Health officials are taking new steps to address a long-standing problem.
Over six months last year, nearly 1,500 pills prescribed to 35 residents of a health care facility in Sauk Rapids, Minn., were missing under nurse Lora Asfeld's watch.
Asfeld later admitted to stealing the drugs, mostly painkillers. She was fired, reported to police and had her license suspended in February by the Minnesota Board of Nursing -- one of 13 licensees to be disciplined in a spell of about four months for stealing pain medication.
While drug thefts have long been an issue in hospitals and nursing homes, health officials are taking new steps to address the problem. The Minnesota Hospital Association and state Health Department are organizing a coalition of hospitals and licensing boards to identify and close loopholes in drug-handling protocols that make it easier to steal.
"People are starting to realize that this is a serious and ongoing problem," said Keith Berge, who chairs the Mayo Clinic's medication diversion prevention committee. "They're starting to recognize what they've been seeing. I think we've been seeing this all along and not recognizing it for what it is."
In perhaps the most dramatic recent case, a nurse anesthetist in Minneapolis was accused of taking most of the painkiller intended for a patient undergoing kidney-stone surgery in November. A criminal complaint said the nurse told the patient to "man up" as he endured the worst pain.
Opioid pain relievers such as fentanyl or oxycodone are the most commonly stolen prescription drugs, according to the federal Drug Enforcement Administration (DEA). Hospital workers have stolen them by replacing a patient's prescription with ibuprofen, siphoning medication from IV bags, taking leftover pills meant for the trash, falsifying patient records and forging prescriptions.
Once someone is addicted to prescription drugs, they'll go to great lengths to get their fix, said Ron Buzzeo, who was deputy director of the DEA's Office of Diversion Control for more than 20 years. He now consults for hospitals.
"People who are abusing drugs are extremely creative," Buzzeo said. "It's difficult to stay one step ahead of them."
There is no central tracking system for drug theft by medical personnel in Minnesota, and since facilities report incidents to a variety of entities, it's difficult to tell how often it happens. Many places don't report all drug thefts to the DEA, despite a federal law requiring them to do so, said Jack Henderson, supervisor of the DEA's local diversion group.
Hospitals can be vulnerable if they lack a thorough tracking system for medications, ideally an electronic one. Because many stolen drugs are bound for the trash, hospitals should also have a disposal system that includes safeguards such as requiring half-empty bottles or syringes to be returned to the pharmacy.
Tracking is generally done through software linked to password-protected medication cabinets called automated dispensing units. That lets facilities check for high-use patterns by a certain employee or for more complaints of pain than usual from patients who should have received enough medication.
In the past decade, most hospitals in Minnesota have gotten automated dispensing machines. At Hennepin County Medical Center (HCMC) in Minneapolis, they look like short, wide vending machines. When a nurse enters his or her password, a list of patients pops up, along with the medications for each. Once a medication is selected, a drawer pops open.
If a drug is packaged in a quantity larger than the patient's dose, the remainder must be thrown away. If it's a narcotic, many hospitals require nurses to have a co-worker verify they watched by typing a password into the machine.
After a 2008 incident at a Mayo hospital in Mankato in which a nurse replaced fentanyl with saline, Mayo Clinic in Rochester formed a committee to improve protocols. All leftover medication from operating rooms is now collected in a locked drop box that's returned to the pharmacy, which randomly tests them to ensure they weren't diluted.
In March, St. Cloud Hospital found itself dealing with a rash of unusual infections that it concluded were caused by a nurse using a syringe to steal painkiller from IV bags. The hospital has taken steps to make that harder, including placing tamper-resistant plastic caps over the ports where medication is added. Plastic bags are placed over the IV bags that can be removed only by perforating them.
High-tech systems such as dispensing machines are expensive. HCMC spent more than $2.5 million on its 80 machines. Smaller hospitals and nursing homes may rely on paper records to spot thefts.
Benedictine Health Systems, a long-term-care provider with headquarters in Duluth and Cambridge, uses bound notebooks with numbered pages to document medication, and it would be obvious if a page were missing, said Howard Juni, who provides medications to Benedictine facilities.
Some nursing homes use video cameras. That's how a Burnsville assisted-living center caught a health care aide in 2009 stealing OxyContin from an 89-year-old resident and replacing it with ibuprofen. But Juni said placing video cameras in residents' rooms raises privacy issues.
Despite hospitals' best efforts, most experts say it's impossible to eliminate drug theft. "We could spend an infinite amount of money creating electric fences around these things and we would still never completely stop the problem," Berge said.