A Yale infertility clinic failed to protect patients from pain when a nurse tampered with 75% of fentanyl vials intended for procedures over a 5 month period. Read on to learn more about this story and how the pandemic adds to the risk of substance abuse among healthcare workers.
On March 2nd, a former Yale nurse pleaded guilty to altering fentanyl vials intended for outpatient surgical patients. The nurse, Donna Monticone, worked at the Yale Reproductive Endocrinology and Infertility clinic in Orange, Connecticut and was responsible for ordering and stocking narcotics needed for procedures. According to the U.S. attorney’s office, the nurse began stealing fentanyl in June 2020 for her own personal use. Monticone would remove the drug from secured vials, inject herself, then replace the fentanyl with saline.
No Protection from Pain
When Monticone pled guilty, she confessed to actions that are in direct conflict to nursing ethics and standards. Specifically, she admitted to the following:
Knowing that the fentanyl vials she replaced with saline would be used in surgical procedures as an anesthetic.
Knowing patients could experience serious bodily harm without an anesthetic.
Injected herself with fentanyl while working at the clinic.
Eventually taking vials of fentanyl home for self injection.
Refilling the empty vials at home with saline and returning them to the clinic’s fentanyl stock.
Bringing around 175 vials of fentanyl vials she had taken from the clinic and discarded them in the clinic’s trash.
Investigators discovered that between June and October 2020, approximately 75% of the fentanyl administered to clinic patients for surgical procedures was either diluted or consisted only of saline.
“I Screamed”
Patients detail the extreme pain they experienced during procedures at the Yale fertility center. One patient recalls suddenly realizing the anesthesia she’d been given during a painful egg harvesting procedure was not working. She shared her story with a local news station, stating, “It made me scream. I remember screaming in the middle of the procedure from pain”.
Attorney Josh Koskoff represents four victims who had IVF procedures while in extreme pain. He describes the women as feeling betrayed and dismissed when clinic staff did nothing when they reported the pain. Koskoff also questions how the complaints continued to go on for several months without a thorough investigation by the clinic.
Yale’s Response
Yale’s director of university media relations released a statement about the what is being done to reassure the public and prevent this from happening again. Here is a look at what steps are being taken:
The clinic informed law enforcement of the theft and notified patients about the issue.
Informed patients there is no reason to believe the nurse’s actions harmed their health or treatment outcome.
A combination of pain medication is used during clinic procedures and are adjusted if signs of discomfort.
Making needed changes in procedures, record-keeping and storage to prevent diversion in the future.
Bond and Sentencing
Monticone was released on a $50,000 bond and will return for sentencing on May 25th, facing a maximum prison sentence of 10 years.
Healthcare Workers at Increased Risk
Nurses stealing opioids for their own personal use is nothing new and there’s no shortage of news articles reporting criminal charges for diversion. Now, the pandemic is intensifying the risk of substance abuse among healthcare workers. During COVID-19, it’s not unusual for nurses to feel like their best is not good enough and the emotional, mental and physical toll can be overwhelming. Navigating life during a pandemic is stressful already, but add to the mix the extra challenges healthcare workers have faced over the last year. For example:
Long shifts and work hours
Fear of being infected by the virus
Fear of passing the virus on to vulnerable patients
Fear of passing the virus on to loved ones
Busy/chaotic work environments and unable to take time to talk to peers about stress and anxiety
Loss of outlets for stress due to social distancing
Financial hardships due to lay-offs and cancelled shifts during early pandemic
The pandemic has only added “fuel to the fire” in healthcare workers who are already at risk for substance use disorders.
What Do You Think?
Donna Monticone surrendered her nursing license and went to rehab. I do believe she should face the consequences of her actions. But, I also think the stigma and shame of being a nurse with an addiction prevents too many from seeking help. What do you think… is there a bigger picture than what the news reports?
I believe that she should never practice as a nurse again.
There are different levels of substance abuse problems. This example is a very egregious one. It's one thing to get a DUI, which is a lapse in judgment that is totally separate from the workplace. I don't think those people should be disciplined by the Board of Nursing at all.
Then there is someone who smoked a joint, who will get the same penalties as another nurse who stole drugs from the Pyxis. I think that is ridiculous.
Stealing drugs at work is pretty bad. I personally think those people should work in a type of nursing that does not involve giving narcotics. But, the very worst crime is to steal in a way that deprives patients of needed pain relief. Those people should get help, and should not work as nurses ever again.
A DUI is separate from the workplace and shouldn't be disciplined at all?
Nah, I don't think so. A lapse in judgement can happen in someone who did it once or someone who has a chronic problem. Each deserve evaluation by whoever the BON hires for their addiction programs. Not all nurses who steal drugs actually use the drugs for themselves....yes, they actually steal for someone else. And some nurses who steal drugs give the correct dosage to the patient but just use the leftovers for themselves. Every situation is different and the large majority of nurses are able to go through treatment and return to work. Some of them may not return to working with narcotics but others can. The particular nurse in the above situation will NEVER return to work as a nurse since the harm she did to her patients is apparent, so no need to moralize here.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I will say again, every nurse (and MD too) should have to take CEUs in recognizing and reacting to addiction in colleagues/coworkers. 12% of the population of the USA is addicted to one substance or another. This is also true of nursing. Look around; if you have 10 health care workers around you, chances are ONE of them is an addict. The nursing (and medical) profession(s) are woefully under-educated about addiction and what to do when it's suspected.
This is just tragic all around. Yes obviously she should lose her license etc but I also feel for anyone who is so desperate and addicted that she resorted to this.
I also have compassion for people with addictions. It is horrible to have such a desperation to use that you would steal and cause harm to others. That’s why I hope she gets treatment and support.
I don't feel for the perpetrator, and I have every right to moralize. She brought shame on our profession and grave harm to helpless patients. She's a bad person. She should have bought drugs on the street like a decent addict.
I will say again, every nurse (and MD too) should have to take CEUs in recognizing and reacting to addiction in colleagues/coworkers. 12% of the population of the USA is addicted to one substance or another. This is also true of nursing. Look around; if you have 10 health care workers around you, chances are ONE of them is an addict. The nursing (and medical) profession(s) are woefully under-educated about addiction and what to do when it's suspected.
Yes, yes, yes. An hour CEU should be required of every licensed patient care practitioner. And they are usually well-educated, experienced people and not likely suspects. People everywhere should think of addiction first when good nurses start losing it at work. Work is always the last thing to go after loss of friends and family ties.
Jesus take the wheel! This is the stuff of nightmares. I don’t feel sorry for the drug addict at all. She should be thrown in jail for more than 10 years. These patients were tortured!
Specializes in Community Health, Med/Surg, ICU Stepdown.
I have a pretty good amount of compassion for addicts after working with this pt population for 7 years. But from what I saw these patients mostly hurt themselves (and estranged themselves from friends and family who suffered due to their behaviors, but usually not physically.) This woman could buy street drugs almost anywhere without harming anyone but herself. Not saying I would want her to just do that and not get help or go to work impaired, but what she did is torturous.
I wonder why the patients were not given more meds when it seemed what they got, regardless if the providers still thought it was fentanyl, wasn't sedating them or controlling their pain. Our providers at my surgery center give vastly different amounts of fentanyl to different pts depending on their response. And I wonder why no one thought it odd that ALL the patients seemed to be requiring more drugs? This is so weird.
I REALLY hate the prison system and don't find it appropriate to treat addiction or mental health issues, or that low level drug users/dealers get help in jail, but even I think she should go to jail. She was in her right mind and let people be tortured. Maybe she can deal with her addiction in jail. Sorry if it sounds harsh, just my opinion.
Specializes in Community Health, Med/Surg, ICU Stepdown.
One more thing! I would only have compassion for someone harming someone else if they were in the midst of a true psychotic episode and out of touch with reality, like when a schizophrenic with active delusions hit me. This was premeditated in cold blood with knowledge of how it would hurt the women. Disgusting. Makes me so mad
Tacocat, ASN, RN
327 Posts
She already surrendered her license. I can't imagine it ever being reinstated, but I'm probably very naïve.