U.S. government hospitals placed Native American patients at increased risk for opioid abuse and overdoses, failing to follow their own protocols for prescribing and dispensing the drugs, according to a federal audit made public Monday. The report by the U.S. Department of Health and Human Services’ Office of Inspector General does not draw conclusions about actual abuse or overdoses. But it said all five Indian Health Service hospitals that were review had patients who were given opioids in amounts exceeding federal guidelines.
“There are vulnerabilities with this particular population in the opioid prescribing and dispensing practices,” said Carla Lewis, one of the auditors. The overdose epidemic that has kill more people than any other drug epidemic in U.S. history has hit indigenous communities hard. Native Americans and Alaska Natives had the second-highest rate of opioid overdose out of all U.S. racial and ethnic groups in 2017, according to the federal Centers for Disease Control and Prevention.
Primary health care
The Indian Health Service, the federal agency that administers primary health care for Native Americans, has put an increased focus on opioids lately with a new website and the creation of a committee focuse on decreasing overdose deaths; promoting culturally appropriate treatments and ensuring that communities know how to respond.
The audit covered five of the 25 hospitals directly run by the Indian Health Service: the Phoenix Indian Medical Center in Phoenix; Northern Navajo Medical Center on the Navajo Nation in Shiprock, New Mexico; the Lawton Indian Hospital in Lawton, Oklahoma; the Cass Lake Indian Hospital on the Leech Lake reservation in Cass Lake, Minnesota; and the Fort Yates Hospital on the Standing Rock Sioux reservation in Fort Yates, North Dakota.
The auditors found that the hospitals stray from guidelines in the Indian Health Manual; so in reviewing treatment for patients and their causes of pain every three months. Patients also must sign a written consent form and an agreement to treat chronic pain with opioids so they know the risks and benefits, as well as the requirement for drug screenings. More than 100 patient records did not include evidence of inform consent; also dozens did not have evidence that providers adequately educate patients.
Homes and hospitals
The Indian Health Service said all of its facilities now submit; that data so the agency’s top leadership can track it. Among the report’s other findings: More than two dozen records show no evidence patients were screen; hence for drugs with urine tests when they start opioid treatment and periodically after. Providers did not have an alert system to know when patients were due for the urine tests. The Phoenix hospital has since implement one.
Pharmacists are suppose to review patients’ files before filling prescriptions from an outside provider; but that was not done at four of the hospitals. In one case, Fort Yates fill a prescription from an outside provider despite; so the hospital discontinuing treatment because the patient violate a pain management agreement. The Indian Health Service said it would issue; hence a directive in December for prescribers to track that information.
At all hospitals, auditors noted that providers did not always review; so the data before seeing new patients or during the time patients were on opioids for pain. “Part of it is to ensure the holistic approach of providing care,” Lewis said. Hospital officials and providers often said they were overwhelmed by the number of patients or could not control how regularly they came in sometimes; due to the long distances between patients’ homes and the hospitals. Lewis said auditors try to be reasonable in their requests. “They try to make recommendations that are going to be actionable and cost-effective for an organization,” she said.