John Burke, commander of the Warren County, Ohio, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad, is a 40-year veteran of law enforcement. Cmdr Burke also is the current president of the National Association of Drug Diversion Investigators. For information, he can be reached by e-mail at firstname.lastname@example.org, via the Web site www.rxdiversion.com, or by phone at 513-336-0070.
An issue that has been addressed in this column on more than one occasion is the diversion of controlled substances from health facilities. I am usually discussing not only the horrors that can occur in our nation’s health facilities, but the common practice of those criminal acts not being reported to law enforcement or even regulatory boards. Unfortunately, many times the practice is to dismiss or accept the resignation of the violating health professional. This opens the door for abuse at the employee’s next facility and fails to address the underlying cause–addiction.
A June 2009 report of a Colorado hospital, however, provides an example of a health facility acting properly, resulting in a federal indictment. In November 2008, Boulder Community Hospital announced its discovery– over just a 1-month period–of 108 instances of theft and tampering with fentanyl vials taken from automated dispensing equipment for patients undergoing surgery.
A 27-year-old nurse who had been removing the fentanyl from the vials and replacing it with saline was indicted. This practice, often referred to as substitution, represents the most egregious act in health facility diversion. More than 350 patients potentially were involved, and the investigation started when anesthesiologists became aware that surgical patients did not appear to be receiving enough pain medication.
The report also noted that the individual had only started working at the hospital in June–just 4 months prior to the time the diversion was discovered. Because substitution suggests a hardened method of diversion and fentanyl is a very potent painkiller, I couldn’t help but wonder if he had been employed before, what his experience had been, and if by chance he was dismissed previously for similar reasons. It would be difficult to imagine that this addiction started at Boulder Community Hospital, and in a 2-month period, he began tampering and substituting saline for fentanyl in the surgical department. If the more likely scenario is true, what reporting did his former employer do, if any?
What I don’t want readers to miss is the positive behavior of Boulder Community Hospital. I am commending a hospital for doing what should be routine in this country but unfortunately is not. Officials there suspected drug diversion; they conducted an investigation that led to the indictments against a nurse who had committed scores of crimes against innocent patients. This created the kind of media attention no health facility wants; nevertheless, the hospital demonstrated the backbone to do the right thing and report the illicit behavior to authorities.
It is impossible to know how many innocent patients Boulder Community Hospital kept from being in pain–or even costing them their lives–by simply doing what the law requires and what was right. The nurse has been removed from his livelihood, and I am sure if he has not already, will undergo extensive drug rehabilitation. He will not be merely dismissed or resign from a health facility only to show up at another unsuspecting hospital, jeopardizing the treatment of unsuspecting patients.
Because of the hospital’s diligence, this story has a happy ending, but it is an ending all too often missing in health facilities across the country. My hope is that other health facilities will take note of Boulder Community Hospital’s example and follow its lead when drug diversion issues rear their ugly heads in their hospital or nursing home.
It is not a matter of if substitution will happen in other facilities, but when. Prevention measures and diligence are essential, but acting swiftly and reporting acts of drug diversion to authorities are the ultimate ways to reduce this horrible crime and try to salvage an addict’s life at the same time. â–
The Oncology Care Pharmacist in Health-System Pharmacy
According to the National Cancer Institute, almost 40% of men and women will be given a diagnosis of some form of cancer in their lifetime.
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