact with a monitoring program

supervisor for five months.

“Does the Nurse Monitoring Program have teeth in its monitoring?”

Hopkinson asked. “It has a place. But at least, with other public

programs for drug diversions, there’s transparency. There’s monitoring

the program itself.”

In the Monroe Gonroff case, the nurse signed a release so Hopkinson

could obtain her nurse monitoring records from the board. But the board

refused, until ordered by a judge, to turn over the records.

“We saw gaps in the actual monitoring, and it raises questions. Is

that why they don’t want to release (monitoring program records) when

the nurse says it’s OK to release? The agency itself is still saying,

‘We don’t want you to see what we’ve been doing.’ Well, maybe it’s what

they haven’t been doing,” Hopkinson said.

Board officials’ response, in their e-mail: “The nurse monitoring

program is as transparent as the law allows.” According to the board,

Oregon state law requires that all monitoring program records be kept

confidential.

Drug addiction was at the heart of Lisa Overton’s failure as a

nurse, and it is a common theme among a great number of the

disciplinary cases the nursing board hears each year.

“It is without a doubt the biggest issue we face,” said Board of

Nursing Executive Director Joan Bouchard, also a registered nurse.

Bouchard thinks the nationwide nurse shortage is partially

responsible for the rise in drug and alcohol abuse among nurses,

putting extra stress on working nurses trying to do more with less

help. About half the 759 complaints the board investigated last year

involved chemical dependency.

 

Supervision is lacking

 

Overton had the key to the medication box at Cascade Terrace, even

though her probation forbid contact with narcotics. But that is not

surprising.

Registered nurses such as Overton, working at nursing facilities

predominantly among nursing assistants, are more likely to be

supervisors than supervised, say nursing and medical officials.

Oregon has among the lowest standards for nursing-home staffing in

the country. State law requires only one registered nurse on day shift

and one licensed practical nurse in the evening as long as there is no

less than one nurse hour per resident per week.

“I don’t know how somebody could be engaged in recovery in these

situations that aren’t really supervised,” said Albers, the former

Adult Protective Services investigator. “It’s like you’re a drunk, but

we’re going to allow you to work at your job in the bar. But you can’t

drink any of the liquor. But it’s right there in front of you.”

Three years ago, shortly before the board of nursing accepted the

surrender of her nursing license, Overton said in her confession: “I’m

an addict. I never should have become a nurse.”

Two weeks ago, the Board of Nursing, concluding in a board order

that Overton has been abstinent from addictive substances since 2003,

reinstated her nursing license.

 

 

 

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private power to a point where it becomes stronger than their democratic State

itself. That, in its essence, is Fascism - ownership of government by an

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