Can physicians really stop the actions of reckless caregivers?

In 2010, a surgical scrub technician named Kristen Parker was sentenced to thirty years in federal prison after allegedly diverting fentanyl from operating rooms, injecting herself with the powerful intravenous narcotic, refilling the contaminated syringes with saline, and replacing them to be used on patients.  She was infected with hepatitis C, and her drug diversions infected over two dozen patients in the Denver area.

In 2012, David Kwiatkowski, also positive for hepatitis C, allegedly carried out the same unthinkable acts as Kristen Parker.  His drug diversion activities potentially placed patients in seven states at risk for the development of hep C.  7,900 patients had to be tested for the disease.  To date, over 40 patients have tested positive for the same strain of hepatitis C as that infecting Kwiatkowski.  He is currently in jail in New Hampshire, awaiting trial.

Also in 2012, a prominent Denver oral surgeon, Dr. Stephen Stein, was discovered to be reusing needles and syringes on his patients.  All patients who received intravenous sedation while under the care of Stein from September 1999 to June 2011 are potentially at risk for HIV, hepatitis B, and hepatitis C.  It was later alleged by Stein’s partner, Neil G. Dobro, D.M.D., that Stein had been “getting high before performing surgeries” and reusing needles.  Stein has relinquished his license as an oral surgeon in Colorado and is currently being investigated by the Denver Police Department for prescription drug fraud.

In March 2013, another shocking story emerged involving Tulsa, Oklahoma dentist, Dr. Wayne Harrington.  Purportedly, Harrington used unsterilized instruments on patients in his practice.  Over 7,000 patients were recently notified that they were at risk for infection with HIV and hepatitis.

Although each of these examples varies slightly from the other, they all beg the same question.  Can we ever eliminate the possibility of patients becoming infected with potentially deadly diseases at the hands of reckless caregivers?  As a physician, I would argue that, sadly, the answer is no.  While the diligence of principled healthcare workers is one very important line of defense, it means very little in the presence of a devious mind.  In the fluid and oftentimes chaotic setting of a medical practice or a hospital, there is no practical way to monitor every worker every second of the day.  Furthermore, there is no reasonable way to prevent someone whom is intent on committing a heinous crime from seizing that window of opportunity.  Our only hope is to learn from these criminals and to close the loopholes that allow them to prey upon the innocent.

We can begin to minimize the risk to patients by enacting policies that diminish the opportunity for events like drug diversion or reuse of contaminated equipment to occur.  For example, better communication with interstate databases and more thorough background checks may have prevented Parker and Kwiatkowski from being hired time and time again, thereby keeping them from perpetrating the crimes that hurt so many.  More stringent rules on the storage of narcotics could also minimize access by employees who happen to be addicts.  If all healthcare employees were subject to random drug screens, including nurses and physicians, many users could potentially be discovered before patients were harmed.  Perhaps more attentive peer review by Stein’s and Harrington’s partners and nursing staff may have caught their dangerous practices much earlier.  These suggestions are only the tip of the proverbial iceberg.  We have a long way to go.

One thing that must happen is that such policies need to be implemented in a nation wide, standardized format.  In order to be effective, rules need to be the same from one institution to another.  It is the current state of inconsistency of rules between facilities that makes us vulnerable.  It is this vulnerability that will keep us from winning this deadly game of cat and mouse.

Sherry Gorman is an anesthesiologist.  In 2009, she was sued for medical malpractice after a drug-addicted scrub technician diverted fentanyl and allegedly replaced stolen syringes with contaminated ones refilled with saline.  The scrub tech’s crimes are blamed for infecting over two dozen patients with hepatitis C.  One of those patients was under the care of Dr. Gorman.  Her case settled out of court in January 2012.  Since that time, she has slowly started to heal.  Part of that process involved writing a book under the pen name Kate O’Reilley.  Dr. Gorman hopes that through her book and speaking out to other physicians, she can bring something good out of a situation that nearly destroyed her. 

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  • http://twitter.com/AventuraCardio Dr. Alan Ackermann

    Unfortunately, another issue that has to be addressed is the difficulty to sanction repeat offenders. Here in Florida for example, unless reported to the State, a physician accused of providing substandard care resulting in significant harm, often settles with hospitals to prevent lenghty and costly litigation. Even when Peer Reviews recommend the expulsion and/or sanctioning of a bad physician, hospitals will allow the individual to “voluntarily” relinquish the privileges and no one will know about it. It’s like sweeping the dirt under the rug. Medical Executive committees need to have a stronger backbone to support those decisions and the hospitals need to abide by them as well.

  • http://www.facebook.com/profile.php?id=1536833852 Rick Lundgren

    You have two nurses who properly reported a physician for substandard care, get charged with a felony in 2010 and we wonder why checks and balances don’t work.

    • Suzi Q 38

      Why were they charged with a felony? Where is the story?
      Life is simply not fair.

  • karen3

    Dr. Kevin. Are you really so hard up for content that you have to give this person a platform???

    • Guest

      I thought the pubic hair removal article was the new low.

      • http://twitter.com/sherrygmd Sherry Gorman, MD

        The intellectual, refined, self-controlled side of me begs me not to respond to you. But, for the life of me, I just don’t understand why you would post something so hateful. I never did anything to you. You don’t know me. I worked hard on this article. I researched it thoroughly. It’s a topic that I think is timely, intelligent, and completely valid. Moreover, it isn’t really even controversial. I have presented a problem, used examples to illustrate the issue, and suggested a small list of possible solutions — admittedly only skimming the tip of the proverbial iceberg.
        If you would like to discuss points made in this article, or another topic relevant to medicine, I would love to engage in a civilized conversation with you. But unless you are willing to come forward with a legitimate argument that explains why my article isn’t worthy of publication, could you please refrain from commenting? It’s just mean spirited.

      • Suzi Q 38

        I agree. How embarrassing, and who cares?

  • http://www.facebook.com/gjoachim310 Greg Joachim

    “If all healthcare employees were subject to random drug screens, including nurses and physicians, many users could potentially be discovered before patients were harmed.”

    –Except for that basically every drug aside from marijuana is out of your system within a day or two… all random UA’s would do is get rid of a lot of those who smoke a doobie in their off-time who more than likely aren’t the problem, while the ones stealing dilaudid and morphine and returning the dirty syringes so “the count” isn’t off don’t get caught cause it’s out of their system already.

    • http://twitter.com/sherrygmd Sherry Gorman, MD

      I appreciate your point, and I see the validity if the person using the drug has enough time elapse between self-administration and drug testing. However, it would catch those who steal the drugs on the job and use them during the course of their shift. Admittedly, it wouldn’t catch everyone, but it’s better than doing nothing at all.

      The marijuana issue is an entirely different can of worms. Here in Colorado, it’s legal (although the details of selling, buying, and possessing are still being worked out). However, even though it’s not against Colorado state law to smoke a joint, it is still against Federal law to possess, use, and distribute THC. Furthermore, employers are entitled to enforce their own rules regarding which substances are acceptable and which ones are not. I really could care less if the guy mopping the floors got stoned over the weekend, but I sure wouldn’t want my surgeon or anesthesiologist to have done the same.

      Respectfully,

      Sherry Gorman, MD

      • http://www.facebook.com/gjoachim310 Greg Joachim

        Definitely a different can of worms, especially since you’re in Colorado lol. Mother nature sure screwed this one up- the greater the level of impairment from a drug, the quicker it’s out of one’s system seemingly. Thanks for the response, scary to know that some people would jeopardize their careers by doping up, especially while on the clock.

  • Melanie

    You mean like requiring anesthesiologists to show common sense by locking up their narcotics instead of hiding them under intubation supplies? That would probably help, wouldn’t it?

    • http://twitter.com/sherrygmd Sherry Gorman, MD

      Easy to throw stones when you’re hiding behind the anonymity of a fake computer id. Were you an anesthesiologist in 2009? Are you an expert? If so, what are your qualifications? I don’t know what fills you people with such hate, venom, and self-righteousness. You seem to know an awful lot about me. Why don’t you tell me a little about yourself.

      • Melanie

        Interesting reply from someone who was hiding under a pseudonym until a few weeks ago.

        • http://twitter.com/sherrygmd Sherry Gorman, MD

          You seem to know a lot about me. Are you a stalker? Why don’t you show some courage and reveal yourself? Only then will I ever listen to what you have to say.

          • Chris P.

            I’m not in any way condoning an anonymous internet persona taking shots at a named (and thus both more brave, and more vulnerable) person, but you would have to know that your case was extensively covered in the press and is only a Google away. You also have a book, and a website, neither of which are secrets as you’ve plugged them in both your recent posts here.

            So to put your mind at ease, no Melanie is probably not a stalker, she’s just referring to publicly-known information. You’re a commercial author and personality, it’s going to happen.

            And for the record, I’m just a random name on the internet like Melanie is, but I found your article here both well written and interesting. I hope you keep writing, and wish you the best of luck.

          • http://twitter.com/sherrygmd Sherry Gorman, MD

            Chris,
            Thank you. Thank you for reading, thank you for being fair, and thank you for your decency.
            Sincerely and appreciatively,

            Sherry

          • Guest

            Ignore her. I’m horrified by what happened to you, and I hope you don’t waste another second of your life feeling responsible. You did nothing wrong. At my hospital narcotics were stolen by a depressed woman who ultimately took her own life. Was that an anesthesiologist’s fault? No.

          • http://twitter.com/sherrygmd Sherry Gorman, MD

            Thank you so much. Thank you for your compassion and your empathy. Also, thank you for your insight.
            Warmest regards,
            Sherry

          • Melanie

            Wow. You’ve submitted several posts to a blog that has 100,000 followers. It says right in your little bio below your post that you published using a pen name. The fact that I can read makes me a stalker?

            **backs slowly away**

          • Guest

            The backing away suits you better than the shameless attacking.

    • Guest

      I’m an anesthesiologist, and I know of no one who locks up narcotics in the OR prior to starting a case. Do you? Enlighten us, please!

      • http://twitter.com/sherrygmd Sherry Gorman, MD

        Thank you for your honesty. Even though you speak the truth, so few are willing to say to because of fear of retribution.
        Gratefully yours,
        Sherry

    • hobogloves

      I’m an anesthesia resident, and I just keep all my controlled substances on my person at all times. All my co-residents and attendings do the same thing. Problem solved. No need for locks, no need for a key, and no way for me to lose track of the drugs.

      • Melanie

        That certainly sounds like a reasonable way to handle things.

        • Guest

          Ask Naples Community Hospital about how well the “narcotics in my pocket” deal works with Medicare. Twice nearly lost their medicare contract. Fail.

  • Chris P.

    To Melanie, unless you’ve actually had to deal with a drug addict, you may not understand how crafty their desperation can make them. As determined as doctors and hospitals are to stop drug diversion and protect their patients, and as many steps as they take, there’s always a chance (hopefully ever-slimmer as systems improve) that an even MORE determined drug addict could slip though the cracks, and we get tragedies as happened in CO and NH.

    In a way it’s like Homeland Security: We get better and better at preventing acts of terrorism and protecting our citizens, and are constantly honing our defenses, but the whole thing about people who are bound and determined to commit a criminal act is that it’s not always possible to predict every single twisted way in which they might act. The important thing is that we keep trying, keep working to improve our systems.

    I don’t blame law enforcement for failing to prevent the recent Boston Marathon bombing, and absent any proof to the contrary, I won’t blame a doctor who was following common practice as set down at the time for falling prey to a criminal drug diverter.

    • Melanie

      I’ve dealt with plenty of drug addicts- I’m a nurse in a hospital. And I know enough, and knew in 2009, not to leave narcotics lying around.

      • Guest

        Still waiting to hear about what you know to be proper protocol for securing drugs prior to starting an OR case….

        • Melanie

          Looks my my response got caught up in the spam filter, because I included a link. Suffice it to say, CMS medication managment regulation 03.01.01 states that all schedule 2,3,4, and 5 meds are to be locked up, even in a secure area. Regulation put into effect in 2007.

          • Guest

            Typical of bureaucratic nonsense, I found the regulation you mention but not the specific language you state. I will assume you are correct.

            However, anesthesia carts and machines have locks or combinations, and despite storing these items safely, it is very possible for staff to get access to these drugs. Usually staff knows the combination to these carts should they need to get into them emergently (ie, in a code situation). Finally, propofol, another common drug of abuse, is kept unlocked and unsecured.

            The tragedy that occurred at Dr Gorman’s hospital could have easily happened with propofol. From the description of events, it sounds as though Dr Gorman practiced according to the accepted standard at her hospital at the time (and the accepted standard at every hospital and outpatient center I’ve ever worked at).

            I place 100% of the blame on the drug addict and not on Dr Gorman. I’m not sure why people blame her. She was doing her job and had absolutely no intention of harming anyone. A criminal took advantage of her situation and created circumstances that harmed innocent people. Why do you blame/attack Dr Gorman? Seems so misguided and inappropriate to me.

          • http://twitter.com/sherrygmd Sherry Gorman, MD

            Thank you. Thank you for your intellect, your knowledge, your understanding of the norms of the times, and the intricacies of the OR. Thank you for being kind enough to defend me. Thank you for being intelligent enough to speak to the situation. Thank you for recognizing me as a person. A person with a child whom I adore. A person who invested 25 years of my life into the practice of medicine. A person who is kind, compassionate, loving, and kind. Most of all, just thank you.

          • Melanie

            I don’t know anything about Dr. Gorman except what she’s posted here (four posts about the same thing) and what is available on Google. The very first hit on her name is a news article from 2011. That article states that her hospital had a system of locked carts that she was supposed to use. Furthermore, it says:

            “The anesthesiologist in his case said in a court document that she would cover the syringe with something in a drawer “so that it would not be visible if the drawer were opened.”

            Memos to anesthesiologists at Rose Hospital in 2001 and again in 2009 warn “never leave controlled substances unlocked or unattended.”

            SO, it appears that not only was she not practicing according to the standard of her hospital, but she was actually disregarding their written guidelines.

            Of course Kristen Parker is to blame for this, but I believe that Dr. Gorman is not blameless. We all know that addicts lie, cheat and steal. We also know that they work in the healthcare arena specifically so that they can get access to drugs. What happened with Kristen Parker was not unforseeable.

            All of Dr. Gorman’s posts have been about the stress that she was placed under and I see a lot of “poor, poor me” in them. I don’t see here taking responsibility for her own actions. The second anyone calls her out on them, they are attacked as being a vicious stalker.

            And I can’t get over the irony of her writing a post about stopping the actions of reckless caregivers, when she herself WAS a reckless caregiver!

          • JD

            Melanie, it seems that you equate A) being sued/ settling out of court to B) being guilty of something. The two are not the same. In this country, anyone can sue anyone for virtually anything. Settling out of court is typically the most economical solution. The litigiousness of our society, and the view that “if something goes wrong, then you should go after the doctor”, is what is driving up health care cost through having to pay malpractice insurance.

            Dr. Gorman was not convicted of a crime. She was sued. They are not the same thing.

            Oh, and I should also point out that When Dr. Gorman wrote under a pen name, she was not doing it to attack anyone. You are. That is the difference.

          • Melanie

            I’m not attacking her. I disagree with her. If she can’t take that, then honestly she shouldn’t post on a widely read public forum about contraversial subjects.

          • JD

            That wasn’t the main point of my comment (although others have also considered your comments as attacks). In any case, even if you want to disagree with her, she is no way obligated to engage with you if you are not willing to reveal your identity.

            The main point of my comment was that you should not make assumptions about what she may or may not have done wrong based on her being sued.

          • Melanie

            Of course she doesn’t have to engage me! And I’m not making assumptions based on her being sued. I’m just using what was resorted in the news and her own words from her deposition.

          • JD

            Oh…I see…your one of those…….

          • Guest

            First of all, it’s “you’re.” Second, are you a misogynist? You were attacking that poor resident on the article that was pulled and now this person. What gives? I would expect a fellow physician to behave better than this.

          • JD

            Noni, or guest, or whatever you go by:

            First, I could not care less what you expect. Being cordial to fellow physicians, just because they are fellow physicians, is the worst form of elitism. The way I treat people is without regard to what they do for a living, which is the way it should be. There are good and bad people in all professions.

            Second, and I don’t mean to go off topic, but after you tried to explain to me that the “poor resident” was not trying to belittle cancer patients, the “poor resident” posted a comment that confirmed that MY interpretation was correct. She was, in fact, trying to say that cancer patients are less deserving of job protection than pregnant women.

            Third, I was trying to defend Dr. Gorman from “one of those people” who forms opinions of others based on biased and incomplete internet reports. NONE of us know all the details of the case, so to make allocation of blame is irresponsible and offensive. Do I think that Dr. Gorman is guilty? I have no idea, and that makes me the only honest person in this exchange.

            Fourth, Dr. Gorman is female. Not sure how you define misogyny, but I am pretty sure that my defending her is not an example of it.

          • Melanie

            One of what? I don’t get it.

          • JD

            See reply to guest below

          • Guest

            Thanks for explaining. I see you points. She posts publicly and writes a book yet then cannot handle those that tell her they they think she’s partially responsible. Honestly, I really don’t think she is, but I can see how others might. She’s probably traumatized, which again begs the question why draw attention to yourself and your situation if you can’t handle criticism?

  • LastoftheZucchiniFlowers

    What is it that makes a heretofore decent human being, a provider of medical/surgical skill without addictions – morph into the despicable addict who puts patients in harms way? Do they begin their professional career journey with some inherent character flaw which sets them up for addiction/alcoholism or does this happen later as time and the rigors of ‘the life’ turn the tide. Can we spot them earlier, BEFORE they hit the deck and shame the entire profession, BEFORE they’ve injured countless patients and destroyed themselves and their families? Perhaps the answers lies in the addictive behaviors themselves? ‘Functioning’ alcoholics/drug addicts abound in our profession(s) still undiscovered even as we read this piece.

    As I nod my head in assent and agree with the principles established in this piece, I can still vividly remember many years ago when, as a student in a mid-sized medical center in surgical rotation, I learned that a very ‘esteemed’ surgeon was a flagrant drunk who frequently operated while intoxicated…..When I asked why he’d been permitted to operate under the influence, I was told that NO ONE dared call him on his failures because he brought SO much cash into the hospital. The fear of reprisal (loss of job, blacklisting, etc) was greater than the fear that an innocent patient would be harmed. OR 1st assists, etc. covered his blunders well until he finally ‘retired’ and was then named emeritus at a pretty decent med school. This was in the dark days of DRG .

    The late supreme court justice (and well known Placidyl addict) William Rehnquist was frequently ASLEEP during important work sessions but his clerks covered for him, tacitly avoiding the obvious contraindications of the old jurist’s profound sedation.

  • Suzi Q 38

    Unfortunately not.
    I had a friend that is a nurse that said that she had a drug abuse problem in the past. She used to steal drugs from the hospital.
    My daughter says that most of the drugs are locked up and accounted for now, so it is more difficult to steal. I remember getting a phone call from a pharmacist that said that one of our sales reps stole a huge bottle of our own drug from his pharmacy. I had to report it to my boss, with the caveat that I don’t know that this is true. This can also happen with other doctors as well. It turned out that this pharmacist was not the only one that complained about this individual. Next thing I knew, he was “gone.”
    I felt bad about that, but we have to look after the reputation of our companies. An addict is an addict. An addicted nurse is probably making too many errors as well as stealing controlled substances. Why wait until someone gets hurt or dies?
    A thief is a thief.

    • Marilyn Hubbard

      A little more than a decade ago, a group of very determined individuals were able to change the world using box cutters as weapons, taking control of several airplanes in a manner previously unanticipated. Although laws, procedures and protocols were certainly on the books at the time that should have prevented this tragedy, no one had anticipated these unprecedented acts and thus a window of opportunity was left wide open for these brazen individuals. Although the nature and scope of the disaster is obviously different, it seems to me a parallel can be drawn. The question must be asked- how can a desperate individual subvert medical ethics and ordinary decency? It seems to me that there was an accident in anesthesiology waiting to happen and it could have happened anywhere, to anyone.
      My real name is listed above and I am a nurse practitioner.

      • Suzi Q 38

        My daughter is working on her NP license.
        It is hard to stop people from sneaking around and doing what they want to do. On the other hand, we have to be ready and proactive, protective of the drugs. Lock them up. Trust no one….sadly.

  • Suzi Q 38

    My last point is that health professionals are not immune to being drug addicts. Watch your stuff!
    I do not put the shame and blame on Dr.Gorman, I sympathize with what happened to her. I have been sued before, and it is horrible.
    It takes so much space in your thoughts and brain. It can take years out of your precious life.

    I am sorry you had to go through it, Dr. Gorman.
    That being said, It is triumphant to ultimately prevail, and I am wiser and more mature having gone through it. Not much scares me anymore.

  • Sara

    I was in nursing school with a student who was a (former) IV drug user, and must have had addiction issues because she went through treatment. She seemed to still have a lot of issues, because when we went through IV training, she broke down and had to leave the room. At the time I wasn’t at all sure of the wisdom of this person being allowed into the nursing program, and I still am not sure about it.The faculty were all aware, so likely there had been discussion about her being in the program. The student did graduate, then last I heard got into some trouble at the clinic where she worked because of HIPPA violations, passing on private info from charts…didn’t hear anything about drugs but who knows. I’m not sure much can be done about completely eliminating these sorts of crimes described in the article, other than commonsense safety rules….just hoping my former classmate hasn’t gotten into any other difficulties. Drug diversion among all kinds of health providers isn’t a new thing, I’ve heard stories like the surgical tech cases for years, but instead involving physicians. Not that it’s common- but it’s not a new issue either.