Many people have asked about the timeline of events that led to my nursing license being suspended. This post is to help clarify the details and highlight the discrimination with how we deal with healthcare professionals who suffer with substance use disorders. I began using opioids in 2008 to treat depression resulting from an abrupt divorce. Within 8 months or so after I started injecting heroin I lost everything, my job, housing etc. and was living on the street. During the first few months I was so ashamed and embarrassed I was reluctant to tell anyone, only 2 friends knew and they repeatedly told me to stay quiet in an effort to “protect my (nursing) license. I had also been working in emergency medicine for 15 years at that point and knew how we historically treated people suffering from addiction, so I said nothing. I took 2 FMLA leave of absences and after the second one I never returned to work. I was eventually fired. After about 14 months on the street I entered my first inpatient treatment center. This is where I was introduced to 12-step recovery. At this time I was an atheist in terms of spiritual beliefs and I could not grasp suffering with what was considered a medical illness, yet I was told the only way to get my disease into remission was through prayer, penitence, forgiveness and a spiritual awakening. I was administratively discharged (the clinical term for being kicked out) of this rehab (Cirque Lodge in Provo, Utah) for refusing to believe in god and participating in group prayer. I had completed 42 days of “treatment” at this facility. When I returned home I had a very sour taste in my mouth regrading 12-step programs, however I relied on their belief in “rigorous honesty” and thought if I was honest, everything would work out. So, I called the Pennsylvania board of nursing (BON) and self-reported. I explained that my struggle with problematic substance use began as a way to cope with depression related to divorce (this information is publicly displayed on the boards website): The BON explained that in order to keep my license I would need to agree to entering their program, then called the voluntary recovery program (VRP). The program consisted of more in depth “treatment” including IOP, counseling etc. and 90 12-step meetings in 90 days followed by 3 meetings a week for a period of 3 years, as well as active participation with a sponsor. At this point in my early recovery, and after my experience at Cirque Lodge, I refused to participate in 12-step meetings, and argued that they were a violation of my personal religious rights. The board had a hearing (that I was not notified of) and indefinitely suspended my license. This was in September 2009. I became severely depressed over losing my license and felt like I would never be able to care for sick people again, the career I loved and the one thing that made me feel like my life had purpose. Eventually, I started using heroin again and spent the next two and a half years in active addiction experiencing homelessness. I was eventually arrested for forging a check and spent 6 months in the county jail where I was raped. The BON has a letter I wrote to them on their website (Page 1 Page 2) that is a clear example of how broken I was, but also shows how much I loved being a nurse. It is despicable that this document is posted publicly on their site. When I was discharged I ended up in a Christian recovery program in Philadelphia. Over the next six month period I became interested in the faith and converted to Christianity. I devoted my life to the church and enrolled in bible college. I received a bachelors degree in biblical studies and enrolled in graduate school at Westminster Theological Seminary, where I was studying for the pastorate. During this time I was working for a small community church in Philadelphia’s Kensington neighborhood in their addiction ministry; this is where I met my current wife and got remarried. As a newly married man, I still missed being a nurse and wanted to try to get my license back again, so I called the board of nursing again to try to enroll in the monitoring program, this was in 2012. The VRP had been replaced by the Pennsylvania Peer Nurse Assistance Program (PNAP), however the rules were still the same regarding 12-step programs. At the time I was leading at least 5, but sometimes 8, recovery meetings a week through the addiction ministry, so I asked PNAP if I could substitute those meetings for the 12-step meetings since it would be extraordinarily difficult to fit them in with working full time and being a full time student. PNAP refused to allow me to use faith-based meetings instead of 12-step meetings and, again, held a hearing that I was not aware of and this time labeled me “non-compliant” and placed a mandatory 5 year minimum suspension on my license. I was in recovery for 18 months when I called and had documentation of treatment completion through a 9 month intensive outpatient program, a 12 month residential program, and 18 months of urine drug screens. PNAP would not accept any of the drug screens or treatment, they said I would need to have an assessment done by one of their “approved” assessment centers, begin providing urine drug screens through their contracted laboratory, and follow their guidelines As I continued my theological studies in seminary, my wife and I became foster parents to a 2 week old boy and 4 months later became pregnant with twins. Over the 9 months she was pregnant I became very attached to Micah, our foster son, and I was experiencing growing anxiety that I would lose him some day, as it was looking like he would be reunified with his biological father. When the twins were born, I experienced severe attachment issues stemming from the year long anxiety I felt over potentially losing Micah. This led to a recurrence of drug use, however this was in late 2015, the age of fentanyl. My use escalated quickly and I had a hard time grasping what was wrong. The opioids did not last as long, I was using more times a day than before, overdosing more frequently, and it was much harder to stop than it was 5 years prior. I began going into treatment centers one month into using. Over the next year and a half I entered treatment 16 times. Every treatment center was 12-step, abstinence only based programming. I desperately wanted to re-gain my nursing license and I kept pursuing abstinence because I knew buprenorphine was prohibited by the BON. Many times after I would get out of treatment I would overdose in my home due to reduced tolerance. I would’ve been the perfect candidate for buprenorphine, however I wanted to be a nurse so badly I was prepared to white knuckle recovery, hoping for “the miracle to happen” as they say in 12-step meetings. I eventually abandoned my Christian faith after the church turned their back on me and I found recovery after my 16th time in rehab through the use of Vivitrol (extended release naltrexone). I phoned PNAP and asked to enter the program. At first my case manager said it may only be 90 days until I would be issued a provisionary license. However, that turned out to be an error and she explained that I would need three years of continuous sobriety before I could petition to have my license reinstated. PNAP would monitor me through daily check-ins for random urine drug screens, AA attendance is verified through GPS monitoring on my smart phone, and I had to complete one full year of outpatient addiction treatment. Over the past 30 months I have participated in three 12-step meetings a week and random urine drug screens. I have consistently noted on monthly progress reports how difficult I find 12-step meetings. I disagree with the spiritual roots of their view of addiction. Having survived a very traumatic relationship with the church I saw very clear parallels between AA and Christianity that were very difficult for me to get through. The meetings made it very difficult to restore my marriage and build relationships with my young children. Most importantly, 12-step fellowships are self-selecting, as is any support group, mandating attendance and participation is counter-productive. Everything we know about recovery tells us that the individual does best when they design their own recovery pathway for themselves. I have made this very clear on my progress reports with the hope that my case managers would understand and realize that 12-step recovery is not a good fit for me. However, the only communication I ever received was a voice mail on July 30, 2019. Listen to the voice mail here. When I called back it was clear that the purpose of her contacting me was to intimidate me into continuing with the meetings. In a subsequent email she stated, “I am sorry the 12-step meetings aren’t working for you…yet” implying a common 12-step philosophy that if you go often enough the program will eventually work for you. Instead of realizing the program wasn’t for me, they continued to mandate me to attend and participate. Over the phone my case manager even told me checking off the box “I go because I am required to” on my monthly progress report form was a red flag to PNAP, which is why she called me. They purposefully created a participation level check box with one box stating the above in order to target who they felt was on the verge of relapse. This further highlights the stronghold the 12-step pathway has in the health professional monitoring program. They view a participant not wanting to go to meetings as a precursor to relapse. I also describe in detail on every progress report how difficult the procedure is for witnessed drug screens. Every time I am selected for a screen I re-experience being raped. My case manager, a licensed professional counselor, wrote the following email to me: Here was my response to her, which she never answered: I’ve found it remarkable that a licensed professional counselor, who is my case manager, could ignore a letter explaining what I go through on every screen and not comment on it or offer some form of support. But this has been my experience the entire time I have been a part of this program. PNAP prides themselves to be advocates, however I’ve never experienced advocacy or support through them. From their website: "To identify, intervene upon, advocate for, monitor, and provide support, help, and hope to the Nurse or Nursing Student experiencing Substance Use Disorders, Mental Health Disorders, and/or Physical Disorders that may affect their ability to practice." After 30 months in the program I recently decided to begin taking buprenorphine and I explained my decision-making process in my prior blog post. I emailed my case manager on 4.2.20 to let them know I would be starting opioid agonist therapy and I petitioned to have my license reinstated due to my solid recovery and the current need for nurses due to the coronavirus pandemic. This request was quickly denied, but what struck me was they indicated I was required to provide 5 years of documented recovery, not 3 like I had initially been told. I was under the impression that I had 6 months left until I would be finished with the program. I inquired about the discrepancy and how it was possible PNAP didn't know about the order, this was the email I received: Here is the new board order referenced in the above email that no one has ever seen before:How is it possible that my contract was designed based on a board order from 2012, that they never saw until 4.2.20, and isn’t available on the board’s website for some reason? How is this possible?
Even more interesting, 3 days later I emailed my prescription for my file and PNAP’s response was as if they had no idea I decided to begin taking buprenorphine. It turns out they made the decision to deny my petition for reinstatement without reading my letter. They never had any intention of considering my case. Ultimately what they decided was this, if I will agree to take buprenorphine for a limited time (less than 6 months) they will allow me to stay in the program. However, if I plan on staying on the medication indefinitely, then I will be discharged from the program and my case will be closed. PNAP is forcing me to choose between taking a medication that very well could save my life or continuing to white knuckle through the program and get my license back, so long as I survive, that is. I should also note that I’ve had conversations with PNAP representatives before about OAT and their position on medications for opioid use disorder is, “everyone who uses Suboxone abuses it and are only using it to get high.” There is no question this is a misguided and discriminatory view of OAT. The problem is there are countless nurses out there who have had to decide between their recovery and their career. They have been driven out of the workplace because of an ignorant and antiquated view of medications. Moreover, they have prevented nurses in recovery from practicing. One thing that quickly builds a relationship with a person suffering with a substance use disorder is the comradery gained from having shared lived experience. This opportunity for nurses to bond with a specific patient population is destroyed when you prevent nurses in recovery, and nurses who have taken a pathway to recovery through the use of medications, from entering the clinical space. This is where I stand right now. I must decide between my own recovery, safety, and wellness or pursuing the career I loved in order to care for the patients I love. What a crappy place to be. Some noteworthy points for discussion. My PNAP contract states any biological specimen provided from me becomes property of the commonwealth and they will not release results or records to anyone under any circumstances. This means if I had a screen that yielded a positive result, I would not have a right to see the result. Moreover, now that I am being discharged from the program I cannot have any of my supporting documents to petition the BON directly. 30 months of negative screens, assessments, treatment records, and AA attendance logs are all their property. The financial aspect of being in the program resulted in my wife and I having to declare bankruptcy due to the piling up of debt. There are annual supervision fees associated with being in the program. Every time a participant is selected for a screen there is a fee that goes to the lab for analysis and there is an arbitrary fee paid to the collection site. Collection sites can choose to charge whatever they want for collecting the urine and mailing it to the lab. Fees range from $20-80. Interestingly, at one collection site a urine sample costs $30, however if it was a blood sample they charge $10. I inquired why, understanding that collecting a blood specimen utilizes more materials and should therefore be more expensive. The collection site explained that they charge inflated fees for urine because it is the most common sample form, therefore they can make more money. There is a major conflict of interest regarding the mandatory assessments required by the BON. Assessments must be completed by “approved” centers. However, these assessment sites are usually through large treatment facility chains. Whatever the assessment recommendations are, the participant must complete according to their PNAP contract. Therefore, there is financial gain to be made by the assessor recommending the maximum and most invasive treatment path. I have thought considerably about the past 12 years of my life. I’ve often wondered how things may have been different if there was a culture in health care that normalized professionals struggling with substance use disorders. I would have been more likely to ask for help before I ended up homeless and in jail. If 12-step recovery wasn’t the only exclusive option, perhaps I would’ve entered the program earlier. Had I been in the program and practicing as a nurse in 2015 I may have had an entire support network to assist me manage all the issues surrounding Micah’s adoption. I may have never suffered a recurrence of use. I also think of the hundreds of patients who I could’ve met as a nurse who are struggling themselves. How powerful would it have been to disclose that I have been through what they were experiencing. How many lives could’ve been saved if we would only develop a system that truly offers peer support and allows the individual to exercise autonomy over their own recovery pathway; a recovery plan tailored and designed for them and their unique needs. These are big questions that I don’t know the answer to. However, I do know that everything must change. How we treat our own as healthcare professionals is deplorable, despicable, and is an eye sore for our respective professions. I cannot let it continue. You can access my Pennsylvania Board of Nursing records here: https://www.pals.pa.gov/#/page/searchresult
2 Comments
Wendy A Garcia
4/11/2020 02:31:39 pm
I am so sorry, Bill. I have had similar experiences, though not nearly as devastating, having been through the criminal "justice" system. So much frustration, expense and antiquated thinking. So much simply doesn't make sense.
Reply
9/6/2021 10:40:39 pm
New to pnap. What a disaster this is already in 6 weeks. Would like some advice
Reply
Leave a Reply. |
Bill Kinkle
Bill is a paramedic and nurse in recovery from opioid use disorder who cares about dispelling common myths about people who use drugs, addiction, and recovery. ArchivesCategories |