A judge has ordered the Tennessee Board of Nursing to rethink its decision to let a nurse practitioner who wrote “colossal” opioid prescriptions keep her license, saying the board ignored basic rules of evidence during deliberations

Christina Collins, an East Tennessee pain-clinic employee who once prescribed a patient 51 pills a day, was allowed to keep her nursing license with limitations after a medical discipline trial last year.

The Tennessee Department of Health then asked a county judge to overturn this board decision, arguing that Collins’ prescriptions were “so colossal” their only reasonable use was drug trafficking or suicide.

Collins opposed the appeal, but Nashville Chancellor Russell Perkins ultimately sided with the state. In a Wednesday order, Perkins reversed the nursing board’s decision and told them to try again.

INVESTIGATION: This pain clinic nurse gave a patient 51 pills a day. And she kept her license.

Perkins wrote he was swayed by state arguments that the board of nursing had violated rules of evidence by considering information that wasn’t part of the case. On the second day of deliberations, board member Lee Ann Stearns announced that she had researched opioids on the internet and found information that led her to change her mind about the appropriateness of Collins’ prescriptions.

The information Stearns found online was never introduced as evidence. It is still unclear what she read.

“The Court finds that the Board panel’s exposure to extraneous information cannot be considered harmless,” Perkins said in his ruling. “The independent research on which the Board relied was not made part of the record, such that both parties and this Court are left unaware about exactly what extrinsic information the Board panel reviewed.

Stearns, who has since left the board, has declined to comment on the case.

Collins, 44, wrote large prescriptions from 2010 to 2012 while working at Bearden Health Associates, a Knoxville-area pain clinic that state officials have said was a pill mill at the time. As of 2012, Collins was the ninth-highest opioid prescriber in the state.

Collins has admitted during testimony that came to Bearden with no experience in pain management and began issuing prescriptions on her fourth day. She said she prescribed controlled substances to every patient she saw and often wrote prescriptions for patients she never examined.

She prescribed one patient 51 pills a day, with an opioid dosage of more than 31 times the current recommendation of the Centers of Disease Control and Prevention. In another case, Collins prescribed a pain patient to wear three fentanyl patches at once in addition to taking two opioids and three drugs that can be dangerous to mix with opioids.

Collins’ attorney, Eric Vinsant, said he was not prepared to comment when contacted on Friday.

Brett Kelman is the health care reporter for The Tennessean. He can be reached at 615-259-8287 or at brett.kelman@tennessean.com. Follow him on Twitter at @brettkelman.