drug diversion in nursing homes
TRANSCRIPT
~ With a Diversion Case Study ~
Drug Diversion in Nursing Homes
Special Agent David LogueIllinois State PoliceMedicaid Fraud Control Bureau
Contact Information
Email: [email protected]
Phone: 271-342-7878
David Logue
• Special Agent, Illinois State Police• B.S. & M.S. from Eastern Illinois University• Police Officer since 1998 • 6 years Road Trooper • 5 years Full Time SWAT Operator/Lead
Tactical Medic • 9 years MFCB Special Agent
The Attendee will:
1. Identify the Different Types of Nursing Home Abuse
2. Examine Acts of Drug Diversion & Potential Harm to Victims
3. Evaluate the Case Study and Review the “Red Flags”
4. Understand the Need for
Prevention Applications
Learning Objectives
• Physical Abuse
• Sexual Abuse
• Neglect
• Exploitation
• Emotional Abuse
• Abandonment
• Self-Neglect
• Elder Abuse• Any knowing,
intentional, or neglect act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult.
What is Nursing Home Abuse?
• Theft is a form of nursing home abuse.
• The most common form of nursing home abuse used to be physical abuse
• Now, financial abuse and exploitation is considered the most common type of nursing home abuse.
• It is a real threat facing nursing home residents because they are so reliant on their caregivers.
Is Theft Nursing Home Abuse?
• Stealing personal items (i.e.: jewelry, other possessions)
• Taking cash they find in residents’ drawers and wallets
• Creating fake charities and asking for donations
• Making charges on residents’ credit cards
• Overcharging residents and pocketing the money Residents think they are paying the nursing home
• Extorting assets or money from residents
• Stealing, Adulterating, & Fraud of Medications• Most under reported to Law Enforcement
Types of Theft
• Physical Abuse• Not receiving Meds
• Sub-therapeutic Dosing
• Exploitation• Breach of Trust
• Impact to Benefits
• Risk of Med Errors
Harm to Resident
• Stealing/Adulterating Meds
• Identity Theft• Fraudulent Rx
• Monetary Cost
• Doctoring of Records
Acts of Diversion >
Drug Diversion
• Little Rock, Ark (March 17, 2018)• Nurse was giving patents substitute narcotics/drugs; keeping the patient meds for
her own use
• Greensburg, Pa (March 12, 2018)• Nurse stole Hydromorphone prescription pain killers from the home’s pharmacy.
• Springfield, Oh (Feb 21, 2018)• 2 patients stole unsecured narcotics: one overdosed (history of drug abuse)
• DesMoines, Iowa (Feb 20, 2018)• Nurse w/ history of theft has been convicted of stealing painkillers from 3 patients
• McAlester, Ok (Feb 1, 2018)• 2 unlicensed employees stole prescription drugs from resident’s; including
morphine, zolpidem, clonazepam, oxycodone and hydrocodone.
• St. Petersburg, Fl (Jan 11, 2018)• Nurse is accused of stealing pain pills from patients at least two
assisted living facilities; pills were logged out on the forms, but they were not logged as administered
PervasivenessA Few Mentions: 1st Quarter of 2018
• There are numerous challenges working Nursing Home cases:• Under reporting of crimes
• Age of Victims
• Mental/Physical Health of Victims
• Turnover of personnel
• Lack of incident documentation
• Lack of training• Facility personnel
• Law Enforcement
Investigative Challenges
Case Study
• Suspect’s Background• Is 29 yoa
• Star football player & honor student in HS
• Grew up in a nice successful family in Indiana
• First tried Hydrocodone @ 17 yoa for recreation
• Was given to him by a family member; became addicted
• Registered Nurse > Oct 2012 (IN & KY) then Sept 2016 (IL)
• History of unreported substance abuse
• Arrested > Oct 2017
10
Case Initiation
• Alerted by Director of Nursing• “I think I have another one”
• Advised of the Red Flags• Suspect is tied to all incidents of Red Flags
11
Evolution of “Flags”
• After 1 month of employment > Questionable increase in residents requesting PRN narcotic pain meds
• Suspect was documenting far more pain med administration than any other nurse
• Coming in to work early “to help out passing of meds” so day shift nurse could finish paperwork
• Increase in pain complaints from residents
12
Doctoring of Records
• Reports by Suspect:• Finding a Fentanyl patch on the floor• Finding a Fentanyl patch in the bed sheets of
a resident• Resident scratching a Fentanyl patch off
them self• Accidently dropping a Fentanyl patch on the
floor thus contaminating patch• There was no documentation of a witnessed
destruction
• The Suspect had reported changing a Fentanyl patch “a day early” on a resident
13
Investigation Revealed
• Other nurses had discovered Fentanyl patches missing from Residents
• New Fentanyl box seal – Tampered with (opened) and resealed• 1 of 5 envelopes had been cut w/patch
removed
• Inventory of all Medication Carts > 4 other boxes of Fentanyl with the same tampering• Each box had 1 of 5 envelopes cut w/patch
removed14
Investigative Steps
• Went into the facility the day the incident was reported
• Collected Case Information
• Interviewed Suspect
• Suspect was terminated “that day”
• Filed case with AG’s Office
• Suspect Arrested
15
Investigative Steps
PowerPlugs Templates for PowerPoint Preview 16
Drug Testing
• Drug Test(s):• Facility does NOT drug test employees on
suspicion of drug diversion• Reverse proof:
• Recommended that the Facility should drug test (urine) residents that had allegedly received pain meds from the Suspect Employee after their shift
• Previous cases had several negative results found on drug screens
17
Interview of SuspectVerbal & Written Confession ~ Admitted to:
• Fentanyl patch thefts • (5 mentioned in original complaint – Up to 20 patches)
• Diverted close to 1,000 tablets pain meds • Substituting OTC Tylenol for Hydrocodone & Oxycodone
• Leaving Fentanyl patches on residents for 6-9 days • Changing the Tegaderm/Opsite tape every 3 days
• Diverted the new patches
• Diverting from employer in Indiana • Fired for falling asleep on job
• Diverted pain meds from Dialysis Center• Swap/Stole a few pills at a time during Med Checks
• Fired for go to patients homes for “visits” (Stealing pain Meds)
• Facility is under potential investigation for not reporting18
Post-interview of Suspect
• Background check revealed Suspect worked as an RN in Indiana and Kentucky prior to Illinois
• Contact with IN AG’s Office > revealed Suspect had been investigated in IN
19
• A complaint was made to the Nursing Home
• Suspect was still going into patients homes as “a friend” and stealing their meds
• Victim did not wish to cooperate
• Suspect was interviewed about new incident
• First denied
• Then admitted going w/ intent to steal, but said he didn’t
• Admitted to taking meds from this Victim on an earlier visit
• Additional charges were filed
Continued ActivityAfter case was filed for Prosecution
• This case was the FIRST reported offense to law enforcement in the suspects 5 years of diversion activity across three states
• If a report had been made on the first “bad act” incident, there may not have been subsequent victims
Summary
• Suspect would have a record or arrest of theft/drug use
• Early Intervention
• Minimize Victims
• Reduce Facility Liability
• Protect Public
Reaction• Criminal Investigation
vs. Termination• Passing on BAD
employee
• Thorough Background
• Random Drug Tests
• Facility reporting policies & internal response for any suspicious activity
Action
Pros & Cons of Prevention
