Norton Sound Health Corp. alleges doctor over-prescribed opioids
After a year of internal and external investigations involving the regional Norton Sound Health Corporation and a longtime doctor, two conflicting tales emerge that try to shed light on a doctor, the system and opioid abuse by patients.
According to a NSHC press release, which was posted on its website and made public on the NSHC Facebook page in June, Alaska State Troopers notified hospital administration in July 2016 that several patients of a certain provider at NSHC abused their prescriptions for other purposes than managing their own pain.
Investigator Garrett Frost with the Western Alaska Alcohol and Narcotics Team investigated patients whom he suspected of selling their medications.
Frost said he did not investigate the doctor, but advised administration of the patients’ misuse. Frost was not specific with the number, but said he suspected between two and six patients selling their medications. The names of the suspects have not been revealed.
The hospital’s press release did not identify the medical provider’s name, but it was confirmed by two independent sources, including the accused doctor herself, Dr. Karen O’Neill, that she meets the description. O’Neill was placed on leave without pay in October 2016 and was terminated in February 2017, according to O’Neill.
She has worked at NSHC since 1975 as staff physician, the Assistant Medical Director, Medical Director of Village Health Services, Medical Director of the Health Aide training program, Director of the Nome Ambulance and Medical Director of Medevac Services.
According to the press release issued by NSHC, the health corporation began an internal investigation last year. “As the internal investigation progressed, it became very clear that an excessive amount of opioid narcotics were being prescribed to a group of NSHC patients,” the press release reads. It continues that the provider was asked to “voluntarily surrender their DEA controlled substance prescribing ability” and that the provider complied with the request.
Dr. O’Neill said that this statement is not entirely accurate. “They asked me to stop prescribing pain medications to chronic pain patients, which I did,” O’Neill said. “But I did not give up my DEA license, which is different.”
She explained the time line of events from her perspective. “Last summer, I was advised that anywhere between three and six of my patients had diverted or misused their prescriptions and had them filled in Anchorage, I don’t know how, if they made copies of them, I’m not sure,” she said. “I was in Maine on vacation. So, I right away called the DEA to let them know and I never heard back from the DEA again and I still have my DEA license.”
O’Neill added that she has not been contacted by the Alaska State Troopers, nor the Nome Police Department for questioning. According to the press release, the Alaska State Medical Board has also begun an investigation.
Chief Investigator Angela Birt with the Division of professional licensing at the Alaska Department of Commerce, Community and Economic Development told The Nome Nugget in a phone conversation and by email that an “inquiry” about Dr. O’Neill has begun, but declined to comment further on the case. “We are not able to discuss ongoing inquiries because the partial information could change before the final outcome is known and to share unverified allegations can damage professionals standing in a community, particularly one as small as Nome,” Birt said.
She commented on the process, that she is working in concert with a number of other agencies to explore the allegations in the Norton Sound Health Center’s press release. “We share and exchange information with other state agencies, the hospital itself and law enforcement so as to maximize the materials the Board considers without increasing cost by repeating tasks already completed by another agency,” she said. If any license actions are taken by the board, they will make them public, she said. Dr. O’Neill said she had been contacted by the board once via a letter of inquiry. To date, her medical license is unencumbered.
NSHC declined to name the outside entity that conducted the internal investigation but said it is “a law firm that specializes in hospital legal matters out of Seattle.” NSHC said that the internal investigation spanned a time period over several months and that “many witnesses were questioned, including the provider who was given a full opportunity to give their side of the story.” O’Neill said she was interviewed by the lawyers with Dr. Head present.
O’Neill said the lawyers asked a lot of specific questions, relating to copies of records they had in front of them. “I didn’t have any copies, they would ask about specific prescriptions on a specific day and sometimes I could answer the question, sometimes I couldn’t,” she said.
Answers to follow up questions to NSHC were emailed via the corporation’s spokesperson to the Nugget. NSHC declined to reveal what the full report concluded, but instead pointed to the electronic medical record keeping methods that made tracking possible. “We cannot disclose the full report. We can say that the problem was identified and tracked as a direct result of the new electronic health record, Cerner,” NSHC responded.
When asked of the definition of opioid diversion, NSHC responded, “There was evidence that a provider was prescribing narcotics in such a way that did not meet DEA regulations and guidelines for being medically necessary.”
However, O’Neill defined opioid diversion as something “that would be a patient getting a prescription for a narcotic and not taking it as prescribed for their own problem but selling them or giving them away or doing something else with them.”
O’Neill explained the realities of pain management possibilities in Nome. “Our ability for pain management is limited in Nome,” she said.
“For one, we don’t have resources like an MRI and other things that a patient may benefit from.” O’Neill said she estimates that about 200 patients in the Norton Sound region are suffering from chronic pain and that she was treating 75 percent of those patients. She said that it takes at least a year to be seen at the Alaska Native Medical Center’s pain management clinic and that it takes six months to a year to get a MRI appointment.
Another option are private practice pain management clinics but those don’t take Medicaid patients and they, too, have long waiting lists. O’Neill said options here in Nome included to send patients to the Tribal Healer program if the pain was muscular, to the Physical Therapy program, she also first tried non-steroidal pain meds and adjunct medications that are not opioids.
“We ask patients how much pain they can tolerate, we don’t offer them the possibility of being pain free,” she said. Most people like to be pain free but that doesn’t always happen. We try first non-opioid medications if that doesn’t work we start with low doses and work up over time,” she said.
O’Neill said she drafted pain contracts with her patients, advising them that the amount of medication given would need to increase over time as the patient’s body would become tolerant of it. “We advised them all the time that their body would become addicted to it,” she said.
She said she did not take lightly the task of managing people’s pain. She said she’s been working as a doctor for NSHC since 1975. “I took care of patients that were in pain for a long time, so yes, they became addicted, I can’t argue with that,” she said. “We were unable to find any other way to help them manage their pain. I think, if you don’t live with pain every day you don’t realize how bad it can be. How much it incapacitates you, impacts your entire life, takes the joy out of your life, it affects your relationship with other people, it affects your sleep, your joy of living. I know a couple of people in Nome who committed suicide because of chronic pain, because they couldn’t get relief,” she said.
In February, O’Neill’s contract that had lapsed since the prior year was not renewed. The NSHC press release states “the decision that each Board member supported to not renew the contract of the provider in question was not predicated on any external investigation. This decision was based on NSHC internal investigation and the overwhelming evidence contained therein.” According to Dr. O’Neill she has not seen the full report and cannot comment on its findings. She said she has not had the chance to address the board of directors.
Repeated inquiries by phone and email by the Nome Nugget to the federal Department of Health and Human Services and the Medicaid Fraud Unit remained unanswered by deadline. It remains unclear who the target of the Medicaid Fraud Unit investigation is, given that O’Neill did not perform billing duties.