“If this can happen at Mass General, it can happen anywhere”

Steve Langan, director of HONOReform
Steve Langan, director of HONOReform

Last week, in a blog I wrote on the patient notification in Utah, a situation that is directly related to drug diversion, I mentioned the recent fine levied against Massachusetts General Hospital by the Drug Enforcement Agency.

If this can happen at Mass General, many of us thought, it can happen anywhere. And, sadly, it does.
Among the many acts of drug diversion mentioned in the Settlement Agreement, which is part of the public record, are incidents that involve improper use of injections.

Here is the entire article from the September 28 Boston Globe: “Mass General to pay $2.3 million toresolve allegations of drug diversion,” written by staff writer Travis Andersen.

Massachusetts General Hospital will pay a record $2.3 million settlement to the federal government to resolve allegations that its lax control over the facility’s drug supply allowed employees to steal thousands of pain pills, authorities said on Monday.

“Diversion of these drugs feeds addiction, contributes to potential illegal drug sales, and fuels the opioid epidemic that has had a devastating effect on the Commonwealth,” US Attorney Carmen M. Ortiz said in a statement. “We commend MGH for disclosing and addressing its diversion problems and for taking steps to ameliorate future diversion by hospital personnel.”

Ortiz’s office said the settlement is the largest amount ever paid for a case involving alleged drug diversion, or the use of substances for nonmedical purposes, at a hospital.

According to the settlement agreement, one nurse identified as J.S. stole 14,492 pills, and a second nurse, identified as J.S., pilfered 1,429 tablets.

The thefts occurred between October 2011 and April 2015, and most of the pills were the prescription painkiller oxycodone, officials said.

“MGH did not discover J.S.’s actions until she had been stealing for an entire year — even though she sometimes appeared high to co-workers and other times was seen falling asleep at work,” the agreement said. “MGH failed to report these diversions to DEA [Drug Enforcement Administration] within one business day as required” under federal law.

Ortiz’s office said authorities began investigating the matter in 2013, after the hospital informed the DEA that two nurses had stolen large amounts of controlled substances.

In a written statement, Mass General said drug diversion is a challenge for the health care industry nationwide, and that hospital officials are “confident that no patients were harmed by this misconduct and that all patients in need were given the drugs they were prescribed.”

“We are committed to ensuring that this does not happen again in the future,” Mass General said, adding that the pill count discrepancies represented less than 1 percent of the total drugs dispensed during the relevant period at the hospital.

Ortiz’s office said Mass General has developed a detailed plan to strengthen controls over its drug supply, including the “establishment of an internal drug diversion 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.”

The plan also includes “enhanced diversion monitoring by supervisors and management; annual external audits to ensure compliance with [federal law]; and increased physical controls of controlled substances, including limiting and monitoring access to automated dispensing machines through fingerprint identification,” prosecutors said.

Additional instances of drug misconduct cited in court papers included a doctor, identified as E.P., repeatedly prescribing medications to patients without seeing them or maintaining medical records, and nurses identified as M.B., M.M., and R.C., who stole substances.

Court papers indicate that R.C. “had a substance abuse issue off and on for the past twelve years.
“He was found sleeping at work, unsteady on his feet, and with slurred speech. He admitted diverting Dilaudid, a Schedule II drug, and injecting himself at work.”

The settlement did not indicate whether any of the employees cited for misconduct were fired or charged criminally, and neither the hospital nor Ortiz’s office would elaborate.

According to court records, E.P., the doctor, surrendered his federal license to prescribe drugs in 2014.
The hospital said in its statement that all employees referenced in court papers were reported to the state Board of Registration in Medicine, which oversees doctors, or the Board of Registration in Nursing and “offered treatment for their addiction.”

“Employees who successfully complete treatment may return to their clinical work under increased supervision, including random drug tests,” Mass General said.

Michael J. Ferguson, who heads the New England Division of the Drug Enforcement Administration, said in a statement that his agency is “committed to investigating hospitals that are not in compliance with the Controlled Substances Act.”

“The diversion of prescription pain killers, in this case oxycodone, contributes to the widespread abuse of opiates, is the gateway to heroin addiction, and is devastating our communities,” he said.

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