Advanced registered nurse practitioner Kelly Bell acknowledged in her July deposition that she was self-taught in pain management control.
Pain management was part of the nursing curriculum, and the rest of Bell’s training came from reading, she said.
Bell belonged to a couple of national pain groups, which required only a medical license, interest in pain management and fee payment to join. She also attended seminars, read literature and belonged to online pain groups.
In addition to teaching herself, Bell taught others. In her deposition, Bell said she taught Penny Steers, also an advanced registered nurse practitioner, about opioid prescribing when Steers came to work at the Payette Clinic.
Even without any specialized pain management training, nurse practitioners such as Bell, Steers and Scott Pecora meet the state requirements for prescribing controlled substances.
The Washington Nursing Quality Care Assurance Commission requires only the college coursework for advanced registered nurse practitioners in order to prescribe controlled substances, said Mary Dale, the commission’s discipline manager.
When an applicant is granted an advanced registered nurse practitioner license, he or she also is granted privileges to prescribe controlled substances, Dale said.
In addition to the state approval, prescribers must register with the Drug Enforcement Administration in order to write prescriptions for narcotics and other controlled substances.
The DEA has regulatory oversight of all individuals and entities who have registration numbers to ensure the drugs are not diverted to the illicit market, said Special Agent Jodie Underwood, spokeswoman for the DEA’s Seattle office. The DEA responds to complaints and conducts inspections of DEA registrants to ensure compliance. The Payette Clinic investigation, for example, was sparked by complaints, Underwood said.
The DEA requires applicants to have prescribing authority from their state medical boards in order to apply for a registration number. Once an application is submitted, the DEA conducts an investigation and approves the application in full, places restrictions or limitations on the registration, or denies the application, Underwood said.
Past and current factors, such as investigations, are considered in the application process, she said.