Should drug diverters be prosecuted?

Emergent, RN · Mar 1, 2017

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.

HouTx, BSN, MSN, EdD · Mar 1, 2017

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' . . .

allnurses Guide · Mar 1, 2017

Healthcare workers are in a unique environment where they are constantly around opioids and yet can not be prescribed them, lest they be found out by the BON and be reprimanded. Those who may have pain issues are the only stories I have heard of in my long career. One nurse with renal CA and another with traumatic knee injury that was being misdiagnosed. Those Percocet was what made their shifts physically bearable. Really doesn't matter what you think about prn opioid use, it is illegal, read your nurse practice act, that is in never, not when you are off, when you leave your shift, never. Put that up against what happens to your profession when caught, it is arguably worse to go before the board. Repeat offenders should probably be prosecuted, but first time offenders should probably be given a pass.

I don't know about Maryland But the Nurse Practice Act in California does not prohibit the use of Legally prescribed opioid medication. It prohibits working while impaired. An addict who is trying to stay clean but not in recovery the so-called "Dry drunk" can go to work completely clear of substances and still have impaired practice. Most Nurse Practice Acts will prohibit "Acts of Moral Turpitude" which

include theft and lying. When I came before the BON I was fresh off a suicide attempt. I had been fired not for being impaired but for theft (In my case IM Benadryl). My employer turned me into the Police but the DA declined to bring charges against me. In many cases this happens because the courts are just to packed to bring every addict who steals to trial.

As a person who has chronic pain - I have legitimate prescriptions for both opioids and muscle Relaxants . My employer knows I take these medications on occasion and I have checked with my BON, which sent me a statement that as long as the medications did not impair my practice they had no problem with it.

Hppy

Ruby Vee, BSN · Mar 1, 2017

If some lay person stole those from an outpatient pharmacy they would be charged. Why should someone doing it at work be treated any different?

Probably because the lay person stealing them from the outpatient pharmacy would have to get INTO the pharmacy to steal them, behind the counter and into where the drugs are kept. They'd have to either break in after hours (illegal) or threaten and intimidate the employees (also illegal) in order to get the drugs. Breaking in and threatening and intimidating -- possibly injuring or killing -- people is seen as much worse behavior than stealing from your employer.

RiskManager · Mar 1, 2017

This is an interesting thread, and I need to chat this up with our HR and Legal departments to see if we have a standard approach to this. I can say that based on previous experience, our local LE agencies/prosecutor generally seem to only be interested in cases involving diversion in quantities sufficient for sale, as opposed to personal use; if the theft is valued at more than 'a few thousand' dollars; or if someone is harmed as a result of the theft/diversion. I wonder if this is codified into our practice or not, and we do deal with a number of different LE agencies depending on the location.

heron, ASN, RN · Mar 1, 2017

I want to point out that these programs are referred to as "diversion" programs because they are intended as an alternative to (IOW, a diversion from) criminal prosecution, not because they are for those who divert drugs.

Criminal charges would, by definition, automatically fail that goal, which makes the diversion programs pretty much a waste of money.

They are modeled on similar programs for impaired physicians intended to help them return to practice rather than waste all those years of very expensive training.

Back before we got all tough on crime and all, there were quite a few such diversion programs in the criminal justice system, focused on first-time or non-violent offenders.

foggnm · Mar 1, 2017

If it is against the law, then it should be prosecuted. I also don't think any licensed healthcare profession should be given a chance to practice again if they have diverted drugs. I believe in second chances, but the second chance can be in a different profession.

Esme12, ASN, BSN, RN · Mar 1, 2017

Healthcare workers are in a unique environment where they are constantly around opioids and yet can not be prescribed them, lest they be found out by the BON and be reprimanded. Those who may have pain issues are the only stories I have heard of in my long career. One nurse with renal CA and another with traumatic knee injury that was being misdiagnosed. Those Percocet was what made their shifts physically bearable. Really doesn't matter what you think about prn opioid use, it is illegal, read your nurse practice act, that is in never, not when you are off, when you leave your shift, never. Put that up against what happens to your profession when caught, it is arguably worse to go before the board. Repeat offenders should probably be prosecuted, but first time offenders should probably be given a pass.

I have not heard of this and I have practiced in many states. Could you please reference this please? The only time I have heard about restricting use is when they are under a treatment plan for addiction/diversion.

allnurses Guide · Mar 1, 2017

If it is against the law, then it should be prosecuted. I also don't think any licensed healthcare profession should be given a chance to practice again if they have diverted drugs. I believe in second chances, but the second chance can be in a different profession.

You of course are entitled to your opinion but I would bet you know at least one if not more nurses who have diverted, been caught, rehabilitated, and successfully returned to nursing. My life is a pretty much open book but many nurses choose to stay anonymous.

It is estimated that 1 in 15 nurses has a problem with substance abuse. Not all divert and many never get recovery or get well. Addicts/alcoholics are not bad people they are sick people. No different than any other person with a physical or mental disease. And Addict/alcoholic in the active grip of their disease will do things no normal/rational/moral/ethical person would even consider doing. Then BONs have these programs to protect the public and allow nurses who wish to save their careers to return to safe practice.

A good friend of mine in the program was not diverter but he/she was a meth-addict who was busted for manufacturing/selling. As he/she stood before the judge and her criminal attorney was going over the BON program the judge stopped the attorney and said "I know full well the restrictive nature of the BON program and I will consider it punishment enough if the defendant stays compliant with the stated program" My friend was check in with the court every 90 days until her program with the BON was complete. To my knowledge that person is still in recovery and practicing nursing today.

Hppy

klone, MSN, RN · Mar 2, 2017

Call your BON, they told me that most states operate this way.

Completely not correct.

Volley88 · Mar 2, 2017

There should be punishment. However I do believe it is up to the employer's discretion. Oversight should dictate whether they could press charges and/or reprimand the theft.

Libby1987 · Mar 2, 2017

I didn't think I could ever be torn about this but now I am. Great discussion.