On May 1, Alaska Dispatch News published a below-the-fold story about how "Alaska's two providers of inpatient opiate detox services" had ceased admittance of opioid detox patients.
Firstly, there are three detox programs in Alaska, but everyone keeps forgetting about Rainforest Recovery, and I can't say I blame them.
The other programs ceased opioid admissions because it took two years to realize that the off-label use of Tramadol (a pain medication) and Zyprexa (an antipsychotic) as part of a detox protocol is outside of the scope of a physician assistant since the DEA heightened criteria in 2014.
The article closed with a state program director mentioning outpatient Suboxone as an alternative to inpatient detox. But Suboxone was also part of the changes in 2014, requiring a physician's special prescribing authority, and initially limiting numbers to 13 Suboxone patients. Maybe in 2018 the Alaska State Opioid Treatment Authority will become aware of that change, and perhaps it will again be quoted saying, "We frankly did not see this coming."
[Read it again: Alaska detox facilities suspend new admissions]
These changes were years in the making, with hundreds of chances for public comment. And because all 50 of this country's opioid treatment authorities have been briefed on them repeatedly as part of the yearly American Association for the Treatment of Opioid Dependence conferences to which states receiving federal block grants are required to send attendees, the comments from Alaska's opioid treatment authority, or the scapegoat that they put forward, are either clear indication of the Department of Health and Social Services' dishonesty, or clear stupidity and borderline criminal negligence of federal law.
I was left speechless when I read the follow-up of May 2, where Perry Ahsogeak of Fairbanks Native Association was quoted saying, "There are changes all the time, and everything goes through a review process. We found the issue and we're trying to address the issue."
[The follow-up: Programs say detox shutdown could end in May]
Yes, Perry is right; there are changes all the time; there is also a moral and professional expectation that we who have committed our lives to the vocation of health care are competent and attentive enough to find and correct issues this grave in a period of time shorter than two years. Also is the expectation that the checks and balances of health care engage seamlessly to prevent such travesties.
Let's break this scenario down — for two years: 1) Two detox programs were employing protocols out of compliance with DEA prescribing regulations; 2) Two different physician assistants were writing script for medications outside of their scope; 3) Two physicians were allowing PAs to operate under their medical license while in continued violation of prescribing authority, and arguably culpable to the violations made by these PAs; 4) An untold number of nurses were administering medications improperly prescribed; 5) An unknown number of pharmacies were dispensing medications that should not have been filled; and 6) The quality assurance and compliance processes of these programs, the providers of said programs, the administers of medications, the pharmacies, the Alaska Department of Health responsible for regulating these programs, and the accrediting bodies that have reviewed these programs all failed to identify and correct this issue for two years.
This issue is more than just a story worthy of being below-the-fold the first day, a quick follow-up the next, then quickly forgotten. Every facet of checks and balances, quality assurance, compliance and regulatory oversight failed here for two years.
It is a miracle that this level of medical malpractice, administrative and regulatory incompetence, and break-down in oversight didn't result in the loss of life.
This story is an embarrassing disgrace to this state's Department of Health, but what should remain most alarming to all of us is that they "Frankly didn't see this coming."
Opioid treatment in Alaska should be practiced competently and to a gold standard of current national best practice.
John C. Laux is a health care consultant in Anchorage. He holds positions on the Anchorage Health and Human Services Commission, the Alaska Public Health Association, the Alaska Healthcare Executives Network, the American Public Health Association, and the editorial board of Frontiers of Health Services Management.
The views expressed here are the writer's own and are not necessarily endorsed by Alaska Dispatch News, which welcomes a broad range of viewpoints. To submit a piece for consideration, email commentary@alaskadispatch.com. Send submissions shorter than 200 words to letters@alaskadispatch.com or click here to submit via any web browser.