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Rising concern about a string of painkiller thefts by medical staffers has prompted Minnesota hospitals to take the unusual step of joining with the Drug Enforcement Administration, local police and health regulators to improve their security measures.
The new coalition hopes to recommend tougher controls early next year. Among the security weaknesses they have targeted are lax oversight on bedside drugs and careless disposal methods.
State regulators say drug pilfering by doctors and nurses isn't new -- but the latest rash of cases has come with a disturbing wrinkle, leaving some patients writhing in pain as they're robbed of needed medications.
"It's a problem for a reason,'' said Ellen Benavides, assistant state health commissioner and co-convener of the Minnesota Controlled Substance Prevention Coalition. "This is a Minnesota-focused conversation, but it's a national issue.''
In just the past year, seven nurses and aides have been caught stealing narcotics from hospitals and nursing homes across Minnesota to feed their own habits or to sell drugs on the street. The targets range from anti-anxiety pills like Xanax to powerful pain medicine like fentanyl.
Meanwhile, the Hazelden Foundation near Center City, Minn., has reopened the local branch of a special drug treatment program targeted at medical professionals.
One of the challenges, said Joseph Cappello, a coalition member and an investigator with the Drug Enforcement Administration, is that insiders can always find ways to sidestep hospital security measures.
"What happens almost invariably is that the medical professional is intimately familiar with the way the system operates, and they basically exploit [that]," said Cappello, who has investigated more than a dozen such cases.
"The hospitals are operating in good faith," he added, but they don't always know when an employee is betraying their trust. "Unfortunately,'' he said, ''it's learning by experience.''
The goal of the coalition, he added, is to help hospitals and nursing homes spot "where oversight is weakest," and take steps "to get a handle on these areas that can be exploited."
Two troubling cases
Since 2008, at least 11 Minnesota nurses and aides have been charged as criminals for stealing narcotics from the health facilities where they worked or used to work. Nine of the alleged thefts were from patients.
Benavides said two cases in particular prompted Minnesota Health Commissioner Ed Ehlinger and Minnesota Hospital Association President Lawrence Massa to organize the coalition this summer.
At Abbott Northwestern Hospital last November, registered nurse Sarah May Casareto allegedly told a patient who was writhing in pain during kidney stone removal to "man up" because she couldn't give him more medication. A month ago she was sentenced to probation for stealing his painkillers before the procedure.
Benavides said a coalition subgroup is examining that case and an alleged drug spree at St. Cloud Hospital in March. Twenty-three patients there suffered bacterial infections after a nurse allegedly tapped into their IV bags to take pain medication. The nurse would replace the drugs with saline solution, a hospital spokeswoman said. The nurse has been suspended and the case is under federal investigation.
More recently, a registered nurse at Hennepin County Medical Center was charged with a felony for allegedly stealing powerful pain medications from patients, targeting victims who she felt weren't in excessive pain. And at Mercy Hospital in Coon Rapids, a former nurse was sentenced this summer for siphoning a morphine derivative out of patients' IV bags. She had posed as a nursing student.
Technology tracks drugs
Experts say it's impossible to know if the problem is getting worse among health-care workers, and Benavides said one of coalition's jobs will be to invent a tracking or measurement system.
"The phenomenon of addiction in the workplace setting is nothing new," said Dr. Omar Manejwala, who directs a treatment program for health professionals at Hazelden.
If anything, he suspects that hospitals are getting better at catching culprits, because of technology that tracks every time a drug is prescribed and dispensed. Now hospitals can tell, for example, if a particular doctor is prescribing far more painkillers than his peers. "We're seeing quite a few cases where they are detected right in that way," he said.
"And that's a good thing, because this is a treatable medical condition."
At the same time, it's probably unrealistic to think hospitals can stop the problem completely, said Dr. Marvin Seppala, Hazelden's chief medical officer.
"The people that are caught up in addiction in a health care setting are very bright and they're remarkably motivated to obtain these substances," he said. "They're a lot more motivated than anyone will ever be to stop it from happening because they are acting out of desperation."
The coalition, which includes representatives from the Minnesota Board of Nursing and the Mayo Clinic, meets monthly to hear reports from five working groups. By March, the group expects to go public with its findings.
"The intention is not a report as much as a tool or a set of tools,'' Benavides said. "It's not a big-city thing for big hospital facilities. We want to make sure these best practices are adoptable everywhere.''