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?

[No Stars In My Eyes]

I do recall single doses of injectable meds coming in small glass vials, the top of which you had to snap off to draw up the liquid med. I know it won't solve everything to go back to that kind of packaging, but you can't do multiple draws from a glass vial. If you, as med nurse, had to waste the excess med, held up the vial and said "Wasting 1/2cc of --------(whatever med)" and another nurse okayed it and signed it off. Maybe the meds should be color coded? There was a sneaky nurse I worked with once who always saved the 'excess' (if the patient's dose was smaller than what the vial contained) in a separate syringe and after a few doses were collected in her syringe, she'd go into the nurses bathroom and inject herself. Don't know how anyone can work when 'wasted' on narc-wastes. I wondered, after she was caught, if she mixed the narcs together. By the way, it was bruising on the backs of her arms that gave her away....that and how her pupils were extremely constricted when she walked out of the nurses's bathroom.