In 2009, I checked into the surgical ward of Denver’s Rose Medical Center to have a kidney stone removed. It was a minor procedure, and I emerged from the hospital a bit groggy but otherwise seemingly unscathed. Little did I know that I was soon to be plunged into the shadowy world of drug diversion.
About six weeks after the operation, I was overcome by a crush of debilitating symptoms — it felt like I had the flu on steroids. As a single parent of a 1-year-old, I was terrified it would get worse. When I went to a local urgent care center, the doctor sent me straight to Rose’s emergency department.
Blood tests showed I had hepatitis C — a life-threatening condition that can lead to cirrhosis or liver cancer. As an otherwise healthy 41-year-old, I can’t even begin to describe my shock at hearing that news. I started asking anyone who would listen how I might have been infected with the virus that causes hepatitis C.
The Colorado Department of Public Health and Environment reached out to me when my hepatitis C was reported to it. I spoke with a doctor at the University of Colorado hospital system who was doing a longitudinal study on hepatitis C. At that time, I realized that if I had been infected with hepatitis C while in the hospital, the same thing might have happened to others, so I suggested that the health department start an investigation. Little did I know, one was already underway.
That investigation, by the Centers for Disease Control and Prevention, showed that I and at least 18 others had been infected with hepatitis C by Kristen Parker, a technician at Rose Medical Center who had tested positive for the disease before she was hired. She stole patients’ fentanyl-filled syringes off medication trays, injected herself with the painkiller, then refilled the syringes with saline.
In the summer of 2009 — about three months after I learned I had hepatitis C — Parker was arrested in one of the biggest hospital drug diversion incidents to date. In 2010, she was sentenced to 30 years in prison.
Since then, the national opioid crisis has become an epidemic. Policymakers and health care providers have responded. Congress streamlined multiple opioid proposals into legislation last year. Every health care system in the country seems to be tackling the issue through opioid task forces, educational initiatives, and better communications technology.
But they are largely ignoring drug diversion — drugs stolen by health care workers for their own use or to sell.
Ten years ago, I had never heard of drug diversion. Today I know that 10% or more of hospital staff members have addiction issues. While not all divert drugs at some point in their careers, drug diversion is happening at hospitals across the country and there have been many stories like Parker’s. Yet the issue is barely discussed and too quickly forgotten.
In a Porter Research survey of health industry workers, 90% of respondents said that diversion definitely occurs, though 65% said that most of it goes undetected. A surprising 22% said their health care facility lacked a drug diversion prevention program. And among facilities that have programs in place, like Rose Medical Center, policies are not consistently enforced or are minimal.
For many health systems, the subject of drug diversion by staff members is taboo and swept under the rug. There’s a stigma to being associated with drug diversion — not to mention fines, potential legal ramifications, and a public relations nightmare.
While many hospitals have come a long way over the last decade, some of the responses to drug diversion are still underwhelming. Some health care systems track medications in dispensing cabinets (where most medicine is stored and accessed) as evidence they’re addressing drug diversion. But even with medication-tracking technologies, it can take months, if not years, before a pattern is detected and a potential diversion flagged. Most likely, damage will already have been done to patients.
So where does this leave the health care system and its patients? What can we do to double our efforts to prevent diversion from happening?
My colleagues and I with the Healthcare Diversion Network believe we need greater transparency and accountability — not just visibility into health care workers’ experience, backgrounds, and career histories but also health care institutions’ investigations into suspicious activities.
Part of what has gotten in the way of addressing diversion is the fact that health care systems are not talking to each other and sharing information about it. In my case, Parker had been asked to leave her work in a facility in New York because of performance issues and altercations with co-workers; we don’t know if diversion was involved because no report was filed by the New York facility. It’s possible that if the facility had filed such paperwork, it would have raised a red flag in Colorado. And when Parker was dismissed from Rose and sought work elsewhere, she asked that her new employer not contact Rose, and the surgical center agreed to that.
We need to reduce the institutional stigma associated with reporting diversion so more leaders in health care organizations come forward and report when their employees are diverting. We also need to push for stronger regulations. While hospitals are guided by recommendations from associations like the Joint Commission, we need stronger regulations with teeth in them before we will see reductions in diversions.
What I want most of all is for my story, and the story of hundreds of other innocent people harmed by diversion, to help focus the country’s attention on the larger questions: What more can we do to keep patients safe? And how can we support hospitals and health care systems to make sure their nurses and physicians and pharmacists and other workers have access to the resources and programs they need to address addiction to drugs and other substances before it’s too late?
I never foresaw becoming an advocate for reducing, or better yet stopping, drug diversion. Now that I am, I believe it is a solvable problem. We can do a better job of keeping drug diversion, like swiping syringes filled with painkillers for personal use, from tainting health care systems and harming patients.
But what we can’t do is pretend that drug diversion isn’t a problem that will go away on its own. As one hospital’s chief medical officer told me about drug diversion, “It’s not a question of if, but a question of when.” Only by acknowledging the reality of drug diversion can we move forward.
Lauren Lollini is a psychotherapist, a patient-safety advocate focused on drug diversion, and a member of the advisory board for the nonprofit Healthcare Diversion Network.