State suspends licenses

State licenses for Susan Bowen Small, operator of the former Rosalia Clinic, have been suspended by the Washington State Nursing Care Quality Assurance Commission, according to a Friday report from the state Department of Health.

The report said action was taken on allegations Small failed to properly screen or monitor patient use of prescription narcotics which allegedly led to patient deaths.

The report said action was taken after an investigation of three patient deaths by the Spokane Medical Examiner found the death causes to be drug toxicity including combined drug toxicity.

Suspended were Small’s license as a registered nurse and her license to be an advance nurse practitioner.

A statement of charges listed treatment of nine patients, identified in the charges as patients A through I with treatments dating back to November of 2011.

The statement of charges cites the prescriptions made to the patients and alleged failure of Small to screen for risk and conduct evaluations of patients.

Date of death listed for the three deceased patients were Jan. 24, 2013, March 24, 2013, and June 5, 2013. The charge listed the findings of the Spokane Medical Examiner.

The findings were forwarded to the commission by a Department of Health service consultant who cited alleged violations involving unprofessional conduct, prescriptive authority, patient evaluation, and written agreement for treatment at the end of the 11-page report.

Whitman County Coroner Pete Martin Tuesday said Small’s over-prescription of pain control drugs played a part in two causes of death investigations in Whitman County. He said Small’s practice in Rosalia had become a concern for many members of the medical community.

Martin said he believes the nursing commission report was done in conjunction with the Spokane Medical Examiner’s office because more precise records were available in that county.

Small last September opted to relinquish her certification under the federal Drug Enforcement Agency after DEA inspectors conducted a records inspection at the office in Rosalia. She said at the time she opted to relinquish the license rather then undergo formal enforcement action by the federal agency.

At the time Small opted to relinquish her DEA certification, she told the Gazette she was uncertain about the future of the clinic.

She closed down the clinic late last fall and made arrangements to vacate the lease with the city-owned building at the end of the year. Under an agreement with the town, she was allowed to remove her equipment and records from the clinic office through January.

According to the state Department of Health report, Small has 20 days to answer the charges and ask for a formal hearing on the suspensions ordered by the Nursing Care Quality Assurance Commission.