The recent arrest of a former New York hospital pharmacy director for pilfering nearly 200,000 oxycodone pills underscores the need for facilities to shore up their operations, making sure there are safeguards in place so that no one employee has enough power to divert controlled substances and other in-demand medications
“For a pharmacist working alone, this is one of the larger cases of drug diversion,” … Usually more than one person would have been responsible for theft of this magnitude, he said.
This implies that there are “usually” cases like this, in which mass amounts of pills are diverted to the street by insiders along the supply chain. Forged or stolen individual prescriptions and raids of leftovers in medicine cabinets just don’t account for the volume of pills on the street.
indicted for stealing and illegally possessing oxycodone, which he allegedly began diverting in 2009. The drugs carried a street value of approximately $5.6 million,
Shortly after Beth Israel’s parent company, Continuum Health Partners, merged with Mount Sinai Medical Center to form the Mount Sinai Health System last fall, the new administration received an anonymous letter documenting D’Alessandro’s alleged theft, according to Ms. Brennan’s statement. The administration then launched an internal investigation and audit before referring the case to the Office of the Special Narcotics Prosecutor.
D’Alessandro used his position and knowledge of the hospital’s systems to divert 193,376 oxycodone pills on at least 218 dates between January 2009 and April 2014, the statement said. He accessed the hospital medication vault and removed various quantities of oxycodone, initially 100 to 500 pills at a time. On April 2, the day after hospital administrators questioned him, he removed 1,500 pills from the vault.
D’Alessandro made false entries to the electronic narcotics inventory system indicating the medication was being sent to the hospital’s research pharmacy
But the pills were never shipped to the service, which also fell under D’Alessandro’s control. Additionally, he filled at least seven fraudulent prescriptions written in his wife’s name at a hospital pharmacy.
revealed an apparent breakdown in policies or procedures that should have prevented D’Alessandro from taking drugs from the vault.
. “Directors in a hospital the size of Beth Israel shouldn’t be doing anything at all with controlled substances other than checking processes to provide oversight.”
The fact that such a deception can occur underscores that hospitals may be more prone to diversion than is often assumed, he noted. “People may think that within hospital pharmacies, diversion [occurs infrequently] because there are controls in place,” he said. “But if the pharmacists don’t have accountability, it can be just as prevalent as in community pharmacy locations.”
The exposure to a higher level of checks and balances that occurred as a result of the merger, he noted, may well have been the tipping point in uncovering the oxycodone diversion. “In a stand-alone hospital, the pharmacist-in-charge [PIC] is generally the last protection against diversions,”
Although such solo practice sites have an internal audit arm and an internal compliance area, “those [safeguards] are generally not sophisticated enough to catch diversion by the PIC.”
Mr. Catizone said background checks—both criminal and financial—of all pharmacy employees are essential. Regular inventories also are critical and ideally they should be kept in real time.
I’m disturbed that regular inventories aren’t the very minimum requirement of the law, and also that it’s only an “ideal” that they be kept in real time. This implies that most pharmacists don’t have access to current (“real time”) inventories of their controlled medication stock.
Yet pain patients are forced to account for every individual pill every day, with random pill counts and severe punishment (like being kicked out of pain management treatment) for errors. If opiate medications are being so loosely controlled in storage, it seems obvious where most of the diversion is coming from.
He recommended that hospital pharmacies also conduct regular surveillance of inventory to protect against diversion, and that reviews be performed by at least two employees.
In 2007, hospital pharmacy technician Dianne Hauss and her son Mark were sentenced to prison for conspiracy to distribute a controlled substance. A DEA investigation found that Mrs. Hauss had been stealing at least six bottles of hydrocodone weekly and giving them to her son to sell. An audit revealed a shortage of 623,861 hydrocodone/apap tablets, in addition to numerous record-keeping and security violations, prompting the DEA to fine the hospital $2 million.