VA shoulders drug diversion shame

Hospital Safety Insider, March 9, 2017

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Sticky-fingered employees spell trouble for any organization. But theft poses a unique set of problems in healthcare settings, where missing drugs can introduce risk and violate the trust between patient and provider.

When news of stolen medicine splashes across the headlines—as it did last month for the U.S. Department of Veterans Affairs (VA)—finger-pointing ensues. While drug diversion is a common problem that all healthcare facilities must combat, the VA has come under renewed scrutiny following reports that its response to drug theft by its own workers has been inadequate.

Over the past six years, only about 372 VA employees were disciplined for substance-related problems, The Associated Press reported last month, citing government data. That’s despite there being more than 11,000 reported incidents of drug loss or theft during the same time frame at federal hospitals, which include seven correctional hospitals and about 20 serving tribal groups in addition to VA’s 168 medical centers.

A report released last month by the Government Accountability Office (GAO) found significant shortcomings in the drug-tracking practices of four VA facilities. Two of the four failed, for instance, to conduct monthly inspections of controlled substances as required. A number of factors drove the failures, including weaknesses in procedure, policy, and training, the GAO report noted.

Members of Congress responded with a hearing February 27 in the House Committee on Veterans’ Affairs subcommittee on oversight and investigations. Carolyn Clancy, MD, deputy undersecretary for health for organizational excellence at the Veterans Health Administration (VHA), testified that VA’s loss rates of controlled substances remain quite low, considering the volume of medicine its facilities handle.

“Individuals who are determined to divert controlled substances may find a way to do so despite the existence of robust controls,” Clancy said in her written remarks as prepared for delivery. “This is true within and outside the VA.”

Healthcare consultant Kimberly New, BSN, JD, RN, wrote in the HCPro book Drug Diversion in Healthcare that organizations have good reason, unfortunately, to shy away from reporting drug diversion as they should.

“Hospitals and other institutions commonly avoid reporting diversion out of a fear of negative publicity, legal action, or inviting the scrutiny of regulatory agencies,” New wrote. So institutions should be met with praise, not backlash, for revealing instances of such a widespread problem.

“[D]iversion cases may be used by the press as evidence that an institution is subpar, while in reality, patients are much safer in institutions that regularly catch diverters as opposed to those that claim they have never had a case,” New wrote.

Despite the incentive to keep things quiet, the VA has gone public with some particularly embarrassing allegations recently. Last month in Arkansas, three VA employees were indicted on charges they conspired to steal opioids, erectile dysfunction medication, and other drugs to sell on the street. The trio allegedly managed to divert more than 21,000 pills and other drugs with a total street value of more than $160,000, costing the VA about $77,700.

“It is particularly egregious when the perpetrators of such illegal acts are health care professionals responsible for ensuring that potentially dangerous drugs are dispensed properly,” Matthew Barden, assistant special agent in charge of the Drug Enforcement Administration’s district office in Little Rock, said in a statement announcing the indictment.

“We will continue to work with our law enforcement partners, including those at the Department of Veteran Affairs Office of the Inspector General,” Barden added, “to ensure that if a health care provider illegally diverts pharmaceuticals, they will be held accountable for the harm they cause.”

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