A Clark County nurse practitioner sanctioned by the state health department in 2009 for overprescribing opioids at the Payette Clinic is once again facing disciplinary action.
Kelly M. Bell, who holds both registered nurse and advanced registered nurse practitioner licenses in the state, is facing new disciplinary action for unprofessional conduct tied to her treatment of two patients at her Vancouver practice, Walnut Grove Medical & Mental Health. She apparently closed the clinic in April 2015.
The patients — a 44-year-old woman and her 65-year-old mother — were both admitted to PeaceHealth Southwest Medical Center in late January 2015. The admissions “raised serious concerns about (Bell’s) prescribing practices and overall treatment of these patients,” according to the state Nursing Care Quality Assurance Commission.
Following its investigation, the commission determined Bell’s care of the two women fell below the standard of care for the following reasons: prescribing multiple medications for the same condition, not clearly documenting diagnostic reasoning for prescribing medications, making medication changes without clearly documenting her rationale for those changes, increasing medication dosages despite laboratory tests showing the doses were already too high, not closely monitoring side effects and failing to adjust the patients’ medications despite pharmacy alerts regarding gaps in medications and duplicate medications.
Those actions, the commission said, caused or placed the patients at risk of moderate to severe harm.
Bell has until Jan. 14 to respond to the allegations; she requested and was granted an extension to the standard 20-day response time. The nursing commission will then determine disciplinary action and may consider past discipline.
She could not be reached for comment.
The commission sanctioned Bell in 2009 for unprofessional conduct after the state received multiple complaints regarding her prescription of “extremely high doses of opioids.” In December 2009, the state stripped her of her privileges to prescribe Schedule II drugs — such as oxycodone, morphine and methadone — for two years, at which time she could apply for the privileges to be reinstated. Those privileges have not been reinstated, according to the health department.
Bell’s ability to practice medicine was not affected by the sanctions.
“The 2009 order suspended her ability to prescribe Schedule II controlled substances in order to protect the public, but (the commission) agreed there was the potential for rehabilitation,” the commission said in a written response to Columbian questions. “The current allegations, if proven, will require (the commission) to reassess that issue.”
Since Bell received her license in 2001, the state has received 46 complaints against her. Most of the complaints were addressed in the 2009 action, according to the commission. The state does not currently have any open investigations into Bell. It’s unclear if or where she is practicing now.
New allegations
The latest investigation centers around the care of the two women admitted to PeaceHealth Southwest early last year.
The 44-year-old woman was admitted for flank pain and, at the time, was taking about 31 medications. The hospital physician noted she was drowsy and had mild cognitive deficit, thought to be caused by the excessive use of multiple drugs to treat a single condition, according to the commission.
The patient was on two thyroid medications, as well as multiple psychotropic medications. She was also taking multiple oral medications for diabetes but was admitted to the hospital with severe hyperglycemia, according to the commission.
The 65-year-old was admitted near the same time for altered mental status, most consistent with withdrawal syndrome from antidepressant drugs. She was vomiting for two days, and, at the time, was taking about 27 medications, according to the commission.
“Also, given the large number of prescribed medications, her symptoms could have been the result of an adverse drug-drug interaction or opiate overdose,” the commission alleges.
The allegations also chronicle nearly two years of hospital admissions for the women and instances when Bell’s treatment of the women fell below the standard of care, according to the commission.
