Ain't this a kicker? Drug Crackdown Said to Leave Nursing Home Patients in Pain - NYTimes.com

A Senate panel will hear complaints on Wednesday from nursing home operators, doctors, nurses and pharmacists that a Drug Enforcement Administration narcotics crackdown has left seriously ill patients crying for pain relief.

The D.E.A. says it is merely enforcing the law that requires pharmacies to wait for prescriptions that are signed by physicians before dispensing potent painkillers like Vicodin, Percocet and morphine.

But the nursing home groups say the new enforcement rules upend many years of practice in which the government informally allowed nurses to speed the process by taking doctors’ orders orally, or from medical charts, and passing them along to pharmacies, similar to the procedures used in hospitals.

Now many of the nation’s nursing homes report delays of a day or more in getting pain drugs to patients, according to the Quality Care Coalition for Patients in Pain, a group set up by nursing home operators, pharmacists and nursing groups.

The delays “leave vulnerable, frail patients to struggle through unimaginable pain for hours and even days, while physicians, nurses and pharmacists struggle to collect required D.E.A. paperwork,” the group says in a report to be released on Wednesday to coincide with the hearing.

The hearing, by the Senate Special Committee on Aging, whose chairman is the Wisconsin Democrat Herb Kohl, has been titled “The War on Drugs Meets the War on Pain: Nursing Home Patients Caught in the Crossfire.”

Nearly two million people live in the nation’s 16,000 nursing homes, the Census Bureau says. Surveys show pain management is an issue for 40 to 85 percent of them, and Medicare says they often need more pain relief.

Since last year, though, the D.E.A. has tried to crack down on the nurses’ shortcut and taken action against some pharmacies in Ohio, Michigan, Wisconsin and Virginia that the agency accused of dispensing painkillers without having prescriptions in hand.

Industry officials say the D.E.A. enforcement arose from a case in Ohio last year where a doctor complained about a nurse’s giving an opiate to a dying patient without the doctor’s knowledge and permission.

D.E.A. officials declined interview requests, saying it would be inappropriate before the hearing.

But advance testimony from Joseph T. Rannazzisi, a deputy assistant commissioner of the D.E.A., obtained from the Senate aging committee, cited the law’s requirement that physicians deliver or fax prescriptions to pharmacies before drugs are dispensed. In emergencies, he added, doctors can phone pharmacies and sign prescriptions later.

“This system of checks and balances helps combat diversion, but also protects the patient,” Mr. Rannazzisi said in the testimony.

But nursing home operators and nurses say strict enforcement of the paperwork rules slows the delivery of drugs to patients, without doing anything to combat illegal diversion of drugs. If someone is intent on diverting drugs, they say, it can be done with or without a prescription.

Bonnie J. Zabel, a registered nurse and administrator at Marquardt Memorial Manor in Watertown, Wis., said the D.E.A. should recognize the circumstances of nursing home staffing.

“In the hospital, the R.N. is considered the agent of the physician, but not in the nursing home,” Ms. Zabel said in a telephone interview on Tuesday. “Yet in the nursing home, the R.N. really is the agent of the physician because the physician is here only once a month.”

Many nursing home doctors don’t have office staff or even a fax machine, their trade group says. And hospital doctors can be hard to track down quickly.

“We’re taking nursing staff away from the patients’ bedside to do all this falderal to make the D.E.A. happy,” Ms. Zabel said.