Case Study: The Drug Diverter

One of the most serious and disturbing complaints for KBN to investigate is when a complainant suspects that a nurse is diverting narcotic medications from his/her patients for his/her own personal use or for the use of others.  The allegations may indicate that a patient did not receive his/her narcotic medication and that the nurse is potentially addicted to the narcotic medication.

Drug abuse and drug diversion now rank among the top concerns of healthcare managers and human resource professionals and continues to be a growing problem in the healthcare industry.  Drug diversion in facilities has the potential to put patients at risk, as well as drain a facility’s budget.  Diverters/abusers get their “fix” while patients suffer pain.  In addition, healthcare workers have become more creative in how they steal drugs and how they hide their addictions.  Some employers do not require drug screening as a condition of employment, while others fail to have policies in place for random “for cause” drug screens.

Drug diversion by nurses is not only a violation of the Kentucky Nursing Laws, it is also a violation of the Criminal Penal Code.  Holding a nursing license is a privilege . . . not a right.  When a nurse receives his/her nursing license, he/she becomes a professional and must act accordingly.  However, drug addiction is a disease and needs to be addressed with the nurse in an appropriate manner.  KBN may take disciplinary action against a nurse who is found to have diverted drugs from his/her employer, or he/she may be referred to the Kentucky Alternative Recovery Effort (KARE) for Nurses Program, an alternative to discipline program.

Nurse A has been a trusted employee at her facility for over 10 years.  Nurse A became addicted to Demerol after she was in a car accident 3 years ago that fractured a bone in her back.  She was prescribed Demerol by her primary care physician.  Nurse A started to take more than the required dose of medication and, before long, she was taking up to 20 pills on a daily basis. 

Her physician was trying to wean her off the medication and was prescribing less and less of the medication, although her dependency was growing stronger.  Her only means of getting her “fix” was at work.  Nurse A would ingest her patient’s Demerol and give them Tylenol instead.  She would chart the medication as given or wasted.  Nurse A would ask Nurse B to initial the medication as wasted, when in fact Nurse B had not witnessed the medication being wasted.  Nurse B trusted Nurse A as a friend and coworker; someone whom she had worked with for over 6 years. 

The facility started an internal investigation after several patients denied receiving their medication.  An audit of the medical records revealed a pattern of discrepancies in the documentation and administration of narcotic medication by Nurse A.  The investigation revealed Nurse A’s cover up.  Upon questioning, Nurse A admitted to the diversion.  Nurse A and Nurse B were terminated from employment and were reported to the Kentucky Board of Nursing.

KRS 314.091(1)(d) - Has negligently or willfully acting in a manner inconsistent with the practice of nursing.

KRS 314.091(1)(f) - Abuse use of controlled substances, prescription medications, or alcohol.

KRS 314.091(1)(g) - Has misused or misappropriated any drugs placed in the custody of the nurse for administration, or for use of others.

KRS 314.091(1)(h) - Has falsified or in a negligent manner making incorrect entries or failed to make essential entries on essential records.