Chronic pain: Fatal practice
ALAMOSA — After conducting an investigation that revealed thousands of controlled substance prescriptions written within a year’s time — including prescriptions for the “holy trinity” of drugs — and the deaths of three patients related to drug intoxication, on March 8 the State Board of Nursing under Program Director Sam Delp issued a summary suspension of the professional nursing license of Alamosa nurse practitioner Debra Rice, R.N., A.P.N., R.X.N., practicing at SoCo Medical Services in Alamosa.
Rice had been licensed and granted prescriptive authority since 2008.
As part of her practice, Rice wrote prescriptions for controlled substances including narcotic pain medications, benzodiazepines, and muscle relaxers. According to the State Board of Nursing between January 1 and May 23 of 2016 Rice wrote more than 2,400 prescriptions for controlled substances, including oxycodone/acetaminophen, Diazepam, Methadone, Oxycodone (10 mg, 16 mg and 20 mg) and Tramadol.
From January 1, 2016 through February 25, 2017, Rice wrote more than 7,000 prescriptions for controlled substances including Oxycodone/Acetaminophen, diazepam, methadone, oxycodone (10 mg, 15 mg and 20 mg), morphine and tramadol, according to the state board.
The state board added that several of Rice’s patients on the same day received prescriptions for the "holy trinity" (an opioid, benzodiazepines and carisoprodol), “a cocktail of drugs known to be used for the euphoric effect of this combination and not for legitimate medical purposes.”
The state board stated that reviewing Rice’s controlled substances prescribing from January 1, 2016 through February 25, 2017, “indicates that respondent's [Rice’s] prescription practices are not consistent with safe dosing of narcotics, including safe tapering for withdrawal. In addition, medications are prescribed in excessive amounts and in combinations that are not consistent with tapering.”
The board found that numerous patients including some from the Denver area would drive to Alamosa to obtain prescriptions for controlled substance from Rice.
According to the state board, Rice provided care to a patient who died on February 27, 2016. The patient’s autopsy results indicated that he died of methadone intoxication. On February 22, 2016, Rice last wrote prescriptions for this patient for 90 10 mg dextro-amphetamine, 180 10 mg methadone, 90 10mg oxycodone and 60 5 mg. The patient's toxicology screen at the time of death was positive for amphetamine, methadone, methamphetamine, opiates, B·Acetylmorphine, morphine, codeine, methadone metabolite, continine, naproxen, and ibuprofen metabolites, according to the state board.
Another patient of Rice’s died on May 24 of 2016. That patient’s autopsy results indicated that he died of mixed drug intoxication, according to the state board. On January 11, 2016, Rice last wrote prescriptions for this patient for 120 10 mg methadone, 120 15mg Oxycodone and two prescriptions for 30 5mg Diazepam (one filled on Jan. 21, 2016 and one filled on Feb. 9, 2016). Additionally, on May 19, 2016, another provider working with Rice at SoCo Medical Services wrote prescriptions for this patient for 120 15 mg Oxycodone and 60 5mg Diazepam. The patient’s toxicology screen at the time of death was positive for amphetamine, methadone, methamphetamine, opiates, 6·Acetylmorphine, morphine, codeine, methadone metabolite, continine, naproxen, and ibuprofen metabolites, according to the state board.
A third patient of Rice’s died on July 25, 2016. The patient’s autopsy results indicated that she died of hypertensive and atherosclerotic cardiovascular disease with diabetes mellitus in the setting of drug intoxication. On May 10, 2016, Rice last wrote a prescription for this patient for 120 Oxycodone (20 mg). The patient’s toxicology screen at the time of death was positive for Methadone, diphenhydramine, mirtazapine, benzoylecgonine (cocaine metabolite) and hydrocodone, according to the state board.
“Based upon the information obtained in the board's investigation, objective and reasonable grounds exist to believe, and the board so finds, that respondent [Rice] is guilty of deliberate and willful violation of Article 88, Title 12, C.R.S., (Nurse Practice Act) and/or the public health, safety, or welfare imperatively requires emergency action.”
Rice was ordered to immediately cease practicing as a professional nurse, pending disciplinary proceedings.
Upon calling SoCo Medical Services, the following recorded message is received: “SoCo Medical Services regrets to inform you that any scheduled appointments have been cancelled. Due to unforeseen circumstances we cannot reschedule at this time. We encourage you to look for a new provider as the office will be closed until further notice. We will work with you to transfer your files to a new provider. We will send patient charts directly to the new provider. We do not have any referral information at this time … Thank you for your understanding.”
San Luis Valley Health Chief Medical Officer Dr. Gregory McAuliffe said other medical providers in the Valley have been trying to do their best to assist Rice’s former patients.
“We have seen a number of those patients, people who are addicted to opioids,” he said. “They can certainly go into an uncomfortable withdrawal, but they are not going to die from it. You don’t die from opioid withdrawal.”
However, he said, some of the other drugs prescribed at SoCo Medical Services, especially in combination, could result in a lethal withdrawal. Patients have to taper down their use, he said.
McAuliffe said providers taking on former SoCo Medical Services patients are helping them to get off of their previously prescribed medications. He stressed that these providers were not going to continue what Rice was doing, however, and patients needed to understand that.
This is part three in a series called "Chronic pain: Solutions and concerns." Click here for part one and here for part two.