Theft of drugs is serious problem, putting patients, hospitals at risk
Theft of drugs is serious problem, putting patients, hospitals at risk
Doctor had been treated, convicted and still credentialed by hospital
Despite background checks and lengthy credentialing processes, drug abuse by physicians remains a stubborn problem in hospitals throughout the country. As one incident last year involving an anesthesiologist shows, hospital risk managers postpone implementing drug abuse policies at the risk of patients and hospitals alike.
A Pennsylvania anesthesiologist sentenced earlier this year to 10 to 23 years in prison for stealing pain medication from patients going into surgery is a frightening example of what happens when doctors are addicted but it’s not the only one. Addicted anesthesiologists aren’t all that rare, and chances are good that one eventually will pass through your hospital.
Frank Ruhl Peterson, MD, a 45-year-old anesthesiologist from Hazleton, PA, stole drugs from patients who then underwent surgery with almost no anesthetic and may have suffered excruciating pain. The case is a perfect example of the risk posed by drug-abusing hospital employees and physicians, say risk managers.
Peterson could have been sentenced to up to 54 years for assault and other offenses connected to 12 operations at Hazleton-St. Joseph’s Medical Center in Wilkes-Barre, PA. He worked at the hospital from June to August 1996 and was assigned to approximately 200 surgical procedures. He was employed by a local anesthesiology group and credentialed at the hospital.
Several patients have complained of unbearable pain during surgery, including fully sensing the scalpel cut as the procedure began. Hospital officials say the patients did not complain until lawsuits were filed, but court papers say surgery had to be stopped in several instances and included statements from patients who had suffered through the surgery while paralyzed from medications but feeling almost all the surgery sensations. The procedures included several Cesarean sections and spinal procedures. Hospital officials would not discuss the patients’ claims or confirm that surgery was stopped.
Sometime in August, acting on the "suspicions" of operating room personnel, hospital officials sent two intravenous drug bags recovered after surgery for lab analysis. The lab reported that the drug mixtures, both prepared by Peterson, contained no more than trace amounts of the necessary painkillers. Further investigation determined that Peterson had been stealing anesthetic agents from patients so his own use would be covered by a legitimate paper trail showing the drugs were used in surgery.
The hospital’s investigation also revealed that the doctor had requisitioned more narcotics than had other anesthesiologists and had not fully accounted for some drugs he received. At the same time the hospital sent the medication bags for testing, Peterson was forced to provide a urine sample. The sample tested positive for Sufenta, methadone, and Prozac. Sufenta is a particularly addictive narcotic.
After being suspended by the hospital in August, Peterson reportedly used a retained key to enter the hospital and steal more drugs. Local police arrested him soon after, and he pleaded guilty Jan. 30 to burglary, theft, assault, and obtaining illegal drugs. The court determined that he stole $4,022 worth of drugs directly from the hospital, in addition to what he stole from patients in surgery. He was sentenced Feb. 25.
Doctor had a criminal record
During his arraignment, Peterson told the court that he had previously been arrested in Massachusetts, California, New York, and Ohio for various crimes including drug possession, kidnapping, and assaulting a police officer. Hazleton Police Detective Edward Harry investigated the allegations against Peterson and tells Healthcare Risk Management that the anesthesiologist had been convicted on "quite a few of those charges. He has an extensive criminal history."
Officials at Hazleton-St. Joseph’s Medical Center did not know of the doctor’s criminal record, but they were aware of his past drug addiction. (See p. 39 for details on the hospital’s reaction to the crime.)
Though hospital officials dispute patients’ legal claims that they suffered excruciating pain during surgery, the police detective says that indeed there were complaints from patients before Peterson’s involvement was discovered and charges were brought. Harry says the patient complaints were among the first signs of trouble, and hospital officials investigated after detecting irregularities in the facility’s controlled substance records that were traced to Peterson.
Crime fits the pattern of hospital drug theft
The anesthesiologist’s crime in Pennsylvania is shocking but not surprising, says Jeffrey Driver, ARM, corporate risk manager for Children’s Hospital and Health Center in San Diego. He notes that drug abuse by hospital employees and physicians is a well-known problem and requires safeguards. Drug abuse and theft can occur with any employees or physicians, but anesthesiologists are at higher risk because of their unique access to and familiarity with the drugs.
"They manipulate the consciousness of patients on a daily basis, so they extend that to their personal lives," he says. "If they need to be up, they find a way to be up. If they need to be down, they find a way to be down."
Denny Thomas, director of risk management for St. Joseph’s Hospital in Marshfield, WI, agrees. (The hospital has no connection to Hazleton-St. Joseph’s in Pennsylvania, where the crime occurred.) He recently helped develop a corporate policy on impaired health care providers, and he tells HRM that "the problem is very real. The impaired health care provider is a reality."
Versed and morphine seem to be commonly abused and stolen drugs in health care settings, but any frequently used drugs may be targeted. The more a drug is used for legitimate purposes, the less likely the system will catch a diversion of that drug, experts say.
Doctors and nurses who steal drugs usually do so for their own use, but they also may steal them for friends or sell them. They tend to give more medications than others, volunteer to give medications to patients, and they may have higher rates of breakage and waste. They also may be seen going to the bathroom or lounge soon after medicating patients.
Drug thieves also tend to order the maximum allowable dosage of medication for patients, keep most of it for themselves, and give patients only a minimal amount. The records show patients are being fully medicated, but the patients still may complain of incomplete pain relief. Among physicians, including anesthesiologists, drug abuse and theft are more common among residents and younger practitioners, health care experts say.
The fact that the problem is widespread means that hospitals and other facilities have a strong obligation to discourage and detect drug theft. Driver’s facility has had some experience with drug abuse, though nothing as dramatic as the Pennsylvania case, so the hospital has extensive policies and procedures to address the issue. (See p. 40 for suggestions.)
He points out that a facility probably will be held liable for any patient injury, including pain and suffering, that arises from drug theft or mistakes attributed to a drug-using employee. The connection to the facility is more direct if the culprit is an employee, but the hospital is not off the hook if the abuser is a non-employee physician. A court or jury is still likely to find that the facility had some responsibility for preventing or detecting the problem.
It is no surprise that patients are suing the Pennsylvania hospital for the trauma of undergoing surgery without proper anesthesia, Driver notes. The claims will create a special burden for the hospital because the notion of undergoing surgery without anesthesia is especially sensational and would have quite an impact on a jury or judge.
"It would be a very difficult case," Driver says. "The less you have done to deal with the problem ahead of time, the more your exposure grows. You are really vulnerable for punitive damages if you have no policies and procedures in place to deal with this problem."
Encourage users to come forward
Thomas cautions that risk managers must strike a balance between a hard-nosed, aggressive approach to rooting out drug abusers and the more understanding and helpful approach that will encourage them to come forward on their own.
"You don’t want to drive the problem even deeper underground than it already is," he explains. "We see it as a health care disorder, and we use an approach that makes people more willing to come forward and ask for help without fear of losing their jobs."
A strong employee assistance program is a key part of that system. While impaired health care providers must be removed from patient care immediately, immediate dismissal may not be the best response.
Employers also must provide a safe way for health care professionals to report suspicions that someone is using or stealing drugs.
"Employees often know a lot more about who is impaired than management, just because they are on the floor working beside them every day," Driver says. "But they’re often afraid to come forward because they fear retribution, especially if the impaired provider is someone of much higher stature in the organization. You have to provide confidential ways to report those problems and assure people they won’t be punished for it."
For more information, contact Jeffrey Driver, Corporate Risk Manager, Children’s Hospital and Health Center, 3020 Children’s Way, MC 5071, San Diego, CA 92123-4282. Telephone: (619) 495-4980.
Or contact Denny Thomas, Director of Risk Management, St. Joseph’s Hospital, 611 St. Joseph Avenue, Marshfield, WI 54449-1898. Telephone: (715) 387-7366.
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