High-Prescribing Nurse Surrenders Drug Licenses

A Derby nurse practitioner whose prolific prescribing of potent narcotics was the subject of a February story by C-HIT has surrendered her state and federal licenses to prescribe controlled substances and is the subject of an “open investigation” by the state health department, officials said Monday.

Heather Alfonso, an advanced practice registered nurse (APRN) at the Comprehensive Pain & Headache Treatment Centers, LLC, in Derby, surrendered her controlled substance registration after a recent probe by the Drug Control Division of the Department of Consumer Protection, a spokeswoman for the department confirmed.

“The controlled substance registration of this provider has been turned in,” said the spokeswoman, Claudette Carveth. She said the agency had no further comment.

Meanwhile, William Gerrish, a spokesman for the Department of Public Health, said his agency has an ongoing investigation into Alfonso’s APRN license, which is separate from her prescribing registration. The DPH licenses nurses and can sanction providers.

Alfonso could not be reached for comment Monday. She and Dr. Mark Thimineur, an anesthesiologist who is medical director of the privately run pain center, housed in Griffin Hospital, previously did not respond to messages seeking comment.

In testimony late last month to a Congressional committee about the state’s drug-control efforts, John Gadea, Jr., director of the Drug Control Division of the Department of Consumer Protection, disclosed that his agency, working with the DPH and the U.S. Drug Enforcement Administration (DEA), had “just completed a case against (Heather Alfonso), a midlevel practitioner, that has resulted in the surrender of federal and state controlled substance registrations. The same practitioner was recently identified as one of the top ten prescribers of controlled substances in the country.”

Gadea was referring to the Feb. 19 C-HIT story, which identified Alfonso as among the top 10 prescribers nationally of the most potent controlled substances in Medicare’s drug program in 2012 – an anomaly in a state where Medicare records show nurse practitioners rarely prescribe such Schedule II drugs, which have a high potential for addiction and abuse.

Alfonso wrote out 8,705 prescriptions for opioids and other Schedule II drugs in 2012 – the highest prescriber among all Connecticut practitioners, including pain specialists and other physicians, according to Medicare data compiled by ProPublica, a national news organization.

Alfonso wrote out more prescriptions for the opioid Exalgo than any other Medicare provider in the country, and was the seventh highest prescriber nationally of Oxycontin, writing out more than twice as many prescriptions for that narcotic as the next highest prescriber in Connecticut. She also was the 10th highest prescriber nationally of Avinza, a morphine product.

The Medicare records from 2012 – the most recent year for which data is available publicly — showed that 94 percent of Alfonso’s patients received at least one prescription for a potent Schedule II medication. Other nurse practitioners in Connecticut wrote such prescriptions rarely or not at all, according to the federal data compiled by ProPublica. Alfonso issued an average of 18 prescriptions per patient – double the average for nurse practitioners – the data show.

Asked about Alfonso’s prescribing rate, a spokeswoman at the pain center said in February, “We are a very large practice for pain management, and with our patients’ (complex) diagnoses, those are factors.”

Alfonso’s prescribing practices had come to the state’s attention last summer, when she received a reprimand and $2,000 fine from the Board of Examiners for Nursing for improper prescribing practices related to one patient. But she was allowed to continue practicing without restrictions, and there is no indication in the records that the DPH or the board had reviewed her level of prescribing.

In that case, Alfonso was cited for providing narcotic pain medications to a non-cancer patient seven times without personally examining the patient, instead “inappropriately” relying on an unlicensed assistant to examine the patient, state records say.

Thimineur had fewer Medicare prescriptions for controlled substances than Alfonso; he was the third-highest prescriber among pain medicine specialists in the state in 2012, data show. Like Alfonso, most of his prescriptions were for Schedule II drugs.

Gerrish has said the DPH and the state medical board do not monitor the prescription database, which is maintained by the consumer protection department’s Drug Control Division. Instead, health officials access the database only when there is a complaint or referral. The consumer agency is empowered to notify law enforcement or regulatory agencies of any improper prescribing activity.

In the past several years, a number of Connecticut physicians have been charged with illegal prescribing of controlled substances. The DEA is involved in cases that result in criminal charges.

The federal Centers for Medicare & Medicaid Services (CMS), which oversees the Medicare program, has been slow to police high prescribers. The agency adopted regulations last year that will allow it to remove providers from the program – starting in mid-2015 — if it finds a pattern of prescribing that is “abusive,” or if a state suspends or revokes a provider’s ability to prescribe.

In Connecticut, state officials have taken several steps to stem an increase in opioid prescribing and overdoses. In January, the Connecticut Hospital Association joined the DPH and two physicians’ groups in endorsing a set of “voluntary guidelines” aimed at reducing opioid prescribing in hospital emergency departments.

Gov. Dannel Malloy has proposed several initiatives designed to stem substance use and opioid overdose, including one that would require any prescriber supplying more than a 72-hour supply of a controlled substance to first review the patient’s record in a statewide prescription database. Malloy’s proposals stop short of initiatives in some other states which have health agencies and medical boards using prescription data to spot problem prescribing, mandate drug screening for patients on long-term opioid treatment, or impose special regulations on pain management clinics.