Yale Nurse Replaces Fentanyl Vials with Saline

[J.Adderton]

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?

[LubbDubb77, BSN, RN]

On 3/22/2021 at 6:52 AM, subee said:

One of the most frustating things was the number of hospitals who refused to allow an addictions RN into the facility to do a continuing ED on the unit after a nurse had been removed.  Those nurses needed to hear that talk NOW while their emotions and curiosity were high but hospital administrators generally want to keep it all hush-hush.  A few hospital systems have created remarkable programs for their OR's which address ALL members of the OR teams, including, for instance, even housekeeping to be on the alert for sloppy practices.  Anesthesiologists were the worst offenders for leaving Fentanyl syringes drawn up on the top of the anesthesia carts for the taking.  Since the CRNA's were previously nurses, they understand that they would be treated more harshly for doing the same thing and did what we had to do not to leave drugs accessible to everyone.  I remember a tragedy in the 90's where a small group of OR nurses were stealing left over Fentanyl from syringes left on the cart to take home for a little Fentanyl party.  Unknown to them was that the anesthesiologist had already removed the Fentanyl from the syringes and put Pavulon, an old timey muscle relaxant, in the syringes.  The nurses died together and when the OR found out what had happened the anesthesiologist killed himself the next day.  That's part of the reason I have no respect for the procedure of wasting drugs in front of anyone because that person has no idea what you are tossing - it's just a clear liquid like most other IV drugs we give throughout the hospital.  

I just want to say people like you with so much experience are the reason this website is so good. I am a new RN and reading this thread and responses is just jaw dropping! This story and all the stories I have read on this thread are just insane. I feel so naive right now. Im just taking it all in and going to use this information to be more aware. Thank you.

[Been there,done that, ASN, RN]

On 3/15/2021 at 6:28 PM, MunoRN said:

I don't understand how over a period of at least 5 months, no staff using the fentanyl vials noticed that the caps were no longer sealed.

My first thought too. But it wouldn't be hard to glue them back on.

 

[subee, MSN, CRNA]

4 hours ago, Been there,done that said:

My first thought too. But it wouldn't be hard to glue them back on.

 

Absolutely they can be glued and when the red line is aligned straight around the vial, no one even looks - just wanna break that thing without getting any glass in fingers:)

[TriciaJ, RN]

The title of this thread refers to stigma preventing an addicted nurse from getting help.  In other words, if we all had more compassionate attitudes about addiction, would this nurse have sought help sooner and tortured fewer patients?

I don't think I'm buying this.  In the end, we are all accountable for our actions and it's a cop-out to blame our behaviour on someone else's attitude.  

Here's another thing:  she took vials home and supposedly replaced the Fentanyl with saline before gluing the caps back on.  No way was sterility maintained.   How do we even know she used saline or just tap water? Yuck.

Her wanton disregard for the comfort and safety of people entrusted to her care leaves me cold.  Behaviour like this creates the stigma.

[subee, MSN, CRNA]

8 hours ago, TriciaJ said:

The title of this thread refers to stigma preventing an addicted nurse from getting help.  In other words, if we all had more compassionate attitudes about addiction, would this nurse have sought help sooner and tortured fewer patients?

I don't think I'm buying this.  In the end, we are all accountable for our actions and it's a cop-out to blame our behaviour on someone else's attitude.  

Here's another thing:  she took vials home and supposedly replaced the Fentanyl with saline before gluing the caps back on.  No way was sterility maintained.   How do we even know she used saline or just tap water? Yuck.

Her wanton disregard for the comfort and safety of people entrusted to her care leaves me cold.  Behaviour like this creates the stigma.

Do you really believe that someone addicted to Fentanyl is actually THINKING?  Hence, the term "stinkin' thinkin'.  There is no need to shame them more; they can't heal until they learn to deal with the shame because it only accelerates the depression.  She will never work again as a nurse.  What more blood do you want to squeeze from her?

[TriciaJ, RN]

6 hours ago, subee said:

Do you really believe that someone addicted to Fentanyl is actually THINKING?  Hence, the term "stinkin' thinkin'.  There is no need to shame them more; they can't heal until they learn to deal with the shame because it only accelerates the depression.  She will never work again as a nurse.  What more blood do you want to squeeze from her?

I don't want to squeeze any blood from anyone.  I don't want to speculate on how well anyone can think, but it does take a certain amount of planning to take vials home, replace the medication, glue the caps back on and return them.  It also takes a certain amount of ruthlessness to watch someone scream in pain, even if that ruthlessness is due to a drug problem.

Ninety percent of my compassion in this case is for the patient who signed a consent and trustingly put herself in the hands of others.  That leaves about ten percent for the nurse who is not fit to be a nurse, for whatever reason.

[LibraNurse27, BSN, RN]

7 hours ago, TriciaJ said:

Ninety percent of my compassion in this case is for the patient who signed a consent and trustingly put herself in the hands of others.  That leaves about ten percent for the nurse who is not fit to be a nurse, for whatever reason.

It's bothering me how little compassion I feel toward her. I have compassion about the addiction part, but none about what she did. Yes, people out of their minds on drugs do crazy things, but what she did could not be done by someone altered/impaired, plus the part about watching pts in pain feels evil/sadistic. I have met many people struggling w/ addiction, and yes they did bad things like driving while high/drunk, stealing, fighting, etc. But none of it was premeditated and done repeatedly like this. 

I don't want it blamed on mental illness. I have a mental illness and I would NEVER do something like this. People with mental illnesses are more likely to be victims than perpetrators of crimes, although in some cases they can become violent, especially when experiencing psychosis. But people having psychotic episodes don't have the cognitive ability to carry out a scheme like this. Maybe I need to work on my empathy toward this nurse; I swear I usually give people the benefit of the doubt! Just feel like she tortured people...

[TriciaJ, RN]

47 minutes ago, LibraNurse27 said:

 

I don't want it blamed on mental illness. I have a mental illness and I would NEVER do something like this. People with mental illnesses are more likely to be victims than perpetrators of crimes, although in some cases they can become violent, especially when experiencing psychosis. But people having psychotic episodes don't have the cognitive ability to carry out a scheme like this. Maybe I need to work on my empathy toward this nurse; I swear I usually give people the benefit of the doubt! Just feel like she tortured people...

My feeling.  I'm sure there were events leading to her addiction; it rarely happens in a vacuum.  But becoming addicted is not like being diagnosed with MS or something else that people find themselves with.  It did involve some choices along the way.  I agree with you that people have to have some accountability for their actions.  It's just too easy to use mental illness or addiction or some other affliction and expect a free pass.

[sirI, MSN, APRN, NP]

Update:

Former Nurse Sentenced for Tampering with Fentanyl Vials Intended for Patients at Fertility Clinic

Quote

Leonard C Boyle, Acting United States Attorney for the District of Connecticut, announced DONNA MONTICONE, 49, of Oxford, was sentenced today by U.S. District Judge Janet C. Hall in New Haven for tampering with fentanyl vials intended for patients at the fertility clinic where she was employed.  Monticone was ordered to serve three years of supervised release, four weekends of incarceration, and three months of home confinement.

 

[Stillcrazyafteralltheseyears]

Sounding harsh here. But it’s not enough of a sentence.

[Leader25, ASN, BSN, RN]

She did a horrid thing repeatedly,deliberately,hurting the vulnerable.No excuse is acceptable,deserves consequences and social stigma.It is a lack of profound repulsion by society that appears to encourage evil criminals since lax laws are of no consequence to them.

[Tweety, BSN, RN]

 A good deal of addicts have to hit rock bottom before they ask for help.  So it's hard for addicts of all sorts to ask for help and there is stigmatization of addicts in general.

I think though nurses are indeed reluctant to get help because of the stigma, potential loss of license or job, and being part of the most trusted profession and breaking that trust by being weak and harming others.