By Seth Hartman, PharmD, Informatics Pharmacist at Oregon Health and Science University
This is the third in a series of posts about drug diversion.
Drug diversion in hospitals and other healthcare facilities not only puts patients at risk—it also harms the institution and its staff. The impacts are both immediate and ongoing, affecting the healthcare facility for months and sometimes even years after the incident.
Regulatory Scrutiny – After diversion is detected in a healthcare facility, that institution is often subjected to additional regulatory inquest. This could include unannounced site visits, conducting of further investigations into the diversion, and mandatory reporting requirements, which can cause diversion incidents to become public knowledge. These consequences can be expensive and time-consuming, often placing added stress on staff.
Negative Publicity – Even though a healthcare institution may not be directly at fault for, or even aware of, the drug diversion occurring, publicity often portrays the facility as being negligent.[i] This negative press can mar the good reputation of an institution, making it difficult to rebuild patient and community confidence in the facility and its staff.
License and Participation in Medicare/Medicaid – Under the Medicare Conditions of Participation, hospitals are required to protect patients from harm. Because drug diversion compromises patient safety, it could put the facility in jeopardy with Medicare/Medicaid and negatively impact reimbursement.
Fines – The Drug Enforcement Agency and other government bodies have handed hefty fines to health care institutions for a variety of diversion-related issues, including failure to adequately prevent drug theft in their facilities.[ii],[iii]
When faced with the aftermath of drug diversion in a healthcare institution, class action lawsuits may be brought against the facility by those patients affected.[iv] Litigation can go on for years, and if the diverter is prosecuted, the story is often highly publicized. As lawsuits are settled or the case moves on to trial, there is renewed publicity, again putting the institution’s reputation at risk.
Drug diversion can also have a tremendous internal impact on the staff. For example, a pharmacy, nurse director, or a healthcare executive, could be blamed for not detecting drug diversion in their facility. The failed detection could be a simple oversight, such as inadequate medication tracking documentation or procedures. Whether or not the director or supervisor was aware of the diversion, they could still be charged with negligence in handling of the situation.
In addition, colleagues of the diverter may experience distress and disbelief, leaving morale at an all-time low. Some staff members might go through the stages of grief at the unexpected removal of a friend and coworker, or from the astonishment of learning what was done, a process that can take time and assistance to overcome.
Also, there is often an immediate and unexpected reduction in staff after a drug diversion crisis, leaving the unit with a deficit in providers. This will mean additional time, effort and expense of hiring and training new staff for the positions that were suddenly vacated.
Seth Hartman, PharmD, holds a graduate certificate in healthcare management. In addition to academic roles at Oregon Health and Science University (OHSU), he is an informatics pharmacist responsible for clinical and operational software development, deployment and optimization. His areas of focus include automation, decision support, analytic reporting, diversion detection and prevention, pharmacy workflows and integration of multiple health systems.
Continuing the Diversion Discussion
The next post on drug diversion will focus on the profile of a drug diverter, and future posts will discuss how to take action to reduce drug diversion in your facility.
View the previous post on diversion here.
[i] Unze D. Patient sues St. Cloud Hospital, former nurse. SCTimes. July 11, 2014. http://www.sctimes.com/story/news/local/2014/07/11/patient-sues-st-cloud-hospital-nurse/12537381/
[ii] McCullough M. Temple settles with feds over drug diversion. Philly.com, October 27, 2010. http://www.philly.com/philly/blogs/healthcare/Temple_settles_with_feds_over_drug_diversion.html
[iii]Press release from U.S. Drug Enforcement Administration, July 26, 2007, accessed at http://www.justice.gov/dea/pubs/states/newsrel/chicago072607.html.
[iv] Matesa J. Ex-Hospital Worker David Kwiatkowski Sentenced to 39 Years. The Fix.com, December 4, 2013. http://www.thefix.com/content/ex-hospital-worker-david-kwiatkowski-sentence-39-years