The Hospital Tech Who Stole Needles
(page 2)The Kwiatkowski case is not the first crisis of its kind, though his may prove to have perhaps the broadest geographical reach. In September a 49-year-old Jacksonville, Fla. radiology technician got 30 years in prison for stealing drugs and infecting two patients with hep C; one died. In 2010 Kristen Parker, a 27-year-old hospital technician and heroin addict also got 30 years for stealing IV drugs, infecting at least 18 patients at a Denver hospital with hep C. “I put getting my next fix above my career, my family, taking care of my son and the safety and well-being of my patients,” Parker said at her sentencing hearing.
In May 2012, the CDC reported that more than 4% of healthcare workers admit illicit drug use—and that's just the ones who admit it.
In May 2012, the CDC reported that more than 4% of healthcare workers admit illicit drug use—and that's just the ones who admit it. So What can hospitals and other facilities do to protect their patients from the denial and cunning of workers with addiction?
A simple solution is to get recovering addicts to advise hospital administrators and state and federal public health officials on the best ways to prevent addicted healthcare workers from stealing drugs.
Ask Richard Garfein, PhD, MPH, professor in the Division of Global public Health at the University of California-San Diego’s department of medicine. Garfein is a former CDC epidemic intelligence service officer who used to investigate how patients contracted Hep C. He identified systemic risk factors and advised facilities how to develop policy to prevent infection. (He now studies the spread of infections, including Hep C, among untreated addicts on the US-Mexico border.)
Here is how officials think Kwiatkowski stole his drugs: He went into operating rooms where a nurse or doctor with access to locked drug-carts had prepared for procedures by laying out supplies on the carts; then he stole drugs from the top of the carts when others’ backs were turned. Cunning.
If that’s the case, Garfein said, “he must have been using the needle on himself and giving it back to the patient.” Another case Garfein had studied involved an anesthesiologist suspected of injecting a patient with painkillers from a large multi-dose vial, then using part of the rest on himself before using it on one other patient. What's stunning about Kwiatkowski is that he went nationwide, infecting at least 30 patients across the country.
“That's frightening,” Garfein says. “And it’s pretty cavalier—it’s pretty reckless. He must have a serious addiction.”
Garfein and Smith proposed a fairly predictable list of proposed preventative measures:
Drug screening. Both Garfein and Smith suggested mandatory drug-screening for any employee in proximity to addictive medications. Smith noted that it’s important to test for what’s available: the ordinary five-panel urine screen—which tests for cannabis, cocaine, methamphetamine, PCP and natural opiates—will not catch synthetic painkillers such as fentanyl. If Kwiatkowski had been doing cocaine, Smith notes, he would have been caught. “Obviously,” Garfein emphasizes, “you have to test for what you’re looking for.”
Inventory control. Many hospitals track inventory closely, Garfein says, through their billing departments. Should drug-carts be restricted even further? What about the nurses who turned their backs?—You can’t put locks and super-restrictive oversight on everything in a hospital environment, Garfein says. “It would be really hard, and I tell you this from experience working for a health agency—if you’re too restrictive, people can’t get their jobs done.”
Employee-assistance programs. Most employers, including hospitals, have EAPs that serve to educate employees about the risks of substance abuse. “Nobody wants to become an addict,” Garfein says, and EAPs send the message that “we want to make the barriers to get you help as low as possible.” Smith says the trend among hospitals today is toward hospital wellbeing or wellness committees that help to prevent and refer to treatment cases of addiction and other behavioral health problems. But these committees are largely focused on physicians, allowing contract employees such as Kwiatkowski to fall through the cracks.
Staff training. One way to catch cases of drug-theft among contract workers is to educate managers about the ways drugs can be stolen and the ways addicted employees may behave. Healthcare managers, like the general public, operate under stereotypes that need to be debunked. “They think the person that’s going to steal the drug is a street person walking in,” Smith says.
But let’s think outside the box. What better way to debunk stereotypes than to involve recovering addicts in the policymaking?
“You want to stop hackers, you hire a hacker,” Garfein muses. “I think that’s a really excellent recommendation.” He notes that if researchers are studying drug-abuse among prison inmates, they are required to have an inmate on their committee. Inviting recovering addicts to participate in policy-making would give much-needed insight into the thinking processes of people with addiction, as well as a healthy dose of compassion, Garfein says: “There’s a lot to be gained by talking with people who have been on the other side.”
Fix contributor Jennifer Matesa also writes about addiction and recovery at her blog, guineveregetssober.com. For 12 years she researched and wrote about health care policy, including pain management, for the Robert Wood Johnson Foundation.