Employees stealing drugs from Ohio pharmacies, health care facilities

http://www.dispatch.com/content/stories/local/2016/04/17/employees-stealing-drugs-from-pharmacies-health-care-facilities.html

TORONTO, Ohio — Time and again, customers called the Toronto Apothecary to complain after picking up their prescriptions. It was always the same story: Pills were missing from the bottles.

Workers figured the customers had to be wrong. Pharmacists insisted they had double-counted the pills.

Soon enough, though, they learned that their customers had been right.

A pharmacy technician regularly was dropping vials of oxycodone on the floor at the cash register. When she bent to retrieve them, she skimmed a few of the addictive painkillers for herself.

It’s just one example of yet another side effect of the country’s destructive prescription-drug addiction: health care professionals and workers who pilfer drugs to feed their own habits.

“You see it happening all over the place,” said owner and pharmacist Joe Amaismeier, whose Toronto Apothecary is tucked into a strip mall in this Rust Belt town of 5,000 near Steubenville.

He fired the technician, who was linked to $200 in losses at that store and $100 in missing medication at a now-defunct drugstore 12 miles away in Wellsville.

To understand the magnitude of the problem of internal drug theft, The Dispatch analyzed hundreds of state records from multiple agencies and professional-licensing boards and found that:

• At least 217 health care employees in Ohio were implicated in prescription-drug thefts in 2014, according to data from the state Board of Pharmacy and the Drug Enforcement Administration. Some employees were so addicted that they used the stolen drugs at work, their impairment putting the safety of patients at risk.

• On average, at least one health care worker in Ohio every other day is charged in court or loses a job or professional license as a result of theft. No one knows the exact number because experts agree internal thefts are underreported.

• Not surprisingly, the most addictive prescription medications were the most targeted for internal theft: oxycodone, hydrocodone, hydromorphone, morphine and Fentanyl.

• Few safeguards exist to prevent pharmacy technicians, a largely unregulated field, from stealing drugs, then getting a job at another pharmacy.

The details of the cases, culled from a variety of court records, police investigations and licensing-board reports, are troubling:

A Rite Aid pharmacist from northeastern Ohio had seizures while in the store’s bathroom after he overdosed on stolen tramadol. A nurse anesthetist in Springfield tried to kill himself by injecting stolen pain medications at work. A pharmacist at a Downtown Columbus CVS stole at least four pain medications and was caught on camera taking the pills. A Powell doctor repeatedly over-ordered hydrocodone for his practice and then took it himself.

The state Board of Nursing recently added two investigators (it now has 12) to keep up with cases of wrongdoing.

“It has been a problem, and we see it increasing as a problem,” Executive Director Betsy Houchen said.

•    •    •

Professional licensing boards can — and do — take action against health care workers who are caught stealing drugs or who admit addictions. But another group with ready access to drugs remains largely unregulated: pharmacy technicians.

They can exploit a loophole in Ohio’s oversight of health care workers because there is little to prevent techs who steal drugs from getting a job at another pharmacy and stealing again.

There are two significant reasons why.

Ohio is one of eight states that do not license, register or certify pharmacy technicians, according to the National Association of Boards of Pharmacy. And most pharmacy technicians charged with prescription drug theft are granted treatment in lieu of conviction by a court. That means if they complete intensive therapy, counseling and probation, the criminal charge disappears.

Information about treatment-in-lieu-of-conviction cases sometimes shows up on background checks — for certain home health care workers, for instance. But information concerning pharmacy technicians who steal and then enter such treatment cannot be disclosed, according to a spokeswoman for the state attorney general’s office.

That would take a change in state law.

The State of Ohio Board of Pharmacy “is concerned about its lack of jurisdiction” over pharmacy technicians, said Steven Schierholt, the board’s executive director, and it is working toward a “viable solution.” But he did not provide any specifics.

No one disputes that the role of techs is an important one; they really are a pharmacist’s right hand. But with that responsibility comes access, and some are bound to abuse it.

For one 26-year-old North Side man, it started in 2014 with cough medicine with codeine.

As he raced around his evening shift at the CVS at Cleveland and Oakland Park avenues, he would grab a box full of promethazine doses from the shelf and discreetly drop it into the trash. Then he’d go about his work.

At the end of the night, he would take out the garbage. He knew there were no cameras behind the store, so he would quickly and quietly rip open the plastic bag, remove the box of medicine, slip what he needed for that night into his pocket, and throw the rest back in the trash.

No way he could just steal the whole box.

“The security guard checks our bags when we leave at the end of the shift,” he said in a recent interview. The Dispatch agreed to not use his name if he offered insights into the theft problem because he is in a treatment-in-lieu-of-conviction program. “You take just what you can get out in your pants.”

Pretty soon, he was using the same method to steal the narcotic painkiller tramadol, and then came Suboxone, a painkiller that’s also used to treat opiate addiction.

He said he knew what he was doing was wrong, but he was paid $10.85 an hour, after all, and had a host of health issues and no insurance. He figured, a couple of pills here, a dose or two there — who was it hurting?

“I had a choice of doing something about it by self-medicating or live with the pain,” he said.

Eventually, newly installed hidden cameras caught him, and authorities charged him last year with five counts of theft.

Documents that pharmacies or health care facilities are required to file with the DEA when drugs come up missing show the pharmacy where he worked reported a loss of $12,000 worth of drugs in 2014, the largest of any single-site loss in the state that year. Prosecutors said the man couldn’t be linked to all of that, though, and he was charged only with what could be proved.

CVS declined an interview and said in an email that such incidents are isolated.

The pharmacy board received reports of 52 pharmacy technicians who stole prescription medications from their employers in 2015. Since 2012, the board has investigated two pharmacy technicians for repeat offenses. But those cases likely represent a fraction of the number of pharmacy technicians losing their jobs for stealing prescription drugs.

“Most employers dismiss the employee instead of bringing charges forward,” said Carmen Catizone, executive director of the National Association of Boards of Pharmacy.

Many states report that pharmacy technicians are responsible for 50 to 80 percent of prescription drug thefts by pharmacy employees, he said.

In 2014, after pharmacists at the Medical Arts Pharmacy on Cleveland Avenue regularly came up short on alprazolam (often sold under the brand name Xanax), they installed surveillance cameras. Within two days, they had an answer.

Video showed a tech waiting until a pharmacist entered a back room. She then grabbed a stock bottle of alprazolam, dumped pills into an amber vial and stuffed it down the front of her pants. Less than an hour later, she seemed to recognize the new cameras and, an investigator noted, appeared to smile into one of them. The pharmacists contacted investigators, and two technicians ultimately were fired and prosecuted. Both received treatment in lieu of conviction.

But even before their cases were out of court, one of them was working again, this time at Maple Leaf Pharmacy on West Broad Street. That pharmacy also began reporting shortages of Xanax. Records show there was an investigation but no charges filed. The tech was again fired.

Still, not everyone is convinced that techs should be registered, licensed or certified.

State Sen. Dave Burke, a Republican from Marysville who owns and runs a pharmacy there, said he thinks employee theft is minimal. “And I believe it’s been decreasing over time.”

Pharmacy technicians already must take a national test or one approved by the state’s Board of Pharmacy before they can work at a pharmacy, he said.

“I am always leery to impose a law on 0.01 percent of offenders that affects (the other) 99.9 percent,” Burke said.

Pharmacists would be more likely to support the idea of registering pharmacy technicians, though the devil is in the details, said Ernest Boyd, executive director of the Ohio Pharmacists Association. In that case, a technician accused of theft could be flagged and not allowed to work in a pharmacy until the matter is resolved.

•    •    •

At least 34 percent of employee drug thefts in Ohio analyzed by The Dispatch occurred in post-acute and long-term care facilities. The actual percentage could top 40 percent.

In April 2014, a police officer pulled over a car and discovered boxes in the back filled with medication intended for Alzheimer’s patients at a long-term care facility in Dayton. A worker accused of theft told officials that she “accidentally took the medications and didn’t notice that they were in her car,” according to a document on file with the Ohio Department of Health.

That was one of the more unusual cases handled by the department, which in 2015 barred 37 people from working in long-term care facilities as a result of workplace drug theft.

More common are thefts such as one in March 2014 at a Canton assisted living facility. There a licensed practical nurse reported that a resident had been given six tablets of hydrocodone for pain relief during an eight-hour shift. The resident, however, told the director of nursing that she did not receive any.

The patient’s urine tested negative for narcotics; the health care worker accused of wrongfully taking medication refused a drug test.

In many cases, the only way such theft is discovered is if officials notice that a patient’s pain coincides with a particular caregiver’s shift, said Peter Van Runkle, executive director of the Ohio Health Care Association, a nursing home industry group. That could indicate that the caregiver might be diverting prescription medications instead of giving them to patients.

“It’s been around forever and probably will continue to be,” Van Runkle said of employee theft.

Federal officials in recent years have alerted health care providers to tactics commonly used by prescription-drug thieves, such as retrieval of used Fentanyl patches from the trash. Some nurses even remove the patches from patients prematurely, place them on themselves, then stick them back on the patient before the patch is checked again, Van Runkle said.

“Where there’s a will, there’s a way,” said Brandon Webb, the new administrator of the London Health & Rehab Center, formerly known as the Arbors at London. The nursing home reported a theft of Percocet, oxycodone and other controlled drugs by an employee in March 2015.

Webb said two nurses are required to count medications together when they close out a medication cart. “There’s lots of checks and balances,” he said.

Hospitals, meanwhile, accounted for 29 percent of all employee thefts of prescription drugs, according to the Dispatch analysis.

Typical cases include a night nurse at OhioHealth Dublin Methodist Hospital who disappeared during his shift and was later found “sprawled across a chair intended for visitor use.” He admitted to stealing morphine intended for a patient. Another nurse there stole a patient’s Fentanyl and injected it into his own arm while on duty.

Despite those and other internal drug thefts at OhioHealth hospitals, officials said they haven’t seen any pattern that would prompt a change in procedures.

The hospital system monitors for suspicious drug withdrawals from dispensing cabinets and uses surveillance. There’s also an education component to help employees identify warning signs of drug diversion and addiction. There’s a culture of “see something, say something,” officials said.

But workers who steal drugs can be challenging to catch, in part because they have legitimate access to medications.

“They are familiar with the working environment, with the equipment and procedures, and also with their fellow workers and their routines,” Harry Trombitas, OhioHealth’s vice president of security operations, wrote in a statement. “They can plan their actions and be very secretive about it.”

Smaller hospitals also deal with the problem. Berger Hospital in Circleville experienced a series of related employee thefts of hydrocodone and Oxycontin from its pharmacy in 2014. Since then, administrators have installed security cameras and automated dispensing cabinets for medications.

Those cabinets are audited randomly, and the narcotics are reorganized periodically to make it harder for would-be thieves to memorize the location of frequently abused opiates. No employee can access the narcotics safe alone.

The tactics used by internal thieves evolve over time, said Kristin Gardner, Berger’s chief nursing officer: “The challenge is that you don’t always know what you don’t know.”

As authorities work to crack down on the epidemic of drug abuse, the court system has evolved in recent years to give a second chance to those accused of prescription theft.

“An opiate addiction is something that will grab you by the throat and drag you around and make you do things you otherwise wouldn’t do,” said Stephen Palmer, a prominent Columbus defense attorney whose clients include many health care professionals.

“Addiction doesn’t discriminate.”

Filed under: General Problems