A 32-year-old registered nurse (RN) who worked at two Massachusetts long-term care (LTC) facilities, recently pled guilty to one count of tampering with a consumer product and one count of acquiring a controlled substance by fraud or deception.
On March 17 and 18, 2019, while working as a registered nurse at a LTC facility, the RN tampered with morphine sulfate prescribed to an 89-year old hospice patient. To avoid detection, she replaced the extracted medication with another liquid, diluting the morphine to just 26% of its prescribed concentration. The hospice patient received the diluted morphine and suffered unnecessary pain.
Prior to the previous drug diversion incident, the RN worked at another LTC facility where it was discovered she diverted morphine from two bottles that were prescribed to a 68-year old patient. As in the previously described drug diversion incident, the nurse removed morphine from the bottles and diluted the remaining morphine with another liquid, leaving only 1.2%-2.5% of the declared concentration of morphine. The nurse tested positive for morphine on July 18, 2017 and was apparently dismissed.
The charges provide for a sentence of up to 10 years in prison, three years of supervised release, and a fine of $250,000. Sentences are imposed by a federal district court judge based upon the U.S. Sentencing Guidelines and other statutory factors.
Compliance Perspective
Issue
Failing to prevent diversion of controlled pain medications by a nurse who then administered a diluted substance to residents may have caused unnecessary suffering and risk, which could be considered abuse, neglect, and exploitation in violation of state and federal regulations. The facility may not be adequately screening personnel prior to employment since this nurse previously committed the same type of drug diversion at another facility.
Discussion Points
- Review policies and procedures regarding the facility’s system for securing controlled substances and the screening used to ensure that individuals with a history of drug diversion and addiction are not employed.
- Train staff regarding the facility’s protocols for preventing drug diversion and tampering with controlled substances. Also provide education about abuse, neglect, and exploitation, and how to report suspected incidents to a supervisor or through the facility’s Hotline.
- Periodically audit the medication log used to reconcile the dispensing of controlled medications to ensure there is no evidence of drug diversion or tampering. Periodically interview residents receiving narcotic pain medications, asking about their level of pain relief and any related concerns.
FOR MORE INFORMATION ON THIS TOPIC view: DRUG DIVERSION – WHAT EVERY NURSING FACILITY NEEDS TO KNOW
