I-Team In-Depth

Nurses’ Drug Abuse Top Cause Of Disciplining, But Once Sober, Some Nurses Get Relicensed

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Out of work and addicted to the anti-anxiety medication Klonopin, Heather Delaney, a licensed practical nurse from Stratford, checked herself into Bridgeport Hospital in 2011 when she could no longer handle withdrawal without medical help. After a brief hospitalization following a suicide attempt the previous fall, Delaney spent two horrific months on her own in the throes of withdrawal. The corners of her eyes felt “chapped,” and “it felt like somebody had wrapped me up in a scratchy blanket of needles,” said Delaney, who had given up her nursing license after being caught altering her Klonopin prescription. Sara Kaiser, an LPN living in Manchester, stole morphine from the nursing homes where she worked and was addicted to heroin from age 18 to 24. She spent time homeless and in prison, ultimately going through 14 rehab programs before getting sober in 2010.

I-Team In-Depth

Desperate Choices: Giving Up Custody For Care

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Ten years have gone by, but Lisa Vincent and her son, Jose, flash back to their goodbye with fresh anguish and faltering voices. He is 21 now, but the 11-year-old boy he was back then easily re-surfaces, all anger and confusion. “I didn’t understand. I was under the assumption I was going back to her,” Jose says. “For a long time, I felt that whole ‘she gave up on me like everyone else did.’ Now, I realize it wasn’t her.

I-Team In-Depth

Derby Pain Clinic’s High Prescribing Of Cancer Drug Extends Beyond Nurse

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Four nurses, all of them affiliated with a Derby pain clinic, were responsible for nearly all of the state’s 2014 Medicare spending on the powerful opioid painkiller Subsys, which is at the center of a kickback probe. New Medicare data for 2014 show the four nurses, all who worked at the Comprehensive Pain and Headache Treatment Center of Derby, were responsible for 279 claims for Subsys, at a cost of $2.3 million. The highest prescriber was Heather Alfonso, an advanced practice registered nurse (APRN) formerly employed by the clinic who is awaiting sentencing on charges she took kickbacks from Arizona-based Insys Therapeutics for dispensing Subsys to patients. The new data is the first indication that the propensity to prescribe Subsys extended beyond Alfonso, to other clinic staff. None of the other three nurses has been implicated in an ongoing federal probe of Insys’ marketing of Subsys that resulted in the criminal charges against Alfonso.

Fines & Sanctions

Highest Prescribers Of Cancer Drug Paid As Speakers

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Eight of the top 10 prescribers of a potent narcotic used for cancer pain were paid more than $870,000 in speaking fees by the drug maker in 2013 and 2014 — indicating that Derby nurse Heather Alfonso was not the only high prescriber compensated by the company. Alfonso, an advanced practice registered nurse (APRN) who worked at the Comprehensive Pain and Headache Treatment Center in Derby, pleaded guilty last month to accepting $83,000 in kickbacks from 2013 to March 2015 from the drug company Insys Therapeutics, which has heavily marketed a painkiller called Subsys, a sublingual fentanyl spray approved only for cancer patients. Alfonso was paid to speak about Subsys at more than 70 “dinner programs,” but most of those programs were attended only by her and a sales representative for Insys, or by Alfonso’s colleagues and friends who had no authority to prescribe the drug, according to the U.S. Attorney’s Office for Connecticut. Alfonso faces a maximum prison term of five years and a fine of up to $250,000 on the charge of receiving kickbacks in connection with a federal healthcare program. In pleading guilty, she admitted that the money she was paid influenced her prescribing of Subsys, often to non-cancer patients, federal investigators said.

I-Team In-Depth

Handful Of High Prescribers Boost Medicare Spending, New Data Show

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Ten Connecticut prescribers, including a Derby nurse practitioner who is under investigation by the state, were responsible for more than 22 percent of the state’s Medicare spending on potent narcotics in 2013, new federal data show. More than 4,300 Connecticut clinicians, mostly physicians, wrote Medicare prescriptions for oxycodone, morphine and other Schedule II drugs, which have a high potential for abuse and addiction, at a total cost of $40 million. But a handful of those providers accounted for the largest share of those prescriptions, an analysis of the data show. Topping the list, in both the number of prescriptions and cost, was Heather Alfonso, an advanced practice registered nurse (APRN) at the Comprehensive Pain & Headache Treatment Centers, LLC, in Derby, who wrote out 8,523 prescriptions, at a cost of $2.7 million. Statewide, the average number of prescriptions per clinician was 104, and no other prescriber had more than 5,000 Schedule II claims. The average cost per prescriber was $9,138; the next closest individual cost was $1.8 million.

I-Team In-Depth

Long ER Stays For Kids In Crisis On The Rise

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Just a few years ago, it was rare that children with mental health problems would spend two or more nights in the emergency room at Connecticut Children’s Medical Center. Only 40 children stayed that long in 2010. So far this year, more than 250 children have spent multiple nights in the emergency department (ED) – a number expected to reach 500 by the end of the year. As policy makers work to finalize a statewide children’s behavioral health plan, a report by the hospital, obtained by C-HIT, projects that children with mental health problems will spend a total of 3,085 nights in the ED – more than triple the number in 2010. The average stay is about 15 hours, with some children remaining in the ED for 10 days or more.

Fines & Sanctions

State’s Child Care Oversight: Minimal Monitoring, Lax Enforcement

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On its website, the Tumble Bugs Day School in Norwalk boasts a “highly experienced, nurturing” staff who serve infants and toddlers in a “stimulating setting.”

But a review of state Department of Public Health records shows the child care center has had numerous complaints and citations in recent years for lapses in supervision that have injured and traumatized young children. In 2010, the center failed to notify parents when a balancing board fell on a toddler. The same year, DPH cited the center for failing to take action against a staff member who restrained a toddler on a cot by “holding down his head and body” and then falsely reported that a scratch on the boy’s face was an accident. Then, in 2011, two children came forward to report that a preschool teacher had sexually abused them during naptime – an allegation that led to the April 2012 arrest of a 44-year-old Harold Meyers, who worked at the center in 2008 and 2009. DPH investigated the case last year, but determined that the center had made oversight changes and that no further action was needed.

I-Team In-Depth

Long ER Waits: Half Of CT Hospitals Over National Average Of 28 Minutes

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In more than half of Connecticut’s emergency rooms, the waiting time to see a health-care provider exceeds the national average of 28 minutes – a problem that experts say could get worse, as thousands more residents obtain health insurance. The average wait can stretch to an hour or more at Rockville General, Manchester Memorial, Bridgeport, Waterbury and Hartford hospitals, according to a C-HIT review of federal data. The statewide average waiting time is 30 minutes. The longest wait time is at Hartford Hospital, where patients were not seen for 82 minutes, on average; the shortest wait of 14 minutes is at Windham Hospital, the data compiled by the Centers for Medicare & Medicaid Services (CMS) through 2012 show. Officials at Hartford and Bridgeport hospitals claim shorter wait times than the federal data.

Arnold Giammarco

Veterans Expelled From U.S. For Minor Crimes Fight Deportations

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After honorable discharges from the Army in 1979, and the National Guard in 1983, Arnold Giammarco sunk into a pattern of substance abuse, shoplifting and jail before turning his life around, marrying in 2010, and becoming a father. But the Italian-born Giammarco, 57 – one of thousands of legal residents who serve in the U.S. military, despite lacking citizenship – now counts the days away from his family in Sulmona, Italy, after immigration authorities abruptly took him from his Groton home to a detention facility in May 2011 and deported him to Italy last November.  Today, (Nov. 12) Giammarco filed a lawsuit to compel the government to rule on his 1982 citizenship application, which he says was never processed. Mark A. Reid of New Haven, 49, spent six years in the Army Reserve before his honorable discharge in 1990 and still speaks about being “willing to die for this country.” Now he sits in a Massachusetts jail, facing deportation to his native Jamaica because of four drug convictions including sale of narcotics and possession of heroin.  Last November, immigration officers moved Reid – who came to the U.S. at age 14 — to Immigration Custody from the Brooklyn, CT jail where he was serving time for what he described as “a $30 drug sale.’’

The two men are among what veterans’ advocates say is a growing number of noncitizen military veterans who are being deported for crimes for which they served time years earlier. Giammarco moved to the U.S. at age 4.

I-Team In-Depth

Brand-name Drug Choices Drive State’s High Medicare Costs

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Connecticut seniors on Medicare are more likely to take sedatives for insomnia and medications for depression than their counterparts across the country, according to a new report by Dartmouth researchers. An analysis of state data in a national report by the Dartmouth Atlas Project also shows that Connecticut’s Medicare program relies heavily on brand-name drugs, versus generics, especially in wealthy towns in Fairfield County – a factor that could be contributing to the state’s ranking in the top 10 nationally in prescription drug spending per patient. Connecticut seniors spent an average of $2,795 on medications in 2010 – 45 percent higher than the lowest-spending state, Minnesota, and the highest rate in New England. The new report provides an in-depth look at how prescription drugs are used by Medicare beneficiaries, age 65 and older, in the program’s Part D drug benefit, which had 37 million enrollees in 2012. It shows wide variations in the use of both effective and risky drugs among the 306 regional health care markets across the U.S.

While the underlying health status of populations is a factor in prescription drug use, “it really does not explain the variations in drug use intensity that we observed,” said Dr. Nancy Morden, a lead author of the study.