A 61-year-old Massachusetts registered nurse recently pleaded guilty to drug tampering in a U.S. District Court. She was charged in June with one count of tampering with a consumer product, oxycodone, a medication used to relieve pain, while she worked as an RN at a Care and Rehabilitation Center.
The drug diversion involved the nurse’s tampering with three blister card packages of oxycodone that were prescribed for an 89-year-old resident suffering from Alzheimer’s disease, breast cancer, and severe dementia. To avoid detection, the nurse replaced the stolen oxycodone pills with other prescription drugs that were similar in appearance to the oxycodone. Consequently, the resident was deprived of her prescribed pain-relieving medication for at least a month and ingested at least 77 unnecessary prescription tablets.
The nurse is scheduled to be sentenced on January 19, 2021 and faces a possible sentence of up to 10 years in prison, three years of supervised release, and a fine of $250,000. The sentence imposed by a federal district court judge will be based upon U.S. Sentencing Guidelines and other statutory factors.
Compliance Perspective
Failure to prevent staff members with access to controlled medications from diverting those medications for personal use or financial gain may be considered abuse, neglect, and misappropriation of resident property, and subject the residents for whom those medications were prescribed to unnecessary pain. Additionally, significant medication errors may occur when substituted look-alike medications are ingested by the residents for whom the controlled pain medication had been prescribed, which can be deemed immediate jeopardy and provision of substandard quality of care, in violation of state and federal regulations.
Discussion Points:
- Review policies and procedures to ensure that all controlled medications are properly stored and monitored, and that the protocols for reconciling and accounting for these medications are performed according to policy.
- Train staff on the danger of drug diversion and that replacing prescribed drugs with other medications is considered abuse and neglect and places residents at risk for significant harm from medication errors. Also, train staff on their responsibility to immediately report any reasonable suspicion they have regarding drug diversion to their supervisor or through the facility’s Hotline.
- Periodically audit the facility’s medication logs to determine if there are indications that controlled medications may have been diverted. Physically examine the packaging of controlled medications. Consider interviewing residents who are prescribed controlled medications, and who can communicate, to determine if their pain levels are under control every shift.
