A Montana nurse accused of stealing opiates from multiple healthcare facilities in 2021 admitted to criminal charges. The government alleged in court documents that the nurse diverted opiates in 2021 while working at three facilities. In June 2021, a community hospital manager reported the theft of oxycodone tablets from the hospital. The hospital’s records reflected the loss of 392 oxycodone pills over the previous three months. The records showed that the nurse routinely pulled oxycodone from the pharmacy but did not document the administration of that drug to her patients. A review of 50 patient files showed that she did this on 49 occasions. Several patients confirmed they never received that drug. When management confronted the nurse, she denied stealing controlled substances but quit shortly after the meeting.
In an interview with a police department detective, she again denied any diversion and claimed the hospital was retaliating against her, criticized its training program, and stated that another nurse would confirm the lack of documentation for the administration of drugs. The detective spoke with the nurse she identified and other hospital employees. All said they were required to record when controlled substances were given to patients, and that it would be extremely rare for someone to fail to enter that information.
Another diversion occurred in October 2021 at an assisted living center where she worked as a traveling nurse. Only three individuals, herself included, had access to narcotics at that time. The director provided records for the missing drugs, which included 26 hydrocodone and 80 oxycodone tablets. Several medication logs had been torn out, many drugs had been marked “destroyed” with no nurse signature as required, and at least two patient files had been improperly altered. Management then announced a drug screening, and most nurses provided urine samples, which were all negative for the diverted drugs. She did not submit to the drug test and did not return to work at that facility.
A third diversion occurred in November 2021 at another assisted living facility. The director of nursing advised that a drug count on November 21, 2021, determined 52 oxycodone and 27 morphine tables were missing. And on Nov. 23, 2021, a drug count determined 115 oxycodone and 60 hydrocodone pills were missing. The director then requested urine samples from the staff working those dates. All complied and tested negative except for the nurse in question, who initially refused and left the facility. Her employer then contacted her and instructed her to provide a sample. She returned to the facility several hours later and requested a specific bathroom for the drug test. When she provided the sample, it was cold, and the result was inconclusive because the temperature was not within the approved testing range. In addition, patient logbooks for the two dates included pages that were crossed out, folded over, and not signed as required by policy. She was the only person with access to the medication cart on both days.
Issue:
Failure to prevent diversion of residents’ prescribed controlled medications by staff who sell or take the drugs for their personal use may be considered abuse, neglect, misappropriation, and fraud, in violation of state and federal regulations. Staff who divert medications have developed a number of ways to conceal diversion. Facilities should implement a proactive diversion-prevention program which identifies the types of medications most likely to be taken, signs that diversion has taken place, and signs of impairment.
Discussion Points:
- Review your policies and procedures on preventing, identifying, and responding to drug diversion. Update as needed.
- Train appropriate staff on actions that can be taken to prevent, identify, and respond to any suspicion of drug diversion. Provide education on the impact of drug diversion on residents as a form of abuse and neglect, staff responsibility to report concerns immediately, and the consequences of theft of controlled substances. Document that the trainings occurred, and place the signed document in each employee’s education file.
- Periodically audit to ensure that all controlled substances are accounted for each shift, and that proper documentation of controlled substances has occurred. Your consultant pharmacist can be included in this effort.
