Five Indian Health Service (IHS) hospitals had patients who were given opioids in amounts exceeding federal guidelines, according to the results of a federal audit by the Department of Health and Human Services (HHS).
According to the report, these hospitals failed to follow their own protocols for prescribing and dispensing opioids, placing Native American patients at increased risk for opioid abuse and overdoses.
The IHS, the federal agency that manages primary health care services for Native Americans, oversees a total of 25 hospitals. The HHS audit only covered five hospitals: 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 discovered that hospitals had failed to appropriately review patient records and inform patients about the risks and benefits of opioid use. Auditors found that more than 100 patient records did not include any record of informed consent, and many forms did not indicate that doctors had properly educated patients about their medications.
In addition to procedural failings, auditors found that physicians were prescribing doses of opioids that matched or exceeded the Centers for Disease Control recommended opioid dose of 90 morphine mg equivalents per day, a measure comparing an opioid dose with morphine. For example, at the Shiprock hospital, daily doses were more than four times this limit. Physicians also were prescribing opioids in conjunction with benzodiazepines, which “puts patients at a greater risk of a potentially fatal overdose.”
The report also found:
- Many patients did not undergo drug screening when they began opioid treatment. The Phoenix hospital has since implemented one.
- Many opioid prescriptions were not in a secured safe. The Lawton hospital had a safe, but had the combination to the safe, on the safe itself. The IHS said it has revised its manual to require opioids awaiting pickup to be locked up.
The HHS authors also included more than a dozen recommendations to help hospital staff better track patients’ health records and more securely store opioids.