Should drug diverters be prosecuted?

Nurses General Nursing

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I was just reading an article about drug diverters.

KARE 11 Investigates: Health workers stealing drugs, patients at risk | KARE11.com

According to the article most health care providers caught stealing drugs are not prosecuted in a court of law. A spokesperson for the Mayo Clinic interviewed for the article states that they always pursue legal action when they catch nurses and others stealing drugs.

They discuss several cases in the article where nurses were diverting and endangering patients. Usually, they state, nurses are just put into a program, and do not have to face the legal system.

So what is your opinion, should nurses get a pass on this? They discuss in the article how this is a rampant problem and many nurses slip through the cracks. Would harsher legal consequences deter healthcare workers? Is it fair that healthcare workers get let off the hook while other people stealing drugs get thrown in jail? Does legal prosecution deter anybody? I'm not talking about drug use here but stealing. Is there any difference between a nurse stealing drugs or someone shoplifting?

I have to be honest, I heard of them, but I never actually think I met any. Should they be helped? Should they be prosecuted?

On the other hand... the drug addicts, get their dilauded 2mg q1h, yet they will be running in the hallway chasing the nurse 45 minutes later, "in excruciating pain", threatening her with complain to administration, while they refuse all treatments... and that is all very well alright.

So hmmm no. I don't think we should prosecute diverters, if we do nothing about torturous drug addicts.

People who use narcotics on a regular basis for chronic pain syndromes may well have NO impairment whatsoever. It's not a blanket assertion that narcotics render nurses incapable of providing safe care. I would NEVER use narcotics while nursing because at present, I have no tolerance for them at all (have only used them post op and once when I got the shingles). As my BON states, there are no specific legally prescribed medications that are forbidden for working nurses-it is an individual situation that the nurse and her physician must address carefully and objectively.

Obviously, all that said, if a nurse does have a bad outcome that can be traced to any kind of negligence, the presence of narcotics/benzos, etc., are going to be taken into consideration and could well have terrible results with regard to the nurse's license.

And I agree that tolerance can build up and some can function just fine on narcotics; at the very least, they don't feel impaired, just as many people over the legal alcohol limit believe they can drive just fine.

However, as one who had to go through 5 years of Hades in a monitoring program (following a DUI for a legally prescribed non-narcotic muscle relaxant that had nothing to do with my job other than the fact that, as a nurse, I should have known better than to take it before I got home), I would never in a million years encourage anyone to work while taking controlled medications, prescribed or not. If it's an acute problem, stay home! The judge in traffic court won't care whether it was legal or not--and I'm here to tell you all from hard experience that, whatever is in the newsletter or on the BON website, neither will the Board. Once you appear on their radar, it's not up to them to prove you are/were impaired; it's up to you to prove otherwise. And it takes 2 to 5 years, can make it almost impossible to find a job, and ruin you financially. I am not kidding.

Not meaning to belabor the point, but I am trying to prevent good nurses making bad mistakes that can cost them their careers; if it can't wait until you get home, you shouldn't be at work in the first place. Sorry.

As for OP's original question, no, nurses shouldn't be prosecuted for diverting. The court will probably be much more lenient--at least for a first offense--than any Board monitoring program. Trust me.

If the reason for prosecution is about theft, it has to be because the meds taken aren't available without a script, which is a federal offence. If the drugs are being taken to sell I say prosecute to the fullest extent, those people are worse than drug dealers and deserve to rot in jail forever. If the drugs are to support a habit though, I say sincere expression of the desire to go to rehab and get better should allow for a free pass from prosecution but I don't think a future career in nursing should be an option. I think the penalty should be loss of nursing license forever.

I admit I don't know all the states' particular practice acts, but I do know that, in the two states I lived in while being monitored, those who clearly diverted in order to sell are not eligible for monitoring programs.

As for nurse-addicts, the whole idea of diversion programs was to prevent them from losing their licenses forever. Yes, they're flawed; aren't we all? Besides, why throw out the baby with the bathwater? Because if you can get through the monitoring program, you deserve a second chance.

One more thing: The strongest, most dedicated, most honest people I ever met were in my NA group. Recovery ain't no joke--it's the hardest thing you'll ever do, but most of the people there were there of their own free will, doing it. It was really humbling. So yes, addicts can do awful things; but if they come out the other side, they turn out to be amazing people.

Specializes in Critical care.
What is the reason hospitals avoid reporting to the police, do you all think? Is it just too much trouble to help build a case? Other workers might be called to testify. It might bring bad publicity and cost the hospital money as well.

I doubt it's out of concern and mercy toward the nurse.

As you can see from many of your replies some softhearted fools feel this is an illness. This is why few are prosecuted, we actually had an ER tech smoke meth on site, when caught he claimed it was a disease, and needed treatment. HR had their hands tied and had to send him in for treatment, he passed his rehab, came back to work, and was actually caught smoking meth in the ambulance bay of the hospital. Put them all in jail in my opinion.

I am sure I am about to get flamed ... flame on!

Cheers

Specializes in ER.

It costs a lot of taxpayer money to keep people incarcerated, there's that to consider...

Specializes in CRNA, Finally retired.
As you can see from many of your replies some softhearted fools feel this is an illness. This is why few are prosecuted, we actually had an ER tech smoke meth on site, when caught he claimed it was a disease, and needed treatment. HR had their hands tied and had to send him in for treatment, he passed his rehab, came back to work, and was actually caught smoking meth in the ambulance bay of the hospital. Put them all in jail in my opinion.

I am sure I am about to get flamed ... flame on!

Cheers[/quote

What kind of monitoring program would a non-nurse be in? Most of the posters here seem pretty ignorant about how state diversion programs for nurses and who is even eligible to quality for an alternative program. The success rates for nurses are well above recovery rates for non- nurses. Recreational drugs are rarely seen among nurses. The large majority get hooked on prescription opiods for work-related injuries.

Many if them decide to take jobs with no access ti narcotics after restrictions are lifted. So for those if you just reacting here without knowing what you're talking about, go to your SNA and check out their monitoring programs and get educated. Or go work for Trump and get out if nursing.

Diverters definitely need to be prosecuted. There aren't many crimes a nurse can commit that are worse than taking meds from their patients. It is the highest betrayal of your oath and your profession. Call me harsh but I don't think people who are caught doing it should continue to be nurses. I know drug addiction is a disease and we are supposed to be " forgiving" and "supportive" but this is one crime that should not be forgiven or tolerated in this profession EVER

Specializes in CRNA, Finally retired.
Diverters definitely need to be prosecuted. There aren't many crimes a nurse can commit that are worse than taking meds from their patients. It is the highest betrayal of your oath and your profession. Call me harsh but I don't think people who are caught doing it should continue to be nurses. I know drug addiction is a disease and we are supposed to be " forgiving" and "supportive" but this is one crime that should not be forgiven or tolerated in this profession EVER[/QUOT

We used to take them from work in handcuffs in the 70's. Accomplishes nothing. No treatment, no recovery, no education. When we DON'T treat it as a medical dx., then no one reports anyone because they don't want to see a colleague

lose their license forever or go to prison. With that kind if fear if reporting, the staff operates with a high level if denial and don't put two and two together until late in the disease. The fact us that nurses in programs tend to be better educated and job focused (until late) than the their non-addict colleagues. They're more willing to pop a pain pain than call in sick. I hope you don't treat your patients as judgementally as you treat your peers at work. And, I hope you're still very young

and educable.

im going to read my nurse practice act more closely. I have never heard of a nurse not being Able to take a prn opioid when he or she is off the clock if it is prescribed and indicated. I know that a nurse mustn't be under the influence of any mind/judgment altering substance while he or she is working under their license and caring for patients. For example- if a nurse has his/ her wisdom teeth removed, she can take ibuprofen and acetaminophen while at work, but when she is home, why shouldn't she be able to control her pain more with an opioid if it is prescribed to her and is indicated? Maybe I misread your post.

They take them all the time and sometimes prescribed in the hospital they work. If you need it, you get it---just don't go to work, and stop as soon as possible. Pain does not discriminate.

When someone diverts, they are probably breaking more laws than just theft.

For example, they remove 2 percocets from the Pyxis, but only give 1 to the patient. They pocket the other. Insurance/Medicare/Medicaid will be billed for 2 percocets, but the patient received 1. That is fraud.

The nurse would have to chart that they gave 2 percocets to make all the counts correct. Now they have falsified a legal document.

Another way of diverting is to inject a partial dose into themselves. Add saline to the syringe to make it appear to be the correct dose. Then give the remaining dose to the patient. Now they have possibly exposed the patient to a blood borne illness. That could be viewed as assault.

A local 600 bed hospital has a diversion specialist (JD, RN). I heard her speak on diversion and that hospital's methods of detecting theft/loss of controlled substances. She described how they investigate suspected diversion. They have solid evidence before they confront someone. She said they have only had a couple of people who didn't confess when shown the evidence the hospital had.

She said when they first hired her and implemented their diversion program, they were catching 2 nurses a month. Now they average 1 nurse a month. I was shocked it was that high, but it is probably only 1-2% of their nurse workforce so actually not that high.

(Other types of employees divert not just nurses. The majority of people caught diverting are nurses, because nurses vastly out number other type of employees and nurses have greater access to controlled substances than most others.)

That hospital's policy is they report every single case of diversion to:

the local police

the state bureau of investigation

the board of pharmacy (required by state law)

the professional board (required by state law)

the DEA (required by federal law)

They also revise and rebill every patient affected even if it doesn't affect the bill (e.g. DRG).

They report to the police and let the DA decide whether to pursue charges. The DA usually lets the professional licensing board handle it unless there is patient harm. They had one case where a PACU nurse was diverting. They determined they had over 300 patients who had received NO pains meds following surgery. The DA prosecuted that nurse.

I agree with the approach of reporting to law enforcement cases of diversion, because it is a crime. Let the DA decide if they think prosecution is appropriate. If someone has a substance abuse problem, but is not diverting then just report them to the appropriate professional board. Diversion is different.

The diversion specialist said the number 1 reason hospitals don't report diversion to the police is fear of bad publicity. Also high on the list is fear of being sued.

Prosecuting people for diversion is just not helpful. It would be better that the BON deal with them. Restrict them to jobs that do not include narcotics. I am tired of the tax payors being responsible for useless prosecutions, but no adequate rehab. That sentiment applies to everyone, including non-nurses. We have more people in the judicial system than the populations of some whole countries. I am out of money. Let's be creative and not punitive. Remember, an alcoholic nurse or doctor is more likely to cross paths with patients than the employee diverting drugs.

There are so many different ethical issues bubbling around in this thread. It's very interesting to see all the divergent opinions. Thanks for sharing.

IMHO, the intent of drug diversion needs to be factored in to any decision about consequences. Nurses who are stealing drugs for further distribution need to be treated differently than those who are diverting for self-medication. The former should always be prosecuted but the latter should be treated for their addiction.

I believe that if any patient harm was involved - e.g. substitution of saline for pain med resulting in under-medication - this reflects a deliberate decision by the nurse and should incur significant consequences, including loss of license.

But I also believe that ALL clinicians should be treated the same. In most states, there is a vast difference in the way nurses are treated as opposed to physicians or pharmacists. Just sayin' . . .

"the intent of drug diversion needs to be factored in to any decision about consequences"

Disagree. A controlled substance has been stolen from the facility.

That is theft. The same theft as walking out the door with a TV. It is a deliberate decision.

Who cares if the thief is diverting to treat a personal medical issue?

If someone steals from ME.. I do not give a rat's patootie if it is to treat their drug addiction. They will be prosecuted.

Specializes in ER.
"the intent of drug diversion needs to be factored in to any decision about consequences"

Disagree. A controlled substance has been stolen from the facility.

That is theft. The same theft as walking out the door with a TV. It is a deliberate decision.

Who cares if the thief is diverting to treat a personal medical issue?

If someone steals from ME.. I do not give a rat's patootie if it is to treat their drug addiction. They will be prosecuted.

You make an excellent point there. A lot of the theft that happens in stores is to feed drug habits. Should we then excuse people who break into stores or houses? What about shoplifters? Should they be let off the hook and sent to rehab if drugs were the motivation for their crime?

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