Nurse Suspended for Over-Prescribing Psychiatric Drugs
The PCNS' license was suspended for deficient record-keeping and over-prescribing generic forms of Adderall, Ritalin and Xanax to several Coventry residents and others.
The RI Department of Health has recently ordered the immediate and indefinite suspension of the nursing and Controlled Substances Registration licenses from Psychiatric Clinical Nurse Specialist (PCNS) Lisa Marenaro who is in a collaborative practice with Dr. Mindy Rosenbloom, MD.
The suspension comes after the Department received a complaint from the Coventry Department of Human Services, leading to the review of five of Marenaro's patients. The Human Services Director stated that she had made numerous attempts to contact Marenaro about two high-risk patients and had received no response.
Among the findings, one patient was prescribed a 180-day supply of Amphetamine Salts (generic Adderall) in 75 days, at 90 mg/day. According to the RI Department of Health, the usual dose is 40mg/day, and "there was no explanation in the records to explain the prescription of a dose approximately two and one-half times higher than the usual amount." A second patient was prescribed a 120-day supply in 60 days of 120mg/day of the same substance, and a third was prescribed three times the recommended amount of the substance along with 210 Alprazplam (generic Xanax) on the same day with two different sets of ingestion directions.
A fourth patient was prescribed higher-than-usual dosages of Methylphenidate (generic Ritalin) as well as Alprozolam (generic Xanax) at more than twice the recommended dosage. In each of these cases, the Board found that Marenaro's records contained "no problem summary list, no active controlled substance log, no active medication list, [and] scant progress notes." Further, Marenaro "taped prescriptions to the outside door of her office, unsecured, and with patient names on the outsides of the envelopes." According to Board of Pharmacy report, "Those prescriptions could have been accessed and filled by anyone who came by, and confidential patient information was placed in an unsecured location."
Marenaro's records also showed no evidence of patient utilization tracking, urine monitoring or assessment for suicide or substance abuse, despite being notified by DCYF in April 2011 that they believed one of her patients was abusing drugs.
Based on the findings, the Director of Health has determined that Marenaro's licenses as a PCNS and as a Registered Nurse constitute an "imminent threat to the health, welfare and safety of the public." These licenses are suspended indefinitely pending further order of the Department of Health. No action was taken against Marenaro's Registered Nurse license and she agreed not to reapply for a PCNS license for at least two years.