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SALT LAKE CITY — After the discovery that up to 4,800 patients at McKay-Dee Hospital in Ogden may have been exposed to hepatitis C — and that a former nurse who was stealing morphine may have been the source — patients and hospital officials alike are asking whether more can be done to detect these cases earlier.
"I think we're all trying to figure this out," said Angela Dunn, a medical epidemiologist with the U.S. Centers for Disease Control and Prevention who is stationed with the Utah Department of Health.
In the past 10 years, at least 84 nurses, pharmacists or pharmacy technicians have been disciplined by Utah's Division of Occupational and Professional Licensing for stealing medications from their employers. Among them:
- An Ogden nurse who admitted to stealing hydrocodone, oxycodone and hydromorphone from his employer, a rehab center in Ogden, throughout 2012 and 2013. He recorded that he had given them to patients when in fact he was ingesting them himself, "often while still at work," according to the licensing department's documents.
- A nurse anesthetist at Mountain West Medical Center in Tooele who "regularly" stole liquid opioid medications for his own use. According to documents from the licensing department, he collapsed in the operating room while performing a general anesthesia procedure in 2005 and tested positive for fentanyl, meperidine and normeperidine.
- A North Salt Lake nurse who was caught hiding a bag of fentanyl last year and pulling narcotics at a significantly higher rate than other nurses in her unit. A search of her locker turned up "intravenous start kits, IV needles with blood on them, empty needle packages and 10 ml syringes that appeared to be used," according to documents from the licensing department.
A growing problem
A nationwide wave of prescription drug abuse is forcing health officials to reckon with the consequences of addiction entering the workplace.
Christine Nefcy, the chief medical officer at McKay-Dee Hospital, said drug abuse is "rampant in communities across our country," Nefcy said. "Hospital personnel, hospital employees aren't any different."
When people steal pharmaceutical drugs — usually powerful painkillers like oxycodone or fentanyl — that's called "drug diversion."
And drug diversion cases involving health care workers are occurring more and more over the past few years, according to John Eddington, an agent with the Drug Enforcement Administration office in Salt Lake City.
Pharmacists do it by forging prescriptions or calling in phony orders. Nurses may pocket pills, giving the patient one instead of the prescribed two. In the most egregious cases, health care providers steal powerful narcotics by tampering with vials and syringes, potentially exposing themselves and other patients to infectious diseases.
McKay-Dee Hospital officials declined to give an update on the hepatitis C investigation, except to urge patients who received the letter to get tested as soon as possible.
Mary Khalaf, an Ogden mom whose 17-year-old son got the letter and got tested Friday, said her mind is "racing."
Khalaf said her son, who is developmentally disabled and relies on her for care, went to the emergency room twice — once for complications related to his diabetes and another time for a broken foot.
Khalaf knows that hepatitis C cannot be spread through casual contact. But she is struggling to remain calm.
"If I die … then who would take care of him?" she said. "It's scary to think that all his life he's worked to be normal. … He wants to be a person with a car and house and wife."
Hepatitis C, a blood-borne pathogen that affects the liver, can remain asymptomatic for up to 25 years.
Dunn emphasized that, while scary, hepatitis C is hard to contract. Data shows that even after being exposed to infected blood via a needle stick, the risk of infection is less than 2 percent, she said.
But she said the health department will "certainly" be working with hospitals and the licensing boards to create "better testing mechanisms so we can identify these cases a little more readily."
Finding the balance
The potential exposure at McKay-Dee was discovered by chance: It wasn't until a patient got a blood test "on his own means," according to Dunn, that he found out he was positive for hepatitis C.
That was when health officials got involved, found out about the nurse and asked her to undergo testing, according to Dunn.
Currently, it's not standard for hospital employees who are caught diverting medications to be tested for infectious diseases. And public health officials aren't brought in until after an outbreak is detected, making it hard for them to be proactive.
But several high profile cases in other states in past years have accelerated discussion about whether more can be done, Dunn said.
In 2009, a Denver hospital technician infected at least 18 patients with hepatitis C by swapping syringes of pain medication with used ones containing saline. After that case, Colorado health officials urged hospitals to work more closely with the public health officials so they could use their own data to look for any signs of disease transmission, according to Dunn.
In Minnesota, after a series of widely publicized cases of health care workers stealing controlled substances, a coalition of health officials and hospitals released new guidelines for investigating prescription drug theft, including the recommendation that hospitals create diversion teams and engage local law enforcement as early as possible.
Many of these cases are often handled internally by the hospital and licensing boards but aren't reported to law enforcement, according to Scott Byington, president of the Utah chapter of the National Association of Drug Diversion Investigators.
"A lot of the clinics or hospitals, when they catch employees doing theft, I would say more go unreported than reported," said Byington, who has investigated pharmaceutical drug cases for six years with the Layton Police Department.
"All of a sudden somebody doesn't show up for work and the rumor mill starts going," Byington added. "They'll report it to us anonymously, usually, and when we go to investigate, (Human Resources employees) sometimes will just say, 'We're not going to release any information from that.'"
Hospitals are afraid that releasing information could jeopardize the employee's privacy, Bhington said. Sometimes, hospitals just don't know who to contact or think local law enforcement officials aren't trained to investigate pharmaceutical drug theft.
Questions also remain about whether health care facilities have an obligation to inform patients that their medication — or even the quality of the care they received — may have been affected by an employee diverting drugs.
Dunn said the CDC recommends that if a health care provider is found to be diverting medications, the patients should be informed and tested for communicable diseases.
She also said that testing the health care provider "is probably the reasonable route to go," although she acknowledged that's not what happened at McKay-Dee.
Dunn compared the recommendation to the standard procedure for accidental needle sticks, which trigger testing for both the employee and the patient at many hospitals.
Chris Dallin, a spokeman for McKay-Dee, said the hospital would be "willing" to look into mandatory reporting to patients and mandatory disease testing for employers caught stealing medications.
But Nefcy, the chief medical officer, said any discussion of that has to be balanced with the individual's right to privacy regarding their health information.
As an example, she said, consider the recent measles outbreak in Utah. Measles, a highly communicable disease, is "a different situation" than hepatitis C, Nefcy said.
"I think people in public health really feel like they need to balance panic and distress with true risk," Nefcy said. "And that's not always an easy balance to get, but it's an important one."
Contributing: Nkoyo Iyamba
Daphne Chen is a reporter for the Deseret News and KSL.com. Contact her at firstname.lastname@example.org.