In the largest settlement of its kind involving allegations of drug diversion at a hospital, Massachusetts General Hospital (MGH) in Boston has agreed to pay the United States $2.3 million to resolve allegations that lax controls enabled MGH employees to divert controlled substances for personal use. MGH voluntarily disclosed the diversion.
MGH also has agreed to implement a comprehensive corrective action plan to address future diversions, U.S. Attorney Carmen M. Ortiz, JD, announced. “Under the law, hospitals like MGH have a special responsibility to ensure that controlled substances are used for patient care and are not diverted for non-medical uses,” Ortiz said.
In 2013, an investigation was launched after MGH disclosed to the Drug Enforcement Administration (DEA) that two of its nurses had stolen large volumes of controlled substances. The two nurses stole nearly 16,000 pills, mostly oxycodone. Both nurses stole from automated dispensing machines.
DEA’s ensuing audit of MGH’s controlled substances revealed count discrepancies totaling more than 20,000 pills, missing or incomplete medication inventories, and hundreds of missing drug records. MGH cooperated with the DEA’s investigation and subsequently disclosed additional violations of the Controlled Substances Act (CSA). Specifically, MGH disclosed the following:
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a pediatric nurse with a 12-year substance abuse problem had injected himself with Dilaudid at work,
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a physician had prescribed controlled substances for patients without seeing them and without maintaining medical records,
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several nurses were able to divert prescription drugs for many years without being detected, and
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medical staff had failed to properly secure controlled substances and even had brought them to lunch on occasion.
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The corrective action plan that MGH accepted includes the establishment of an internal drug diversion prevention team; the creation of a full-time drug diversion compliance officer position; mandatory training of all staff with access to controlled substances, including on how to identify the signs and symptoms of substance abuse; enhanced diversion monitoring by supervisors and management; annual external audits to ensure compliance with the CSA; and increased physical controls of controlled substances, including limiting and monitoring access to automated dispensing machines through fingerprint identification.
Over the past decade, outbreak investigations have documented more than 100 infections and nearly 30,000 potentially exposed patients stemming from drug diversion in U.S. healthcare facilities, a CDC study reveals.1 Of course, diverted drugs are frequently painkillers, meaning patients can suffer both the injury of infection and the insult of painful care. (See Hospital Infection Control & Prevention, June 2015).
As disturbing as those factors are, it should be noted that while protecting patients is paramount, there is an employee health issue: the addicted healthcare worker. For example, nurses emphasize the ethical obligation to try to get their addicted colleagues into treatment: “Drug diversion is a symptom of the disease of addiction …a treatable disease.”2
Encouraging healthcare workers with an addiction problem to seek treatment may be one of the best ways to save a caregiver’s career before the disaster of an outbreak — the event that typically reveals the diverter.
REFERENCES
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Schaefer, M.K., Perz, J.F. Outbreaks of infections associated with drug diversion by US health care personnel. Mayo Clin Proc 2014;89: 878–887.
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Tanga HY. Nurse Drug Diversion and Nursing Leader’s Responsibilities: Legal, Regulatory, Ethical, Humanistic, and Practical Considerations. JONA’s Healthcare Law, Ethics, and Regulation 2011;13:13-16.
