The Portland State student health center continued to violate state law on dispensing prescription drugs for at least a year, despite multiple questions and concerns from the health center nursing staff, nurses say.
Cyna Colombo said she first questioned a requirement for nurses to dispense prescription drugs, a violation of state law, when she was hired in November 2005. Colombo worked as a registered nurse at the health center from November 2005 until she quit last week because of the situation.
The Center for Student Health and Counseling (SHAC) had registered nurses fill, bill and hand out prescription drugs for the center’s dispensary as a part of the nurse’s regular duties, which were described in their PSU job descriptions.
It is against state Board of Nursing regulations for Oregon registered nurses to fill, bill or hand out prescription drugs. Consequently, the Board of Nursing and the state Board of Pharmacy are reviewing the dispensary’s operating procedures and are advising SHAC.
SHAC has filed documents with the pharmacy board to become a county health clinic and a family planning clinic. Being classified as one of these clinics would let the registered nurses at PSU hand out the prescription medications.
Nurses were dispensing controlled substances, or narcotics, including sleeping pills, anti-depressants and morphine, according to Colombo.
The directors of SHAC acknowledge that the nursing board’s prescription drug rules were being violated but they said they were following rules of the state Board of Medical Examiners, which allowed such activities in the center’s situation. They said they didn’t know about the nursing board’s rules.
As far as is known, no student patient has been harmed by the violations.
The dispensary closed on Jan. 8 after Colombo showed the health center management that the dispensary was operating against state law. The dispensary, which operates like a small-scale pharmacy, reopened nearly two weeks later and is currently open two hours each weekday with doctors dispensing prescription drugs.
As Colombo and other nurses raised questions about prescription drug dispensing during the year that she worked at SHAC, Colombo said Sandy Franz, associate SHAC director and a registered nurse, told her that center nurses were allowed to fill, bill and hand out the prescriptions.
Colombo said that she and other nurses asked the SHAC management for training in the dispensary during multiple staff meetings. Registered nurses, who are graduates of bachelor degree nursing programs, are not trained to work in dispensaries or pharmacies.
“I have said to her that this was outside of our scope of practice–it has to be,” Colombo said, referring to Franz. “She would essentially ignore me.”
Franz said that she had received a statement from the Board of Medical Examiners, which she says she subsequently cannot find, that said registered nurses could dispense drugs. However, the nursing board, not the Board of Medical Examiners, oversees registered nurses.
Franz said she never realized that having nurses dispense medication violated state law. Having contacted the Board of Medical Examiners and the pharmacy board, who approve some registered nurse dispensing, she said she did not think of checking whether the protocol violated nursing board regulations.
Mary-Beth Collins, director of SHAC operations, said no one in the health center management knew that it was against state law for registered nurses to dispense prescription drugs. She said the management should have investigated nursing board regulations further.
“There is a kind of grapevine effect that lets us know about important changes,” Collins said. “Relying on the grapevine didn’t work.”
Franz said she does not remember having ever been questioned about nurses dispensing prescription medications. She said she thought the process–which had a nurse count out pills, label the bottle, hand the filled prescription to a doctor for approval, and finally hand the prescription to the patient-was a common and accepted practice for registered nurses.
As of 2004, registered nurses were only allowed to dispense prescription drugs if they worked in a family planning clinic or a county health clinic. Nurse practitioners, or registered nurses with a master’s degree, are allowed to prescribe or dispense prescription drugs if they receive the correct training.
Collins said she hopes to know whether the pharmacy board approved SHAC to be a family planning or county health clinic.
Collins said that nurses only asked for more training in the dispensary. She said that neither Colombo nor any other nurse ever approached her with questions about whether they should work in the dispensary.
Nurses set up a committee to research the dispensary in 2006 because so many nurses did not know how to properly work there. As a committee member, Colombo said it was only by chance that she learned of the violations.
In mid-December 2006, another committee nurse called the Board of Nursing to clear up confusion about nursing terminology. A board representative returned the call to Colombo.
As Colombo asked the question, the representative realized that nurses in the health center were filling, billing and handing out prescription drugs. Over the next month, Colombo said she had multiple conversations with Board of Nursing representatives.
On Jan. 8, Colombo told Ashley Cooley, an assistant SHAC director, that it was against state law for registered nurses to dispense drugs. The dispensary immediately closed and then reopened with doctors handling prescriptions.
Colombo, believing that SHAC management should have known the state law, said,
“I think that all of this could have been handled differently. I think that it’s just very sad.”