By Jason Millman - 12/05/10 07:13 PM EST
President Obama’s nominee to lead the Drug Enforcement Administration is being held up over a Democratic senator’s demand that the DEA allow nurses to deliver powerful painkillers to nursing home patients.
The DEA’s top spot has been vacant for more than three years, but Sen. Herb Kohl (D-Wis.) has vowed to block Michele Leonhart’s nomination unless the agency bends to his wishes.
Kohl wants the agency to work with his panel to develop guidelines that would empower nurses to write prescriptions and administer morphine, Percocet and other powerful painkillers to patients when a doctor is unavailable.
Despite the committee’s warnings that a failure to ease painkiller standards would result in a block on Leonhart’s nomination, the DEA has so far been non-responsive to the committee, said Kohl spokeswoman Ashley Glacel.
“They had plenty of warnings,” Glacel said. “Apparently, they’re not taking this seriously.”
The DEA deferred comment on the nomination to the White House.
The DEA has been without a Senate-approved leader since late 2007. The-President George W. Bush nominated Leonhart, the deputy administrator, in April 2008, but the Senate failed to confirm her before the end of Bush’s term.
President Obama submitted Leonhart’s name for nomination again in February. A failure to confirm her before the lame-duck session ends would mean that she has to go through the nomination process again.
Kohl has no problem holding up Leonhart’s nomination as long as the committee’s concerns with nursing home prescription policies remain unresolved, Glacel said.
“It doesn’t prevent her from doing her job,” Glacel said. “The point is to get [the DEA’s] attention.”
Kohl wants to change DEA rules that allow pharmacists to dispense drugs to nursing home patients only with a verbal or written prescription from a doctor. Advocates say this results in unnecessary medication delays because most nursing facilities do not have a full-time doctor on staff and may have trouble reaching a doctor at crucial moments.
A DEA crackdown last year against pharmacies that allowed nurses to place orders for painkillers without a written prescription brought new focus to the issue.
Following an Aging Committee hearing earlier this year, the DEA in early October relaxed its rules to allow nurses to call in prescriptions for certain painkillers, but the most powerful drugs must still be prescribed by doctors.
Evvie Munley, senior health policy analyst for the American Association of Homes and Services for the Aging, said the new guidelines made “very little” difference in the way nursing homes dispense drugs in emergency situations because restrictions on more powerful “Schedule II” painkillers were not eased.
“We’d characterize it as a small step forward,” Munley said.
Nursing advocates and Kohl say that any agreement must allow nurses to deliver the more powerful drugs in emergency situations.
The DEA has proposed a fix that would require each state to change DEA registration rules to treat nursing home nurses more like hospital nurses, who may phone in a prescription from doctors.
Kohl said the DEA’s position would take too long to implement.
“Every day, nursing home patients continue to suffer from agonizing pain, and we need an interim solution as soon as possible,” Kohl said earlier this week.
The senator let Leonhart’s nomination pass through his committee, but he threatened to block her confirmation in the full Senate.
Kohl sent the DEA draft legislation that would authorize specific staff positions to act as an agent of a prescribing physician that would be authorized to transmit by fax or verbal order a prescription for pain medication. However, Kohl’s spokeswoman said the committee has not heard back from the DEA about its proposal.