Should drug diverters be prosecuted?

blackvans1234 · Mar 14, 2017

Not sure, but this isn't the only field where ''those on the inside'' get away with lesser punishments.

IE police doing things against the rules and not being punished to the full extent.

1sttime · Mar 15, 2017

Absolutely not- There but for the grace of god, go I. I did not have gods grace- but I did get a second chance. Ask yourself, how many nurses take a little tylenol from the patient supply, maybe even some zofran? How about those patient water bottles? Where should we begin with violations of the nurse practice act- I can't tell you how many parties I went to where the nurses were drunk "Conduct unbecoming a nurse".

My story of addiction began like so many others- misdiagnosed- told I deserved to be out of pain- prescribed opiates. Finally diagnosed correctly- off the opiates cold turkey while working in a PACU. My brain pathways had changed, I was not myself. If Mary takes an ibuprofen to treat her pain, whats wrong with taking the waste? Pretty soon I was outright taking medication from the pyxis, the hospital was too cheap to link up the charting systems- so I wasn't caught for some time.

We jail the most people in the world, and it has done nothing. Evidence shows that treating addiction as a public health issue is effective. Why would professionals who live in the world of evidence based practice advocate for an ineffective treatment? You not only lose a good nurse from the profession, but now you have stigmatized them so they would be unable to get employment. It is sad to see so many comments supporting a bad outcome, especially from those who know the dynamics of the profession.

1sttime · Mar 21, 2017

We should be treating all drug addiction as a public health issue- more articles this week outlining how: the length of time a person is prescribed a narcotic indicates how long they will use it, and how most addicts start with a prescription.

It should have been criminal to give me a script for 30 days supply of narcotics- After 10 just days there is a 50% chance of being on narcotics for 2 years. I was set up by the pharmaceutical industry- "you deserve to be out of pain". Just about every doctor and nurse I know is/was complicit in the "pain as a 5th vital sign" scam.

The excellent point to be gleaned is that our system is failing to address the larger problem in society- The criminalization of health issues which then takes a person beyond the point of being able to adequately provide for themselves, or contribute to the community.

subee, MSN, CRNA · Mar 21, 2017

Been there,done that said:

"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.

Well, you can prosecute them but it often ends up in drug court where the person has to follow a treatment plan. Better they go to the BON and get a treatment plan that addresses the needs if our "profession."

Here.I.Stand, BSN, RN · Mar 23, 2017

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

It's not just us softhearted fools who believe addiction is a disease -- the AMA does as well, and in fact addiction medicine is a medical specialty.

By the way, that was not a "flame." To flame is Internet colloquial meaning to make an ad hominem attack. When one can't logically refute a position, one instead attacks their opponent's character. One example: when one believes addiction to be a character flaw rather than a disease, instead of providing scientific evidence for this position, one calls his opponent a softhearted fool. :whistling:

Kooky Korky, BSN, RN · Mar 24, 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.

If a nurse uses prescribed pain Rx, it is OK to work, drive, etc. as long as the nurse is able to perform the job safely and correctly.

What state are you in?

Kooky Korky, BSN, RN · Mar 24, 2017

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.

1 diverting nurse every month sounds awfully high to me. Maybe I was just naive, but I never heard of nurses diverting meds before fairly recently.

subee, MSN, CRNA · Mar 26, 2017

The PACU nurse in the above example may not, actually, qualify for an alternative program since obvious patient harm was done.

RNOTODAY, BSN, RN · Mar 27, 2017

Only if they are given a non punitive treatment plan to adhere to . If they won't comply with that, I believe yes, diverting medication should be charged as a crime ...

RNOTODAY, BSN, RN · Mar 27, 2017

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

Diverters do not always let their patients go without their medication, pocketing the waste of a vial is the most common diversion activity by RNs

ex: 1 mg Dilaudid ordered , 2 mg vials available... PT gets their 1 mg... diverter keeps the remaining 1 mg.