DOVER – Secretary of State Jeffrey Bullock and the state Board of Nursing have suspended the Delaware nursing license of Joanne F. Bogardus in light of recent criminal charges against her related to prescription drugs.

In making this determination, Secretary Bullock and the board considered criminal charges brought by the Delaware State Police, as outlined in a complaint filed with the board by the Delaware Department of Justice. According to the complaint, Ms. Bogardus forged signatures of other nurses to conceal the improper disposal of various narcotic and non-narcotic medications, including oxycodone, morphine, Percocet, Ambien and Xanax. During the time this activity is alleged to have taken place, Ms. Bogardus was intermittently employed as director of nursing at New Castle Health and Rehabilitation Center in New Castle, Del.

Delaware Code Title 24 enables a temporary emergency suspension pending a hearing to be issued upon the written order of the Secretary of State with the concurrence of the board chair, if the activity of the licensee presents a clear and immediate danger to public health, safety or welfare.

The suspension of Ms. Bogardus will remain in effect for a period of 60 days, during which time disciplinary hearings will be held or the final disposition for this individual will take place. As the result of a hearing, the Board of Nursing has the authority to impose disciplinary sanctions up to and including revocation of a practitioner’s license or certification.

The licensure status of Ms. Bogardus has been updated on the Division of Professional Regulation’s online license verification service. A copy of the signed order suspending the license of Joanne F. Bogardus can also be viewed here.

DOVER – Continuing efforts to curb the abuse of opiate pain medication in Delaware, the state agency charged with regulating medical practice and drug prescription recently unveiled rules that will help doctors and pharmacists more closely monitor and control the use of opiates by patients under their care.

The new requirements contain expanded procedures related to prescribing opiates for acute episodes as well as for chronic, long-term pain management. Some components are at the discretion of the prescribing provider while other requirements are situation-based.

The result of an 18-month rulemaking process that included input from medical professionals, public health experts, the Attorney General, and other stakeholders, these regulations were published in the January issue of the Delaware Register of Regulations and will take effect on April 1.

“These regulations can save lives by helping to curb the abuse of opiates in our state. Delaware’s prescription rate for certain opiates is among the highest in the nation, according to the Centers for Disease Control, and we know what many users of heroin tell us: Their drug abuse can be traced back to a time when they were prescribed opiates for an injury or some other valid medical need,” said Secretary of State Jeff Bullock, whose department regulates and licenses prescribers of controlled substances in Delaware. “With these regulations, we are supporting the efforts of those seeking to break that cycle – including doctors, pharmacists, public health workers and our law enforcement agencies.”

Key elements of the new regulations are aimed at controlling the amount of opiates given to new patients and aggressively monitoring their treatment. First-time opiate prescriptions may not exceed a one week supply under the new rules. If further opiate prescriptions are deemed necessary, further action is required, including a physical exam with discussion of relevant patient history and the risks of opiates, and a check of the statewide Prescription Monitoring Program database.

Prescribers statewide will receive an overview of the new regulations and also be directed to HelpIsHereDE.com, which contains educational materials about identifying and fighting addiction, sample forms, and a link to access the Prescription Monitoring Program.

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FACT SHEET – New Opiate Regulations, Jan. 2016

Key elements related to prescribing for an acute episode (injury or procedure) include:

• A first-time prescription to an adult patient for an acute episode cannot exceed a 7-day supply
• No prescription to a minor can exceed a 7-day supply at any time If professional judgment dictates more than a 7-day supply is necessary
  o Document the condition triggering the prescription
  o Query the Prescription Monitoring Program to obtain a prescription history
  o Indicate that a non-opiate alternative was not appropriate
  o Obtain Informed Consent
  o Administer a fluid drug screen, at the discretion of the provider
  o Conduct a physical examination which must include a documented discussion to elicit relevant history, explain risks/benefits of opioid analgesics and possible alternatives, and establish other treatments tried or considered
  o Schedule periodic follow-up visits and evaluations to monitor progress, whether there is an available alternative to opiate use, and whether to refer the patient for a pain management or substance abuse consultation

Key elements related to prescribing for chronic, long-term treatment with an opiate include:

• Those listed above
• Query the PMP
  o At least every six months and more frequently if clinically indicated
  o Whenever the patient is also being prescribed a benzodiazepine
  o Whenever the patient is assessed to potentially be at risk for substance abuse or misuse
  o Whenever the patient demonstrates loss of prescriptions, requests for early refills, or similar behavior
• Administer fluid drug screens at least every six months
• Obtain a signed Treatment Agreement

Informed Consent elements must include at least:
• The drug’s potential for addiction, abuse, and misuse
• The risks of life-threatening respiratory depression associated with the drug
• Potential for fatal overdose as a result of accidental exposure, especially in children
• Neonatal opioid withdrawal symptoms
• Potential for fatal overdose when interacting with alcohol
• Other potentially fatal drug interactions, such as with benzodiazepines

Treatment Agreement elements must include:
• The patient’s agreement to take medications at the dose and frequency prescribed, with a specific protocol for lost prescriptions and early refills
• Reasons for which medication therapy may be re-evaluated, tapered or discontinued, including but not limited to violation of the Treatment Agreement or lack of effectiveness
• The requirement that all chronic pain management prescriptions are provided by a single practitioner or a limited, agreed-upon group of practitioners
• The patient’s agreement to not abuse alcohol or use other medically unauthorized substances or medications
• Acknowledgment that a violation of the agreement may result in action as deemed appropriate by the prescribing practitioner such as a change in the treatment plan, a referral to a pain specialist, or referral to an addiction treatment programs
• The requirement that fluid drug screens be performed at random intervals at the practitioner’s discretion, but no less than every six months.

DOVER – Acting on recommendations from the state’s Controlled Substances Advisory Committee, Secretary of State Jeffrey Bullock has suspended certain prescribing privileges of three Delaware physicians, citing findings that they repeatedly violated Delaware’s Uniform Controlled Substances Act.

In making this determination, Secretary Bullock and the committee considered the conclusions of an administrative hearing officer, who found that Steven Grossinger, Bruce Grossinger and Jason Brajer improperly administered pain medications to a patient with a history of substance abuse. The hearing officer determined that the physicians failed to subject the patient to required drug screenings, failed to properly document pill counts in the patient’s chart, and continued to prescribe controlled substances with knowledge that the patient was addicted.

The physicians currently practice at Grossinger Neuropain Specialists in Wilmington and Eddystone, Pa.

The secretary’s order bars the physicians from prescribing or dispensing Schedule II controlled substances for a period of six months, including medications such as oxycodone, fentanyl, morphine, methadone and amphetamine. The suspensions are accompanied by fines of $3,000 for each physician and will be followed by a three-year probationary period, during which the physicians will submit to quarterly random audits of 10 percent of their patient charts.

The licensure statuses of these physicians have been updated on the Division of Professional Regulation’s online license verification service. Electronic versions of the signed suspension orders can be found here, here and here.

DOVER, DE – Delaware has the most complete and effective system of laws and regulations in the country to govern medical practice and protect patients from abuse and unprofessional conduct, according to a 50-state investigative reporting project recently completed by the Atlanta Journal-Constitution.

Where gaps often exist in other states that allow medical practitioners to avoid consequences in cases where patients are mistreated, Delaware’s reporting and accountability structure is comprehensive, the newspaper found.

“Delaware has some of the nation’s strongest patient-protection laws,” Journal-Constitution reporters wrote in an article summarizing the findings of a year-long investigation into medical practitioner misconduct and how states address it.

“There exists trust between doctor and patient unlike other relationships we have, but we know that we cannot rely on trust alone to preserve that relationship,” said Gov. Jack Markell. “The most important duty of state government is to keep its citizens from harm. In Delaware, we are committed to protecting our neighbors when they are at their most vulnerable.”

Delaware sits at the top of the scale in four out of five categories crafted by journalists to evaluate transparency, duty-to-report laws, regulatory boards, criminal statutes and disciplinary rules. Delaware scored 100 percent on the newspaper’s scale for effective and comprehensive duty-to-report laws. The Journal-Constitution noted that Delaware requires all health care facilities and medical professionals to report incidents or reasonable suspicions of unprofessional conduct to state regulators within 30 days.

“We have come a long way in how we deal with allegations of abuse by medical professionals. The reforms enacted after the Bradley case and the improved coordination with law enforcement, especially the Attorney General’s Office, have created a system that can respond swiftly and deter abusive behavior,” said Secretary of State Jeffrey Bullock, whose department houses the state’s professional regulatory agency. “We also know that some health care professionals are wrongly accused. We need to be equally vigilant to make sure that we protect the reputations of the vast majority of health care professionals who provide the best care possible to their patients.”

Many of the key reforms that earned Delaware high marks were adopted in the aftermath of the horrific child sex abuse case of former pediatrician Earl Bradley.

“The tragedy of the Bradley case remains incalculable, but the improvements to our laws and regulatory structure since will substantially protect future patients from suffering abuse at the hands of a medical professional,” said David Mangler, director of the Division of Professional Regulation, which oversees the licensing of physicians, nurses and other health practitioners.

The product of extensive review of the Bradley case by then-Attorney General Beau Biden and the Markell administration, the 2010 package of legislation strengthened many aspects of Delaware’s medical practice laws. Most notably, these reforms:

• Reorganized the state Board of Medical Licensure and Discipline to increase the number of public members, and gave the board the ability to expedite suspensions of medical licenses where there is a threat to the public;

• Allowed the state to discipline health care institutions if they fail to make mandatory reports of child abuse, and increased civil penalties for persons or entities who fail to report child abuse;

• Authorized fines for health care institutions that have a duty to report physician misconduct but fail to do so, and increased fines for unprofessional conduct by a physician;

• Required all physicians – both currently practicing and new physicians – to undergo state and federal background checks; and

• Improved communications between regulatory bodies and the criminal justice community by requiring the Division of Professional Regulation to report criminal activity to law enforcement.

DOVER – Governor Jack Markell announced today the state will be moving to ban the dangerous stimulants commonly known “bath salts” to make them illegal in Delaware as soon as tomorrow.

The Controlled Substances Advisory Committee will hold an emergency meeting Friday, September 30, at the request of the Secretary of State, who seeks to exercise his authority to issue an immediate ban on the drugs. Title 16, Section 4713, states the Secretary of State shall place a substance in Schedule I if that substance has high potential for abuse and has no accepted medical use in treatment in the United States or lacks accepted safety for use in treatment under medical supervision.

Secretary of State Jeffrey Bullock will be taking an unprecedented step to immediately ban these substances for presenting a clear danger to the public. He plans to exercise his emergency authority to ban three synthetic chemical compounds used to produce “bath salts.” Marketed under names such as “Ivory Wave”, “Purple Wave”, “Vanilla Sky” or “Bliss”, these products are comprised of a class of chemicals which can mimic the effects of cocaine, LSD, MDMA and/or methamphetamine.

“We have every reason to make these drugs illegal,” said Governor Jack Markell. “These drugs present a danger to public safety. They have no legitimate use and can cause incredible damage to the lives of the user and those around the user. Criminalizing the sale and possession of these designer drugs will hopefully reverse their rising popularity and get them out of the hands of potential abusers.”

This action will empower state law enforcement agencies to treat bath salts the same as other harmful illegal drugs, which means those who possess and, more importantly, those who sell bath salts will now face criminal penalties.

“Getting these dangerous substances out of stores and off the streets will make Delaware a safer place,” said Attorney General Beau Biden. “Bath salts are dangerous drugs that have no place in our communities.”

Bath salts have become increasingly popular, particularly among teens and young adults, and are sold at places like tobacco shops, gas stations and head shops. The drug can also be bought on the internet. The federal Food and Drug Administration has not approved these chemicals for human consumption or for medical use, and there is no oversight of their manufacture.

Recently discovered data on three of the chemicals used to produce “bath salts” – mephedrone, methylone, and methylenedioxypyrovalerone (MDPV) – demonstrate that they have a high potential for abuse and currently have no accepted medical use in the United States.

Often smoked, snorted or injected, bath salts can cause impaired perception, hallucinations, reduced motor control, chest pains, disorientation, extreme paranoia, agitation, and violent episodes. They are also believed to have led to numerous suicides.

The Controlled Substances Advisory Committee meeting will take place at 1 p.m. at the Carvel State Office Building, Wilmington, 10th floor. Following the meeting, a news conference will be held at 2:00 p.m. in the Governor’s Office, 12th floor, with the Governor, Secretary of State, and Attorney General Beau Biden.