One Massachusetts nurse says she routinely took pain medication from her patients at nursing homes. But it wasn't until she faced criminal charges of drug theft and patient abuse, and had racked up 10 complaints at 10 nursing homes in just 14 months that the state suspended her nursing license. http://www.boston.com/dailyglobe2/11..._on_job+.shtml
State board slow to act in hundreds of cases
By Alice Dembner, Globe Staff, 4/21/2002
It became nearly as routine as checking a pulse. As Karen Burke made her rounds in one nursing home after another, she would stroll into a patient's room, rip off his narcotic pain patch, and slip into the bathroom to extract the drug so she could shoot up later.
Sometimes Burke, a licensed practical nurse, would take pity on her incapacitated victims and report to a supervisor that their patches were missing. Other times, she left them in pain and went about her duties.
If she was caught at one facility, she quickly found work at another. By her own possibly exaggerated account to police, the Holbrook resident ''worked 18-20 hours a day from nursing home to nursing home taking stuff.''
But it wasn't until Burke faced criminal charges of drug theft and patient abuse, and had racked up 10 complaints at 10 nursing homes from Natick to Norton in just 14 months that the state suspended her nursing license last November. Dsciplinary action
In the past six years, only a fraction of the nurses referred to the state nursing board because of drug offenses have lost their licenses. A breakdown of cases closed by the board, 1996-2001:
* Includes an unknown number of nurses enrolled in a non-disciplinary 5-year rehabilitation program.
Hundreds of other nurses who have been accused of stealing drugs from the nursing homes and hospitals where they work are still at patients' bedsides, according to a Globe investigation, because the Board of Registration in Nursing, the state board that licenses and disciplines nurses, can take up to six years to act and favors rehabilitation over punishment.
Most allegations about drug offenses come through the Department of Public Health, which monitors use of controlled substances at health care facilities. Public health inspectors forward cases to the nursing board only if a preliminary investigation finds supporting evidence.
Over the last six years, the nursing board took away the licenses of only 15 percent of nurses accused of drug offenses in cases referred by the Department of Public Health. Among those still licensed is a Salem nurse who replaced a patient's morphine with water and tried to sell the drug to an undercover state trooper.
The board, which includes 11 nurses among its 12 members, was only slightly tougher on repeat offenders. Three-quarters of nurses facing two or more complaints corroborated by the Department of Public Health still have their licenses, the Globe found, including a Quincy nurse who is accused of taking a smorgasbord of pain pills and stimulants from six nursing homes and has yet to face discipline.
''Where's the safeguard?'' asked Janet L. Bennett, a nurse manager who unknowingly hired an alleged narcotic thief who was in the board's confidential rehabilitation program. ''The nursing board isn't doing a good job. They're putting others at risk. Nurses are supposed to be patient advocates, not protecting other nurses who have a problem.''
These impaired nurses are contributing to a 50 percent increase in the number of reported thefts or tampering with dangerous drugs at Massachusetts health care facilities in the last five years, according to figures from the Department of Public Health.
''This is a problem that needs to be looked at a lot more seriously,'' said Nancy Ridley, assistant commissioner of public health.
Burke said the nursing board needs to get tougher on nurses with drug problems. During a 15-month investigation, ''They didn't put any restrictions on my license,'' said the 29-year-old Burke, who is now trying to live drug-free. ''It's an unfortunate situation for the patients.''
Still, nursing board staff members called the Burke case ''a success story,'' the first time they had used their power to suspend a license because of imminent danger to patients.
''A year and a half is fast action,'' said executive director Theresa Bonanno. ''We do a terrific job with the resources we have.'' sing board lacks resources
The nursing board licenses 131,000 practical and registered nurses, gets 400 to 500 complaints a year, and shares five prosecutors with dozens of other state boards that license everything from plumbers to cosmetologists.
Bonanno said the board's budget is about $13 per licensee per year, one of the lowest in the nation, forcing it to triage discipline cases. By comparison, the state board that licenses doctors spends much more - about $169 per doctor, although that budget is also lower than counterparts in many states.
The Globe's analysis found that the board had dismissed 37 percent of the drug cases referred by the Department of Public Health in the last six years and that 39 percent are awaiting action, in some cases up to six years after the complaint was made.
Bonanno defended the board's record, saying the cases take time to build and defend. Some of the referrals, they said, detail suspicious behavior that is not clearcut enough to warrant action.
The board limits discipline to the most egregious cases, said associate director Rula Harb, because of its tight budget and concern about exacerbating the existing shortage of nurses. As a result, the board doesn't seriously investigate many of the less severe allegations.
In addition, she said, cases dismissed include those of nurses who entered the state's confidential Substance Abuse Rehabilitation Program, which is offered as an alternative to discipline, even for repeat offenders.
Nurses in the program are allowed to work while getting substance abuse treatment, but the board's monitoring of these nurses is flawed by overdependence on their own accounts of their behavior.
Meanwhile, the public - and even some employers - are kept in the dark about the nurses' past. Similarly, the nursing board keeps secret any allegations against nurses that have not yet been acted on, leaving the public to assume these nurses have clean records.
But the Globe's investigation found nurses who weren't in the rehab program and were practicing despite troubling histories.
Licensed practical nurse Robert Cloutier pleaded guilty two years ago to criminal charges that he stole morphine from Sutton Hill Nursing Home in North Andover and tried to sell it to an undercover trooper.
According to police reports, the Salem resident accidentally paged a trooper in July 1999 to ask if he wanted any more morphine. ''I have to wait until I get to work tonight so I can get my hands on the stuff,'' Cloutier allegedly told trooper Frank Hughes, thinking he was talking to a Lowell buyer.
The next morning, Cloutier, still dressed in his nursing whites, met Hughes in a Lawrence parking lot. After his arrest, Cloutier told police he had stolen the equivalent of 15 doses of morphine designated for cancer patients and replaced it with water, according to the police report. Cloutier also told police he had taken tranquilizers and pain pills from two other nursing homes.
Salem Superior Court imposed two years of probation and prohibited him from working for a year in any facility where narcotics were used. But the nursing board, which had received the same allegations against Cloutier, took no action. The case against him remains open and his license remains valid.
Last December, Cloutier was arrested again and pleaded not guilty to buying crack cocaine on a Lawrence street corner. A month later, he was treating patients at an Andover nursing home.
Cloutier did not respond to requests for comment. And nursing board officials declined to discuss any open case. Patient activist says situation `frightening'
But Linda DeBenedictis, president of the New England Patients' Rights Group, said ''it's frightening to know that your care might be compromised by any of your caregivers and in many cases nothing is being done about it. If a teacher was found taking drugs, would they be allowed to continue teaching? Nurses are making life and death decisions ... and their competency is critical.''
Richard Spencer's competency was certainly in doubt in his last year as a nurse, said his sister Cheryl Busch. He died of a tranquilizer overdose in December 1999 just days after he allegedly stole five vials worth of the injectible painkiller Demerol from a Raynham nursing home.
It was the third allegation of drug theft against the Taunton man in 16 months, and he was facing criminal charges dating from August 1998 after admitting he stole and swallowed OxyContin and other drugs while working at an East Bridgewater nursing home. But he still had his license as a practical nurse.
In September 1999, the nursing board offered him a choice of rehab, surrendering his license for three years or facing a full hearing before the board. They were still waiting for an answer when he committed suicide three months later.
''They should be moving a lot quicker,'' said Busch last week. ''He shouldn't have been working. If you're suspected, your license should be on hold until you're cleared. Otherwise, it's a tragedy for the nurses and for the patients.''
Bonanno, the nursing board director, blamed a lack of resources for the delay in Spencer's case. ''It took about a year to get through the process,'' she said.
Like Spencer and Burke, licensed practical nurse Christine Conley moved from job to job as accusations of drug theft led to one firing after another. Six employers have filed complaints against her since 1999, but because the nursing board keeps unresolved cases secret, few, if any of those employers were aware of her troubled history before hiring her. As a result, despite all the allegations, Conley is still working as a nurse.
Conley, of Quincy, denied the allegations, suggesting she is being singled out because she gives patients more pain relief, thus using more drugs than other nurses. ''If you don't go along with the status quo of ... nurses that don't medicate anyone, you get a stigma attached to you,'' she said.
For nurses whose drug problems stem from addiction, the nursing board favors rehabilitation over discipline. Up to a month before the board suspended Karen Burke's license, staff were offering her a chance to avoid discipline by entering the 5-year rehabilitation program, which provides treatment, counseling, support and random drug tests. Annually about 10 nurses ''graduate'' from the program and an equal number flunk out.
While many states offer similar programs, Massachusetts' is one of the more lenient. In New York, the program typically takes only first offenders. In Massachusetts doctors accused of diverting drugs may enter rehab but must also face discipline.
''Doctors can't use the treatment program to duck discipline,'' said Nancy Achin Sullivan, executive director of the state medical board.
By contrast, a nurse who enters the program receives no disciplinary action and a blanket of confidentiality.
Participants who return to work after drug treatment are required to tell employers they are in the program, to disclose any license restrictions imposed by the board and to work under close supervision. But the board's only proof that the nurse disclosed her drug rehab and license restrictions is a form the employer signs and the nurse submits quarterly. As a result, a dishonest nurse could keep her drug problem a secret for up to three months at a new employer before the lack of a disclosure report might trigger action.
Nursing board staff members said that rarely happens. ''These nurses are seriously committed to recovery. They're probably the safest people,'' said Bonanno. Hidden pasts,repeat offenses
But in several cases reviewed by the Globe, nurses hid both their past and their participation in the rehabilitation program from employers, were allowed to dispense narcotics and were accused anew of stealing drugs.
Donna Myatt, for example, enrolled in rehabilitation in 1998 after admitting she couldn't account for three doses of Demerol she signed out for a patient previously discharged from Quincy Hospital. In August 1999, Janet Bennett hired the registered nurse to work for Fidelity Skilled Staffing Services and sent her into nursing homes as a temporary worker. Bennett, director of clinical services for Fidelity, said Myatt never told her or officials at the nursing homes that she was in the program. A check of her license had shown no discipline.
By late fall of 1999, the Life Care Center of Plymouth began noticing discrepancies in pill counts when Myatt was on duty. She was suspended from the job and reported to the board. But in the next four months, she landed jobs through other agencies and was accused of drug offenses at two other nursing homes.
''The board should have pulled her license immediately, but it took several drug diversions before she was finally stopped,'' said Bennett. ''There's a huge flaw in the program.''
The board could have demanded Myatt surrender her license immediately for violating rehabilitation rules under an agreement all rehab participants sign. But board officials said Myatt contested the allegations, and the process dragged out for nearly seven months.
Myatt did not respond to several requests for comment.
At a minimum, nursing administrators say, the board should tell potential employers that a nurse is in the rehabilitation program and has practice restrictions.
''The lack of information is relatively paralyzing,'' said Joanne Seifart, director of nursing at Marina Bay Skilled Nursing and Rehabilitation in Quincy. Seifart said she unknowingly used two temporary nurses - one in the rehabilitation program and one with outstanding complaints - who ended up stealing drugs. ''It's horrible that a nurse is able to go from facility to facility and we're left in the dark.''
Karen Burke would agree. Last fall, she said the drug thefts that police confronted her with weren't even the half of it, according to a State Police report.
If narcotic patches weren't accessible, she took OxyContin or even an entire bottle of liquid morphine, which she replaced with water, according to the police report. She'd been addicted for four years and regularly worked while under the influence of drugs, alongside other nurses, she told police, ''as bad ... or worse who are still working today.''
''They did the right thing by taking my license,'' she told the Globe. ''But they need to look at the health care system and their rules and regulations.''
Globe correspondent Bill Dedman contributed to this report. Alice Dembner can be reached by e-mail at firstname.lastname@example.org
This story ran on page A1 of the Boston Globe on 4/21/2002.
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