Rosalia nurse’s license suspended after deaths

State health officials suspended a Rosalia nurse practitioner’s license after three of her patients died from taking prescribed painkillers.

In some cases, the prescriptions written by Susan Bowen-Small exceeded 15 times the daily dosage of pain medication the state considers a threshold for involving pain management specialists, according to the Washington Department of Health.

Bowen-Small said Friday afternoon that her Rosalia Health Clinic caters to poor patients who have long-term pain issues.

“It’s such a big issue for anyone to get chronic pain medication nowadays,” she said.

Bowen-Small faces administrative charges that she overprescribed narcotics and failed to establish pain management contracts in a timely manner with at least nine patients from July 2011 to July 2013.

Three of those patients died after taking high dosages of oxycodone, methadone and other opioid painkillers, according to administrative court records.

The nurse practitioner also is accused of failing to conduct periodic tests to determine if patients would respond adversely to high levels of narcotic drugs, said Paula Meyer, executive director of the Nursing Care Quality Assurance Commission in Olympia.

“We have evidence to show she did not complete assessments on the front end, and ongoing,” said Meyer.

In revoking Bowen-Small’s license, the state ruled evidence produced in its investigation constituted “the existence of an immediate danger to public health, safety, or welfare” if the 30-year license holder were allowed to continue practicing. Meyer said the state wrote tougher rules about how to police prescription medications several years ago, when oral painkillers became more common and deaths due to overdoses increased.

“We have seen a dramatic decrease in unintentional deaths,” Meyer said.

Bowen-Small said she received notice of her license revocation Thursday.

“I was so upset that I couldn’t finish reading it,” she said.

A national database compiled by ProPublica, a nonprofit investigative journalism organization based in New York, shows that Bowen-Small prescribed narcotics to 78 percent of her Medicare patients in 2011, compared with a national average of 21 percent.

Bowen-Small said she caters to patients in southern Spokane County who are poor and have struggled with pain for decades.

“A lot of them have had chronic pain for 25 years or more,” she said.

It’s not the first time Bowen-Small has come under fire from the state for her prescriptions. Charges were brought against her in 2003 when she was working at a clinic in Garfield, Wash., allied with the Whitman Medical Group. State investigators at that time alleged she prescribed stronger pain-control medications than her authorization allowed.

The state ordered Bowen-Small to pay the $1,000 spent on the investigation as well as pen a 1,000-word essay on the proper procedures for a nurse practitioner to prescribe painkillers under state rules, according to state records.

The most recent allegations deal in large part with Bowen-Small’s treatment of patients diagnosed with hepatitis C. At least one of the patients who was allegedly overprescribed did not meet with Bowen-Small face-to-face until several months after methadone and oxycodone prescriptions had been written.

Bowen-Small said she met with many of her patients for 30 minutes – sometimes more than 90 minutes – to collect information. She said it seemed as though the state was “picking and choosing” certain cases of hers for extra scrutiny.

“I’m an easy target,” she said.

Bowen-Small has 20 days to respond to the charges and request a hearing with the state Nursing Care Quality Assurance Commission, according to a news release.