NURSES BLAST DRUG PROGRAM AS RISKY; PARTICIPANTS DEFEND IT

June 3, 1999

State House News Service

JUNE 3, 1999....EJB.....While agency heads defended a program they say is much improved, the state's largest nurses union issued its annual challenge today to a controversial program that allows unlicensed personnel to administer medications to mentally ill and retarded people.

At a hearing before the Health Care Committee, the nurses said the state's Medication Administration Program (MAP) is risky and results in sometimes fatal medication errors. Agency officials countered the program has been a successful tool in moving mentally ill and retarded people toward rehabilitation and independence.

The Department of Mental Health serves approximately 6,500 adults annually, said Commissioner Marylou Sudders. With an average of 8.8 doses of medication per patient per day, MAP staff administer an estimated 1.25 million doses of medication per month, she said.

Last year, the agency received 2,100 reports of "medical occurrences," a term that includes not only errors but also patient refusals. Of those, 22 resulted in medical intervention and "there were no deaths or injuries," Sudders said

Between DMH and the Department of Mental Retardation, the Department of Public Health received 5,470 reports of medical occurrences, or 1 percent of total medication administrations, said Nancy Ridley, DPH assistant commissioner for health quality management. Of those, 26 - less than half of 1 percent of the 1 percent- resulted in medical intervention and none in death.

DMR Commissioner Gerald Morrissey, Jr. said DMR, DMH and the Department of Public Health have implemented most of the improvement plan recommendations made last year for the program. The recommendations include nursing oversight of MAP, centralized certification testing by the Red Cross, creating system linkages and fostering interagency relationships.

"I remain fully committed to ensuring that the system is managed in a safe and effective manner and am open to any thoughtful dialogue and debate which will lead to improvement of this important component of our service system," Morrissey said.

Committee Co-Chairman Rep. Harriette Chandler (D-Worcester) told the trio, "Your feet are being held to the fire. This is a controversial issue, not loved by all. If you're going to do it, it has to be of the highest quality."

The most vocal opponent of the program, the Massachusetts Nurses Association, pushed a bill (S 507) to require that only licensed personnel - meaning nurses - administer medications. Gloria Craven, director of the MNA's Department of Legislation and Government Affairs, charged that the state is trying to save money at the expense of one of the most vulnerable populations.

Even acute hospitals with "very stringent" administration programs have a documented error rate of about 3 percent, she said. Those errors cost about $4.2 billion nationwide per year, and cost Massachusetts hospitals about $5.6 million apiece per year, she said.

MAP training does not necessarily ensure competence, or that staffers will keep proper records, Craven said. Regulatory agencies can't perform annual inspections of the 3,600 group homes across the state, she said, adding that there's a lack of accurate information about the program.

"We're opposed to MAP, we continue to be opposed to MAP, and we ask this committee to look at the financial and human commitment and then ask - can you really afford not to have a nurse?" Craven said.

Not so fast, said Karen Cusich, president of Teammates, a self-advocacy group in Worcester. The 23-year-old, who is confined to a wheelchair and takes eight medications per day, said she prefers her personal care attendants and doesn't want a strange nurse taking care of her. She described as "scary" the idea of a different nurse administering her medications every day.

"Our staff should give us our medications. We don't want or need a nurse to do that," she said. "We want to be independent and lead our own lives. We don't want to plan our lives around when a nurse can meet us to give is medication."

Karen's mother, Jean Cusich, herself a registered nurse, said the people who administer medications need to have an intimate knowledge of their patients in order to accurately evaluate the drugs' effects. She said she feels comfortable with MAP participants' qualifications - a 16-hour training program, a two-part test involving both written and practical components, and a yearly re-certification requirement.

"I feel the current medication administration program is safe and it's not necessary to have nurses," the elder Cusich said.

The Massachusetts Hospital Association also opposed the nurses' bill, saying it involves "sweeping changes" that would replace all existing medication laws. In a statement, the association predicted the bill would prevent physician assistants, trained medical technicians, and licensed personnel such as radiologists from prescribing and administering medications.

The bill would also limit the authority of the public health commissioner over unlicensed personnel in group home settings, the association said. "To create such a massive change in the current delivery system without an adequate rationale has the strong potential of doing far more harm than good," the statement said.