Floyd County supervisors approve equipment for FCMC opioid effect monitoring

By Bob Steenson, bsteenson@charlescitypress.com

The Floyd County Board of Supervisors this week approved spending some of the county’s share of national opioid lawsuit settlement funds to purchase “capnography” equipment and supplies for use at the Floyd County Medical Center.

The equipment monitors a patient’s breathing, making sure that the amount of carbon dioxide expelled by the person’s lungs is in proportion to the amount of oxygen being taken in.

Jon Perin, the chief ambulatory officer at the Medical Center, and Matthew Cooper, the chief nursing officer, explained how the equipment works and why it is important for monitoring people who may be being treated for opioid use, or who may be getting opioid medicines for pain relief while hospitalized.

The request is tied to the county’s approval in January to also use opioid settlement funds to help fund a new clinic at the Floyd County Medical Center (FCMC) for people struggling with opioid abuse or addiction.

The program is providing weekly suboxone clinics through video “telehealth” sessions with Mason City Clinic psychiatrist Dr. Rogerio Ramos MD.

FCMC is providing space for the telehealth clinics with Dr. Ramos, and will administer suboxone as prescribed by Ramos. The planned capacity is to serve up to 100 Floyd County residents with suboxone treatments at any given time.

The capnography equipment request made this week “is an anticipation of treating this population of patients with opioid addiction or dependency and having the tools we need to save their lives when they come into our hospital,” Perin said.

The supervisors approved using $53,370 from the county’s share of opioid settlement money for the equipment and for the initial disposable supplies that are required. Floyd County expects to eventually receive hundreds of thousands of dollars from the settlement funds, as will other cities and counties across the country.

“In a normal respiratory process, you have oxygen coming in, CO2 going out,” Cooper explained. “We breathe, it comes in, goes out. There’s a nice balance.”

But for a person who is addicted to opioids, takes an overdose of opioids, or for a patient who is being treated with opioid painkillers, their breathing can become depressed, he said.

“They might not be breathing as heavy, so they’re not getting that normal exchange. They might breathe in, not quite breathe out,” said Cooper.

When someone comes to the hospital, one of the first things they do is put a monitor on a finger that checks how much oxygen is in the blood, he said.

“But the problem is that your oxygen level can be running at 100% while you’re building up this CO2 in your lungs,” Cooper said. “And what happens long term, you build up the CO2 and it knocks out your respiratory drive, and then you quit breathing so you go into respiratory distress.”

Capnography measures CO2 being breathed out, to see that it correlates with the amount of air being breathed in.

“It’s actually a gold standard of care,” said Cooper. “Individuals, regardless who are using opioids whether it’s recreational or prescribed in a facility, should be on capnography monitoring. It just gives us information to be able to better treat patients and save lives.”

The monitoring is done with a small cable that looks similar to the tubing that can administer oxygen via nose or mask to people who need it, said Cooper.

Supervisor Gloria Carr said she was in favor of giving the Medical Center the funds, but some of the opioid settlements are very specific on how the money is used, tying it closely and specifically to opioid addiction treatment or education.

Auditor Morrigan Miller said the proposal should probably be run through the County Attorney’s Office to make sure the settlement money being used qualifies for this expenditure.

“You need to read the fine print,” Miller said.

In order to speed up the process, Perin offered for the Medical Center to agree to pay back the funds if it turns out that the money couldn’t be used for this purpose and is “clawed back” by the settlement administrators.

With that, the supervisors voted unanimously to approve the funding.

Gail Arjes, the administrator of Floyd County Public Health/Home Health Care, was at the supervisors meeting to add her support to the Medical Center’s request.

She said the suboxone clinic at FCMC has started seeing patients and is open every Thursday from 10 a.m. to noon.

The initial numbers of patients is low, she said.

“It’ll take a few weeks, but it’ll get there, and it’s definitely needed,” Arjes said. “Otherwise, these patients are driving to Waterloo, Mason City, and that’s a challenge to even get there for them.”