PSU prescription drug dispensary limits hours for illegal nursing practices

The Portland State clinic dispensary closed on Jan. 8 because it has been operating under illegal dispensing practices off and on for at least 25 years.

The dispensary is anticipated to remain open for only temporary hours for two months or more, and some are questioning how the health center could operate for so long without knowing its operations were against Oregon State Nursing Board law.

For years the PSU Center for Student Health and Counseling (SHAC) followed the same process in the dispensary: nurses handed out medicines that were pre-approved by doctors.

“We found out two weeks ago that the Board of Nursing found that to be outside the scope of practice for an RN [registered nurse],” said Mary Beth Collins, interim director of SHAC.

Questioning the policy

Sources at the university, who asked to remain anonymous for fear of disciplinary action, said that nurses have approached health center management multiple times, questioning the legality of the center having nurses hand out prescription drug medications.

Collins denied that any nurses approached her to question the legality of the former PSU policy. The management never looked into Nursing Board law to check if there was a conflict with PSU policy, she said, because they had no reason to believe the dispensary was operating illegally.

Collins said that the first time she knew of a nurse coming forward was when one came to SHAC Assistant Director Ashley Cooley on Jan. 8, and the health center responded by temporarily suspending certain dispensary hours.

Sources assert that nurses have approached health center management over the past few years, questioning and commenting about the potential illegal operations of the SHAC dispensary. Collins said that Associate Director and Registered Nurse Sandy Franz, who was the director of the health center two years ago, has not been questioned about the legality of RNs handing out prescriptions either.

A fear of consequences

Sources said that the office environment in the entire health center has drastically declined after it became known to staff that the health center dispensary was operating against Nursing Board law. Sources also said that nurses are concerned with the possibility of receiving fines, losing their licenses or even possibly being sued because they unwittingly handed out prescriptions illegally.

Both the Oregon State Board of Nursing and the Board of Pharmacy regulate the dispensary, and both entities are investigating the issue, but Collins said the nurses will not face any consequences. She said that the university will stand by the nurses in the case of any issue.

“I really don’t think our nurses are in danger from what happened,” Collins said.

Change in guidelines may have caused the center to close

Collins said that she thinks changes to the State Board of Nursing guidelines are the reason that the health center ended up breaking Oregon statutes. Registered nurses can hand out prescriptions at family planning clinics and county health clinics under Board of Pharmacy laws, but not at clinics like SHAC.

Because of changes to the way the dispensary has been run and changes to state laws, the dispensary may have used this illegal operating method periodically for at least 25 years.

The only legal action that could be taken against PSU is through the Pharmacy Board. The Vanguard made multiple calls to the Pharmacy Board Wednesday and Thursday, but heard no response by press time. Collins said she thinks that there will not be any disciplinary action taken against the university because she said PSU did not know that it was operating under illegal methods.

The Board of Nursing is empowered to perform various disciplinary actions on nurses, such as imposing fines or suspending a nurse’s working license. But Barbara Holtry, the Nursing Board’s public information officer, said such actions are unlikely in the SHAC case.

“The Board sometimes disciplines nurses, but in this case we’re more concerned with getting the process right than with being punitive,” she said.

Students referred to other pharmacies

The SHAC dispensary immediately quit accepting new prescription orders, causing some frustration among students. Stephanie Kirmer, a graduate student in the sociology department, said she was in dismay by how the clinic handled the closure.

Kirmer said that when she attempted to fill her prescription at SHAC, she was only told that the dispensary was “in transition.” She said that no one from the dispensary referred her to any low-cost replacement pharmacies.

“I paid $35 at Walgreen’s for a prescription that cost $15 at SHAC,” she wrote in a letter to the clinic. “The secrecy SHAC has attempted to enforce about this issue is completely wrong, and … students and the whole university community should have been notified up-front and quickly of the situation when the problem arose.”

Collins said that the clinic has since begun referring students to low-cost pharmacies. Target and Wal-Mart, for instance, are currently offering $4 prescriptions of many generic drugs.

Meanwhile, the clinic’s doctors have identified 15 medications that the clinic will continue to offer during the period that the pharmacy is mostly closed, including some antibiotics and asthma medications. During this period of limited service, the dispensary will open for 15 minutes an hour so doctors can hand out the 15 medicines.

Administrators hope for quick re-opening

SHAC is looking into two different methods to re-open the dispensary, Collins said.

In the first scenario, SHAC could ask the Boards of Pharmacy and Nursing to write an exemption into their codes that would let nurses hand out the prescriptions. The Nursing Board allows no RNs to distribute prescriptions, while the Pharmacy Board has a few exceptions for RNs: the Pharmacy Board allows RNs to distribute them in family planning clinics and county health clinics, but not at a center like SHAC.

“The practice we’ve been following is almost identical to the practices of some county clinics and family planning clinics,” Collins said. “They’re written into the code of the Board of Pharmacy … one option would be to change the board rules to include us.”

But Holtry said the Board of Nursing’s code does not contain an exemption for RNs to dispense medication. (Nurse practitioners and clinical nursing specialists are allowed to do so in some cases, but regular RNs are not.)

“For registered nurses it is never permitted,” Holtry said. “Yes, they are allowed to do that under Board of Pharmacy rules … [but] under Board of Nursing code [an exemption] has not been addressed,” she said.

SHAC’s other option is to find and hire a pharmacist, transforming the dispensary into a full-blown pharmacy. But Collins said that pharmacists are in extremely high demand and that it could be tough attracting a pharmacist who will take state wages.

“Pharmacy is a very hot job right now,” she said. “I spoke with Dee Thompson at the Career Center and she said ‘Good luck finding a pharmacist.’ But maybe we can find a place-bound person who loves PSU.”

While working with the Nursing and Pharmacy Boards and trying to find a pharmacist, SHAC is also speaking with the pharmacies at Safeway and the Burnside Fred Meyer about possible price reductions for students, Collins said.

In an interview last week, Kirmer wondered if the closing of the pharmacy might not be grounds for a partial refund of the $135 student health fee.

“That’s a tricky one because the dispensary was a self-supporting part of our agency, ” Collins said. “It brought in money and funded itself, because we’d charge the cost of the medicines plus a fill fee. If we’re not selling medicine, we don’t have any money to give back.”