WASHINGTON - U.S. Sen. Herb Kohl (D-Wis.) today pressed U.S. Attorney General Eric H. Holder Jr. on eliminating pain medication delays for nursing home residents.
"I am very much aware that you appreciate the gravity of the problem we are seeking to address, and I appreciate your personal attention to it over the past year," Kohl said to Holder during a Senate Judiciary Committee hearing today. "But the longer this remains unresolved the more nursing home residents will continue to suffer. So I'd like to know that we have your continued commitment to work with us to reach a mutually-agreeable solution."
Kohl explained that for nearly two years he has been working with the Drug Enforcement Agency (DEA) and industry stakeholders on legislation to allow nursing home residents access to medically necessary drugs they need to manage crippling pain.
Holder said that he remains committed to working with Kohl on the issue, and added that he hopes to help resolve the issue by year's end.
Last year, Kohl introduced the Nursing Home Resident Pain Relief Act to address the unintended consequences of the U.S. Drug Enforcement Administration's (DEA) heightened scrutiny of pain medication prescribing practices in nursing homes across America. As a result of the DEA policy, vulnerable patients are sometimes left to languish in pain as physicians and nursing home nurses strive to adhere to the Controlled Substances Act (CSA).
"We have reached agreement on most of the bill, but there are a few outstanding differences between industry and the DEA that we continue to work through, specifically related to the penalties nursing homes would face for minor technical errors," Kohl said.
Under Kohl's bill, a physician may authorize the administrator of the long-term care facility to designate nurses to act as facility designees. On a physician's oral instruction, these facility designees may order and administer pain-relieving controlled substances to residents whose medical conditions warrant immediate pain relief. The bill also requires written records documenting each step in the process, and provides penalties for diverting drugs or refusing to adhere to required recordkeeping requirements.
In 2010, Kohl held a Senate Special Committee on Aging hearing to call attention to the unintended consequences of DEA's heightened scrutiny of prescribing practices in long-term care settings.
Historically, nurses routinely called urgently needed prescriptions into pharmacies upon a physician's order over the phone. Pharmacies would fill the order; residents would get their pain medication; and, physicians would follow up with written confirmation of the prescription. However, to comply with the CSA, DEA has moved to enforce requirements that physicians directly issue prescriptions in writing for all pain medications before they can be dispensed, even in emergency circumstances.
Kohl's legislation would amend the CSA, to provide nursing homes with direct statutory authority to allow designated nurses to transmit prescriptions for Schedule II controlled substances, the category under which nearly all pain medications fall.