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Opioid Drugs

State Wants Overprescribing Nurse to Receive a Harsher Punishment

— January 15, 2021

Tennessee challenges original reprimand of nurse practitioner for excessive opioid prescribing.

Tennessee nurse practitioner Christina Collins, now 43, had prescribed a patient 51 pills a day in 2011, according to court documents, which show the daily dose included 32 methadone, eight Roxicode, four Soma, six Xanax and one Ambien.  At one point, she was overprescribing so much she was the ninth highest  prescriber in the state, and the Tennessee Department of Health argued her orders were “so colossal their only reasonable use would be drug trafficking or suicide.”

However, despite her well-known excessive prescribing, the Tennessee Board of Nursing allows Collins to keep her license.  She would eventually be sentenced to two years of probation but continued to work in the Knoxville area.  State attorneys then challenged the decision in 2020, petitioning a county judge to order the board to take another look at the consequences imposed.

In new arguments filed in that case, the attorneys state the previous decision should be tossed because one board member, Lee Ann Stearns, violated evidence protocols by doing her own research and presenting misinformation about opioid prescribing to other members.  Stearns was then one of three board members who decided Collins’ probation terms.

State Wants Overprescribing Nurse to Receive a Harsher Punishment
Photo by Graham Ruttan on Unsplash

During the second day of Collins’ hearing, Stearns admitted to reading journal articles about opioids the night before and concluding practitioners historically received little to no guidance on how to avoid issuing excess prescriptions, according to a transcript of the deliberations.  Thus, she assumed it would be reasonable for Collins to misunderstand how much was too much and, in doing so, inadvertently overprescribe.

Specifically, in pulling from a 2009 journal article by the American Pain Society, Collins had shared with the board, “theoretically opioids have no maximum or ceiling dose” and said this statement changed her perception of the practitioner’s decision-making.

“There is no doubt she was overprescribing,” Stearns said, according to records. “And that was my very first impression until I read this data.”

Sara Sedgwick, a senior assistant attorney general, wrote in arguments that Stearns should never have conducted her own online research, especially since the article made her more comfortable with Collins’ overprescribing even though what Collins had given her patients was actually twenty times greater than the examples included.

“Even if, as Ms. Stearns stated during the board panel deliberations, the literature she researched and relied on states there is ‘little evidence to guide safe and effective prescribing’ at more than 200 morphine equivalents a day, it does not then follow that the same literature somehow would support a conclusion that prescribing 3,840 morphine equivalents per day is within the standard of care,” Sedgwick wrote.

Collins’ attorney, Eric Vinsant, insisted in 2020, when this all came to light, that his client was well-intentioned and underinformed, and worked with the limited information available at the time.   “This case stretches from 2011 and 2012, which was a time before Tennessee really began looking at the prescribing of opioids and other controlled substances for pain,” Vinsant said. “There was really a very limited amount of guidance for practitioners on what was expected and what were best practices.”


Nurse prescribed ‘colossal’ amount of opioids, kept license through error, state says

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