Washington, DC – The American Health Care Association (AHCA) has endorsed a recent report from the Mayday Fund that calls on government agencies, Congress, and the medical community to address chronic pain as a public health crisis. The report, A Call to Revolutionize Chronic Pain Care in America: An Opportunity in Health Care Reform, is based on the findings of a national panel of experts in adult and pediatric pain, which was convened by the Mayday Fund and which included AHCA. The report from the Mayday Fund’s Special Committee on Pain & the Practice of Medicine observes that pain is “among the most serious of public health concerns,” and laments that “chronic pain has been largely left out of the current national debate on health reform.”
One of the report’s recommendations is of particular interest to the long term care profession and calls on federal, state, and local agencies to adopt a more balanced approach in terms of regulation of controlled prescription drugs. The recommendation notes, “Research has shown that state laws continue to harbor requirements that are outdated or reflect poor medical practice,” and that “A balance must be achieved between the legitimate need to protect public safety and public health through efforts to reduce drug abuse and diversion, and the imperative to address the public health problem of unrelieved pain… including access to medications required for legitimate pain management.”
“A direct parallel can be drawn from this recommendation to the current circumstances facing long term care patients and providers due to stepped up efforts by the Drug Enforcement Administration (DEA) to enforce the tough restrictions on distribution of pain medication contained in the Controlled Substances Act,” remarked AHCA Senior Director of Clinical Services Sandra Fitzler, RN, who served on the Special Committee. “In fact,” continued Fitzler, “Senators Herb Kohl (D-WI) and Sheldon Whitehouse (D-RI), who share our concern that the DEA’s efforts could negatively impact patient care, have contacted U.S. Attorney General Eric Holder, Jr. to discuss the issue.”
Central to this issue is the fact that doctors treating nursing home patients, including terminally ill hospice patients who require narcotic drugs to relieve acute pain, are not always on site at the facility. These physicians often will issue verbal orders to nurses, who routinely document physician orders and act as “agents of the prescriber” in accordance with their nursing licenses and guidelines from the Centers for Medicare & Medicaid Services (CMS). Although medically appropriate, the DEA views such practice as discordant to its strict interpretation of the Controlled Substances Act because the DEA does not recognize the clinical authority of these nurses in terms of ordering controlled or narcotic drugs. In fact, a doctor’s or nurse practitioner’s order to the long term care nurse administering narcotic pain drugs – even in emergency situations – would not be considered a “valid” prescription order according to the DEA, which requires prescribers to communicate directly with pharmacists. Fitzler explained, “For long term care or hospice patients, this extra step could delay much needed pain medications and cause unnecessary suffering, especially for frail, elderly patients who are in acute pain. For long term care facilities caring for such patients, this extra step could jeopardize care quality by interfering with the provision of timely, adequate pain relief. And failure to provide timely, adequate pain relief would have a ripple effect that could lead to serious penalties and fines for the skilled nursing facility.”
In addition to the support from Senators Kohl and Whitehouse, AHCA is pleased to note that the American Medical Association (AMA) has weighed in on the DEA issue, recently passing a resolution by unanimous consent that calls on the DEA to recognize the prescriber-nurse agency relationship in long term care.
There are other examples of outdated policies or government regulations at odds with current medical practice. Each example makes the Mayday Fund report all the more relevant, especially its conclusion that, “Reducing the burden of uncontrolled chronic pain is a societal necessity, a medical challenge and an economic requirement.”
AHCA is proud to join 30 other health organizations such as the American Academy of Pediatrics, American College of Emergency Physicians, American Nurses Association, American Society of Consultant Pharmacists, Association of Professional Chaplains, National Association of Social Workers, The Joint Commission, and The National Hospice and Palliative Care Organization in endorsing this report.
To view the full report, A Call to Revolutionize Chronic Pain Care in America: An Opportunity in Health Care Reform, please visit www.maydaypainreport.org.
As the nation’s largest association of long term and post-acute care providers, the American Health Care Association (AHCA) advocates for quality care and services for frail, elderly and disabled Americans. Compassionate and caring employees provide essential care to one million individuals in our 11,000 not-for-profit and proprietary member facilities.