St. Anthony’s fined $25K for withholding pain medication from two patients – by Sarah Hayden, Reporter – Jul 3, 2019
I’m thrilled to finally see some successful pushback from patients who are deliberately left in pain due to opioid restrictions.
According to the Illinois Department of Public Health (IDPH) first-quarter report, the nursing facility at 767 30th St., Rock Island, was cited for four license violations related to the abuse and neglect of the patients in December.
The report, published in April, states the facility “failed to monitor pain, establish control of severe pain and administer pain medication for two residents,” one suffering from arthritis and the other from chronic leg pain and open wounds.
The first incident
The first patient, suffering from arthritis in the right hip, was prescribed an order for a 5% lidocaine medicated patch to be placed on the hip every morning and removed 12 hours later.
Is this a joke? Lidocaine patches treat pain at the surface of the body under the patch and are not effective for deeper pain. I spent almost an hour researching trying to find out how deeply the anesthetic penetrates and this is what I found:
- They are approved in the US for treatment of postherpetic neuralgia (PHN).
- Topical anesthetics reversibly block nerve conduction near their site of administration, thereby producing a temporary loss of sensation in a limited area.
- Penetration depth, even with the new ‘heated’ patches is only about 8 mm.
- The anesthetic gets trapped in subdermal fat, making it difficult to penetrate any deeper.
On Dec. 10, the patient reported to IDPH investigators that St. Anthony’s “does not do a good job of managing pain.”
The patient reported frequent pain in the right hip and stated he/she does not receive pain medication in a consistent manner.
According to the patient’s medical record, a lidocaine patch was not administered for five days straight — from Dec. 7 through Dec. 11, 2018.
On Dec. 12, a licensed practical nurse (LPN) confirmed to IDPH investigators that the patient had not received the lidocaine patch because it was not “not available due to insurance reasons,” and that “alternative pain medication had not been given” in its place.
The second incident
According to the report, a second patient suffering from chronic leg pain was not given pain medication after being released from a hospital and also during a 45-minute dressing change of his wounds.
The patient was discharged from a hospital Dec. 3 with an order to receive narcotic pain medication every four hours as needed for pain.
On Dec. 10, the patient reported his pain medication was cut in half by St. Anthony’s medical director.
The following day, the patient’s leg dressings were being changed and cleaned by an LPN. The IDPH report states that during the dressing change, the patient stated, “this is really going to hurt. I wish I had a leather belt to bite on so I don’t scream.”
The LPN reported the patient’s entire right lower leg was reddened with scattered open areas actively draining a clear, yellow liquid.
The patient stated he had not had any pain medication since being discharged from the hospital. The LPN told IDPH investigators she had given the patient some Tylenol about 15 minutes prior to the dressing change.
The IDPH report states, “patient’s care plan has no documentation of interventions to address his pain.”
Perhaps they believe that by not documenting pain, it doesn’t exist “on the record” and this frees them from the obligation to provide pain care.