Drug Diversion and Abuse: Health Facility Diversion in the News

Health care professionals are sometimes a part of the drug diversion and abuse problem.

Unfortunately, but certainly not unpredictably, the diversion of medications from health facilities is back in the news. It involves one of the worst-case scenarios of collaborative damage that is possible aside from the death of patients, which is still a possibility.

David Kwiatkowski, a traveling medical technician, was allegedly discovered diverting medications at Exeter Hospital in New Hampshire, where 32 patients contracted hepatitis C in a 1-year period. Kwiatkowski, who reportedly tested positive for hepatitis C, is alleged to have removed fentanyl from syringes intended for patients, and replaced it with saline and other substances after injecting himself. He has been charged federally with crimes that were committed at Exeter Hospital.

The additional problem is that because he was a traveling medical technician, hospitals across the country had to be contacted. This has added to the potential numbers of those infected with potentially fatal liver disease. Pennsylvania and Maryland potential victims have since surfaced.

Different health facilities now allege that there was evidence of Kwiatkowski diverting drugs. The facilities mostly decided to do nothing. One case did report it to law enforcement, and that agency either did not have the expertise to investigate and didn’t look to someone who did, or sloughed it off under the pretense that they did not have enough evidence. Regardless of the reason, the suspect continued working at health facilities across this nation and continued, allegedly, to infect patients. If you have read my articles over the years, you know that diversion in health facilities has been a passion of mine for a very long time. While in charge of the pharmaceutical unit in Cincinnati, I saw my investigators arrest a nurse from a nursing home or hospital every week on the average for diverting drugs. Although this did not result in us catching every violator, this number of arrests was accomplished only by constant contact with facilities and, in one case, threatening the arrest of a hospital official for nonreporting of these criminal violations.

Exeter Hospital was certainly not the first facility impacted by diversion from a traveling health professional, and Exeter patients were not the first patients exposed to harm. Decisions were likely made at many health facilities across the country concerning cases like this, with virtually none of them opting to summon law enforcement to investigate what it is—a crime!

Do these cases involve addiction? Of course almost all of them do, and although we can sympathize with addicts and call it a disease, when innocent patients are harmed, and the acts involve diverting prescription drugs, then a competent criminal investigation must be done as soon as possible! It isn’t an option decided by the health facility, it is morally and ethically the right thing to do, and in some states a legal obligation under criminal statutes. Absent this, a situation festers, which this time just happened to erupt at Exeter Hospital.

Enormous collaborative damage occurs when these facilities do not report, or when reported, law enforcement does a shabby job, or no job at all. Placing aside the mountains of patients that can be harmed due to nonreporting, what about the addicted nurse or hospital worker that needs treatment? Failure to report allows that person to either continue at their current health facility endangering patients, or to move on to the next one and impact a whole new cadre of innocent folks. The employee receives no treatment and his/her addiction only becomes worse and more dangerous for the addict and the innocent patients.

The only way, apparently, that health facilities are going to be more compliant in reporting these crimes is to be the subject of massive civil suits that greatly impact their bottom line. It is sad to think that this may be the most effective result, because many innocent patients were sacrificed in order to reach a goal of health facility compliance.

No question this event will not change the lack of reporting by our nation’s health facilities to any great degree. Those involved hopefully will take on an aggressive program of detecting and reporting drug diversion and others will see the devastation occurring with this incident and also decide to do the right thing. Innocent patients are counting on them.

Cmdr Burke is commander of the Warren County, Ohio, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad.