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 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.
Maybe that's how this person got caught. Staff noticed no analgesia and put a camera on the pyxis. We will probably never know but, when I see bizarre behavior at workplace, I assume addiction until proven otherwise.
I want to respectfully disagree with the part of this discussion about suspecting coworkers and thinking of addiction first if there is a change in behavior and I'm sorry but I will never assume addiction until proven otherwise. To me that is completely different than being aware of something and not overlooking it or refusing to consider it.
The thing that is far more rampant than opiate abuse by nurses is untenable work place stress leading to (or exacerbating) straight-up anxiety, depression and other mental health issues besides addiction. No I will not suspect every coworker because someone somewhere did something horrible.
I've held this position for a long time and even though I regularly have my thoughts challenged and sometimes change my mind on things after considering others' views, I'm not changing my mind on this. Assuming (or disproportionately suspecting) something about someone where the assumption leads to things that have the potential to bankrupt them and ruin their career/goals, etc., is not part of my repertoire for what's acceptable in life.
If I were ever forced into any of the programs like what we read about in the Recovery subforum despite not being an addict, I would leave this profession and never look back. I would also probably be so angry at the injustice that I'm not sure my mental health would ever recover.
I want to respectfully disagree with the part of this discussion about suspecting coworkers and thinking of addiction first if there is a change in behavior and I'm sorry but I will never assume addiction until proven otherwise. To me that is completely different than being aware of something and not overlooking it or refusing to consider it.
The thing that is far more rampant than opiate abuse by nurses is untenable work place stress leading to (or exacerbating) straight-up anxiety, depression and other mental health issues besides addiction. No I will not suspect every coworker because someone somewhere did something horrible.
I've held this position for a long time and even though I regularly have my thoughts challenged and sometimes change my mind on things after considering others' views, I'm not changing my mind on this. Assuming (or disproportionately suspecting) something about someone where the assumption leads to things that have the potential to bankrupt them and ruin their career/goals, etc., is not part of my repertoire for what's acceptable in life.
If I were ever forced into any of the programs like what we read about in the Recovery subforum despite not being an addict, I would leave this profession and never look back. I would also probably be so angry at the injustice that I'm not sure my mental health would ever recover.
I think the point is that we shouldn't automatically assume this is an issue but not rule it out either and to be aware it could be a problem.
Years ago working night shift a nurse fell asleep in a patient's room. She said the patient needed watching. I didn't want to presumed she was stoned on opiates and thought her overly tired because she was also a mother. A few weeks later she quit when 25 Percocets came missing under her name.
Perhaps I didn't do her any favors by not reporting her behavior as suspicious. I was in the land of denial myself. Patient safety could have been put at risk by her and by us ignoring it.
I do agree that someone smoking weed at a party on a weekend is not the same as a drug addict diverting narcotics for self use. You can't presume everyone getting a DUI is an alcoholic or everyone smoking weed on the weekend is a drug addict.
Ultimately, I've learned to put personal feelings aside and do what is best for patient safety.
Perhaps I didn't do her any favors by not reporting her behavior as suspicious. I was in the land of denial myself. Patient safety could have been put at risk by her and by us ignoring it.
I don't disagree with anything you wrote. And you did summarize it well - assumptions are not appropriate but neither is ignorance or denial.
With regard to the above, part of the problem I have (and I realize you didn't do this) is the number of people who are keen to be supposedly suspicious about something, and the number of people who are keen to report their "concerns," compared to the number of people who are willing to do something in the moment of the situation that they are supposedly so concerned about. To me this is proof of their compromised judgment.
There are plenty of people who would see that nurse dozing somewhere and recognize a wonderful gotcha moment to run to management with their "concerns"---at some later point. What's up with that, you know? Those are emotional cripples, not responsible people who are actually concerned about patients.
I don't disagree with anything you wrote. And you did summarize it well - assumptions are not appropriate but neither is ignorance or denial.
With regard to the above, part of the problem I have (and I realize you didn't do this) is the number of people who are keen to be supposedly suspicious about something, and the number of people who are keen to report their "concerns," compared to the number of people who are willing to do something in the moment of the situation that they are supposedly so concerned about. To me this is proof of their compromised judgment.
There are plenty of people who would see that nurse dozing somewhere and recognize a wonderful gotcha moment to run to management with their "concerns"---at some later point. What's up with that, you know? Those are emotional cripples, not responsible people who are actually concerned about patients.
I never said to ACT on a suspicion of addiction until one had actual evidence of a serious change in practice. But most of us are so rushed at work that it is difficult to even think about an issue so fraught with denial. If someone is slipping at work, my point is to just label them unhappy or crazy but assume that there are reasons why a previously competent person is not performing as usual. In my experience, by the time the staff notices that a particular nurse is having behavorial or performance issues at work, don't forget to keep an addiction on your list of causes.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Why would anyone object to continuing education on addiction? I am not saying we all have to go to NA meetings, or learn the 12 steps. I am saying it's very clear, the amount of ignorance on the parts of health care workers regarding addiction and recognizing it earlier. No one suggested it's our first go-to with a problem concerning a coworker.
Continuing education is required for so much, from OSHA to infection control to ethics. Add addiction to the list.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Alternative to discipline programs are rigorous and often just painful from what I have read. But they are better than discipline or prison, it would seem to me, anyhow.
Alternative to discipline programs are rigorous and often just painful from what I have read. But they are better than discipline or prison, it would seem to me, anyhow.
I have read on AN that nurses are bitter about programs in some states. All I can say to this is that holding a person's license is a powerful incentive to do what one has to do to get back to work. Nurses' recovery rates hover around 90% in a good program. It's so gratifying to see a newbie in a support group go from uncontrolled crying with guilt and a family life crashingto morph into another person who is in a much better place after 2 years. The large majority of nurses become addicted from too liberal scripts for pain meds after a back, shoulder or neck injury at work.
Why would anyone object to continuing education on addiction? I am not saying we all have to go to NA meetings, or learn the 12 steps. I am saying it's very clear, the amount of ignorance on the parts of health care workers regarding addiction and recognizing it earlier. No one suggested it's our first go-to with a problem concerning a coworker.
Continuing education is required for so much, from OSHA to infection control to ethics. Add addiction to the list.
Since 2017 Florida has been requiring this every other renewal.
Alternative to discipline programs are rigorous and often just painful from what I have read. But they are better than discipline or prison, it would seem to me, anyhow.
Not if you're not an addict but get funneled into one because of "diversion"--the definition of which has been seriously perverted in the past 5++ years or so.
I'm not trying to be paranoid here but I've been in one particular staff meeting where fingers were wagged all around the room and everyone was warned that if there is any discrepancy with any controlled substance we will be terminated and reported to our BON. This was in a large, "respectable" health system hospital with coveted, flashy designations.
I don't go for that, not when I'm running my *** off all shift and so is everyone else, there's difficulty with wasting meds in real time because of short staffing, etc. I just don't need this, I refuse to be treated this way or to treat others this way. It's a darn good thing I'm a decently cultured human being or I would have told this crazy blankety-blank who was wagging her finger around the room to eff right off.
Secondly, I am not aware of any widespread ignorance about addiction, or nurses and addiction. I'm not on a rampage here, I just seriously have not noticed ignorance of this being an issue. I've responded at least a few times in recent years to posts here about "signs of addiction" which have always bothered me because somehow at least 50% of the signs found on lists like these are utterly non-specific. I have a problem with that.
I am just not going to suspect people unless they give me a darn good reason to, and that's not because of ignorance it's because of my personal beliefs. If I have a serious concern about the well-being of a coworker, I don't even need to concern myself with the underlying "why." I am prepared (and willing) to speak with them and/or let someone know of my concern. If I have a serious concern about their care of patients I am prepared and willing to immediately get help.
Those are the only two things I need to be responsible for, and I am prepared to follow through.
subee, MSN, CRNA
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Maybe that's how this person got caught. Staff noticed no analgesia and put a camera on the pyxis. We will probably never know but, when I see bizarre behavior at workplace, I assume addiction until proven otherwise.