What Happened
A registered nurse at a Jacksonville surgical center was caught on surveillance camera removing controlled-substance vials from a locked cabinet minutes after being fired for forging an anesthesia record.
Katherine Jee Rankin was confronted by a supervisor after the supervisor discovered she had forged an anesthesia record, and was told on the spot that she was being terminated. While still in the building, a coworker and a surveillance camera captured her removing vials from the controlled-substances cabinet. Rankin then told three other employees that she had an addiction, had been taking drugs from the facility, and that the center's drug count was "going to be off."
She eventually turned over four vials of injectable hydromorphone, initially claiming they contained saline rather than the labeled drug. She admitted she had removed the hydromorphone, replaced it with saline, glued the caps back on, and returned the vials to inventory so the drug count would reconcile. Laboratory testing confirmed both physical tampering (caps removed and reglued) and chemical tampering (heavily diluted hydromorphone) in all four vials. A subsequent records review found numerous instances where 200 mL of hydromorphone was charted as administered — an unusually large amount — with a digit in the record appearing altered from 1 to 2 to mask the discrepancy, along with implausible post-operative administration entries. Rankin pleaded guilty in October 2023 to tampering with a consumer product; a sentencing date has not been set.
What Went Wrong
A nurse was able to tamper with controlled-substance vials and falsify administration records before termination triggered any review of her prior conduct. Key failures included:
- No inspection process caught physically tampered vials — removed and reglued caps — before they were returned to inventory and made available for future patients.
- Administration records showing an unusual, doubled dosage volume were not flagged or reconciled against typical dosing for the procedure type.
- Post-operative administration entries that were clinically implausible were not cross-checked against the actual care timeline.
- The center only learned of the ongoing diversion because the employee volunteered it after being terminated for an unrelated documentation offense, not through routine surveillance of inventory or records.
How It Could Have Been Prevented
- Inspect controlled-substance vials for tampering — cap integrity, seal condition, fill level — at receipt, at dispensing, and again before administration.
- Flag and investigate administered-dose volumes that deviate from a procedure's typical dosing range rather than accepting the charted amount.
- Reconcile administration timing against the operative and recovery record to catch implausible post-operative entries.
- Immediately audit a terminated employee's recent controlled-substance transactions and inventory counts as a standard part of the termination process, especially when the termination itself involved falsified documentation.
Related Guidance
- Investigation Playbook — Running an internal diversion investigation when product integrity is in question.
- 15 Red Flags of Drug Diversion — Behavioral and documentation indicators of diversion by clinical staff.
- Hospital Diversion Prevention Checklist — Self-assessment covering surgical and controlled-substance inventory controls.
- Employee Screening & Fitness for Duty — Controls for staff with controlled-substance access, including offboarding checks.