Learn how to tell if your healthcare provider is using and what to do to safeguard yourself.
By Cathy Cassata
Imagine going in for a routine kidney stone removal. The surgery goes as expected, and all seems well, until several weeks later you start feeling so ill that you rush to the emergency room, where you discover that you’ve caught the potentially deadly liver disease Hepatitis C.
This was Lauren Lollini’s terrifying reality in 2009. “I had no idea what Hepatitis C was. When I saw a specialist a few days later, we went over the risk factors and it just didn’t make sense. I had gotten a tattoo years before but had given blood many times since then so it was kind of a mystery how I could have gotten it,” said Lollini. “The only thing that seemed like a possibility was that I had surgery a few weeks before. I asked the doctor if I could have caught it then. He said ‘maybe’ and just kind of dismissed the notion.”
But several weeks later, Lollini’s suspicion was confirmed when the Colorado Health Department informed her that an addicted surgical technician, Kristen Parker, who worked at Rose Medical Center in Denver where Lollini received surgery, was arrested for stealing fentanyl laid out in operating rooms in preparation for surgery. Despite having Hepatitis C, Parker would inject herself with the fentanyl that was intended for patients and then refill the same syringes with water or saline solution, leaving the patients without the intended medication and exposed to Hepatitis C. Parker infected 24 people with Hepatitis C between the Fall of 2008 through the Spring of 2009.
Parker’s act of stealing drugs is called “drug diversion,” and it's an issue that’s happening more than you might think. Alarming research revealed by USA Today in April 2014 stated that more than 100,000 doctors, nurses, technicians and other health professionals struggle with substance abuse or addiction.
WHY IS DRUG DIVERSION SUCH A PROBLEM?
Kimberly New, JD, BSN, RN, president of the Tennessee chapter of the National Association of Drug Diversion Investigators, which aims to educate healthcare providers and law enforcement on investigation, prevention, detection and resolution of drug diversion cases, says the nature of the job plays a part. “Healthcare providers have a high stress profession whether they’re a physician, nurse, radiology technician, lab technician or other provider. They see patients die and experience a lot of vicarious trauma. Many have compassion fatigue, and physical injuries because of the actions that they go through in the course of their job - lifting patients, turning patients, etcetera,” she explained. “A recent nurse I found diverting said he started using because the medication he was taking for back pain from lifting patients wasn’t cutting it anymore.”
Still, New says the number one factor in healthcare diversion is access and availability. “Controlled substances are right there at their fingertips. People find ways to access these drugs that are in the facility where they work. If they have access to the medicine cabinet, that makes it easier, but we find other providers who figure out ways to divert even if they don’t have that access,” said New.
HOW ARE PATIENTS HARMED?
Cases like Lollini’s are the most dangerous instances of drug diversion and the hardest for the patient to detect in the situation. “Since Lauren was unconscious, there was no way for her to suspect something was wrong. Becoming educated on the topic is patients’ first line of defense,” said New.
The first thing to know is that nurses are the number one healthcare provider population who have regular access to controlled substances and who have a job responsibility to administer controlled substances. New says patients can be harmed in the following three ways by an impaired nurse or other healthcare provider in a similar role:
Tampering and substitution. Like Lollini’s experience, this is when a provider will remove a controlled substance from a syringe or vial, inject themselves with the substance, and then replace it with water or saline. “The patient doesn’t get the medication they were supposed to, and is also potentially exposed to blood borne pathogens that the diverter has. It’s like sharing needles,” stated New.
Delivery of care in an impaired state. Nurses who divert are often times in intensive care or emergency care settings. “These are critical care environments where they need to be making succinct decisions and may not be capable of doing that if they’re impaired. This really puts patients at risk when they need immediate and attentive care,” New said.
Withholding medication from patients in need. In these instances, the provider simply doesn’t give a patient the medication they need and instead steals the medication or takes the medication for themselves. “They place their addictive needs above those of the patient, leaving the patient untreated and possibly in pain,” stated New.
HOW CAN PATIENTS PROTECT THEMSELVES?
Prior to seeing a provider, New suggests checking with his or her state medical board (for physicians) and licensing boards (for nurses) to find information regarding any recorded disciplinary issues against the provider. “Also visit social media sites that offer reviews of providers. And if you’re having surgery, ask who is going to be involved with your care,” she said. “Patient care in an institutional environment has changed a lot. Years ago there was this blind faith in physicians, and patients just trusted them to do the right thing. Patient care has become much more consumer-based and really it’s the patients that are advocates for themselves, and are empowered to ask questions.”
If having a procedure, New says always have an advocate with you. “During recovery, this person can watch as medication is administered and can be a presence so the provider knows you’re not alone,” she said.
The Centers for Disease Control and Prevention’s Only One Campaign, which aims to educate on safe injections, suggests that patients (and advocates) ask healthcare providers the following questions before they receive an injection:
Will there be a new needle, new syringe, and a new vial for this procedure or injection?
Can you tell me how you prevent the spread of infections in your facility?
What steps are you taking to keep me safe?
Speaking up about pain management is another way to protect yourself. “Sudden unrelieved pain from methods that previously worked is something to address right away. For instance, if a patient is getting morphine and it’s working great and then one particular day it’s suddenly not working, that’s when you need to tell someone,” said New, adding that you should tell a supervisor, not the nurse in case the nurse is diverting. “Pain during procedures should be expressed immediately. There was a case in Minnesota where a CRNA, who is usually the person delivering the anesthesia, told the patient that he needed to ‘man up’ prior to his procedure. He nearly jumped off the table as the surgeon made the incision. The CRNA was diverting the patient’s pain meds.”
When it comes to providers you already know, New says it can be difficult to notice if they’re using because often times providers who are diverting don’t always fit the stereotypical profile of somebody who’s a drug addict. “Many are very high achievers and enormously liked by everybody. Often times they’re even award winners, and receive many compliments from patients. The drugs they take can give them a state of euphoria, allowing them to super perform for a time. Over time, they will spiral downwards if they’re allowed to continue to divert,” she said.