Diversion Case Studies

Pharmacist Pleads Guilty to Stealing 67,000 Doses of Prescription Narcotics — Minnesota, 2014

Burnsville, Minnesota

Anissa Jeanne Shores, a full-time pharmacist at a retail pharmacy in Burnsville, Minnesota, responsible for maintaining controlled-substance inventory records, began in 2011 falsifying the pharmacy's written and computer receiving logs to understate incoming shipments, then stole the difference for her own use. Over the course of the scheme she diverted an estimated 67,000 dosage units of hydrocodone, oxycodone, carisoprodol, diazepam, and the non-controlled drug tramadol. She was charged by criminal information in October 2014 and pleaded guilty that same month to one count of obtaining a controlled substance by fraud.

Pharmacy technician admitted taking Xanax, Lortab and Luminal without payment from a national chain pharmacy

Baltimore, MD

A pharmacy technician employed at a national chain pharmacy in Baltimore, Maryland was the subject of a State Board of Pharmacy order for summary suspension. The order's investigative findings state that the technician admitted, orally and in writing, to taking Xanax, Lortab and Luminal from the pharmacy without payment, and stated that the count was not accurate and that she stole the drugs. According to the order, the technician was terminated by the pharmacy and was criminally charged in the District Court of Maryland for Baltimore County with theft under $1,000 and theft-scheme under $1,000. The Board summarily suspended the technician's registration to practice as a pharmacy technician in Maryland.

Former Trinity Home Health/Hospice nurses accused of diluting and diverting patients' morphine and hydromorphone

Minot, ND

Two former nurses at Trinity Home Health/Hospice in Minot, North Dakota, were accused of diluting nursing home patients' medications and administering morphine instead of hydromorphone. The text states they were reported to the North Dakota Board of Nursing in 2014 and voluntarily surrendered their nursing licenses after admitting to drug-diversion allegations. An investigation of records for 104 patients found multiple instances of drug diversion, and police charged suspects with Endangering a Vulnerable Adult, Conspiracy, and Theft of Property; warrants were issued.

Pharmacy licensee in Mitchell, SD diverted prescription drugs for personal use and received three-year probation

Mitchell, SD

A pharmacy licensee violated laws and rules governing pharmacy practice and diverted prescription drugs for personal use. The Board ordered a three-year probation effective September 29, 2014, with continued participation in a monitored program for health professionals, quarterly reports, and successful completion of the Multistate Pharmacy Jurisprudence Exam before probation ended.

Physician indicted for trafficking controlled substances prescribed to friends and co-workers

Andover, OH

A physician practicing at St. Joseph’s Andover Medical Center in Andover, Ohio, was alleged to have prescribed controlled substances to friends and co-workers who were not patients and not for a legitimate medical purpose. A grand jury indicted the physician on 26 felony counts of trafficking in drugs. The physician pleaded not guilty and was released on a $10,000 personal recognizance bond.

Delaware state hospital nurse charged with forging medication records to obtain oxycodone

The Delaware Attorney General announced on March 24, 2014 that a former nurse at the Delaware Hospital for the Chronically Ill had been arrested by the Medicaid Fraud Control Unit and charged with obtaining a controlled substance by fraud or forgery, second-degree forgery and falsifying a business record. Investigators alleged that between February 1 and March 18, 2013 the nurse forged the signatures of other nurses on controlled-substance sheets to indicate oxycodone had been given to patients, while allegedly keeping the drug for personal use. The charges were allegations at the time of the announcement, and the nurse was released on unsecured bond after arraignment.

Burlington pharmacy technician accused of taking thousands of hydrocodone, zolpidem and buprenorphine tablets

In 2013 the Vermont State Police Drug Diversion Unit investigated a pharmacy technician at a Burlington retail pharmacy who police said took 4,184 tablets of hydrocodone, zolpidem and Suboxone. According to the police report described in the article, she told investigators she gave the drugs to her husband. The article does not report the outcome of any charges.

Vermont supermarket pharmacist wrote and filled fraudulent hydrocodone prescriptions in two states

State police reported that in 2012 a pharmacist at a supermarket pharmacy wrote and filled 11 fraudulent prescriptions in Vermont and New York, most of them for hydrocodone-acetaminophen. According to the police report described in the article, the pharmacist admitted writing the fake prescriptions and said he had been going through hard times and had flushed the pills he had. The article does not report a court outcome.

Former nurse at Delaware Hospital for the Chronically Ill charged with forging controlled-substance records to divert oxycodone

Smyrna, DE

A former nurse at the Delaware Hospital for the Chronically Ill was arrested on March 21, 2014 and charged with obtaining a controlled substance by fraud or forgery, forgery, and falsifying a business record. The charges alleged that between February 1 and March 18, 2013, the nurse forged other nurses' signatures on Controlled Substances sheets to indicate oxycodone had been given to patients while allegedly keeping the drugs for personal use. The investigation began after a hospital administrator reported illegal obtaining of oxycodone to Smyrna Police and was handled by the Attorney General's Medicaid Fraud Control Unit.

Emergency room nurse sentenced for stealing prescription drugs from patient accounts via a hospital dispensing system

York, ME

A former emergency room nurse pleaded guilty in York County Superior Court on January 31 to ten counts of stealing drugs and three counts of falsifying private records, according to a statement from the Maine Attorney General. From August 2011 to April 2012, the nurse accessed a computerized dispensing system at the hospital using their own name and withdrew drugs in the names of emergency room patients, according to the indictments. On March 26 the nurse was sentenced to two years in prison with all but six months suspended, a second consecutive two-year term all suspended, four years of probation, and was ordered to pay $4,000 in fines and $8,318 in restitution. The nurse's license is under suspension and probation prohibits employment giving access to controlled substances.

UW Hospital nurse charged in morphine and hydromorphone syringe diversion

Madison, WI

A nurse at UW Hospital was investigated after a pharmacy technician noticed red tamper-evidence caps on drug syringes had been tampered with. The nurse admitted to hospital staff that she diverted pain-management drugs for herself since October 2013, and police found she accessed morphine syringes from a secured machine, replaced them with water or an unknown liquid, and diverted 42 morphine and hydromorphone syringes. The nurse was arrested on June 12 and was to be charged with 42 felony counts of diversion of drugs and 42 counts of reckless injury; she was no longer employed by the hospital.

Roseville Pharmacy break-ins lead to indictment for theft of Schedule II and III controlled substances

Roseville, OH

A suspect was indicted on 69 felony counts after an investigation into a series of break-ins at the Roseville Pharmacy in Roseville, Ohio. The suspect is alleged to have been responsible for break-ins from September 2010 through January 2014, during which 6,140 Schedule II and Schedule III controlled substances were reported stolen, with an estimated street value of over $37,000. The investigation was conducted jointly by the Ohio State Board of Pharmacy and the Muskingum County Sheriff's Office.

Traveling Radiologic Technologist Sentenced for Fentanyl Diversion and Multistate Hepatitis C Outbreak — New Hampshire, 2013

Exeter, New Hampshire

David M. Kwiatkowski, a traveling radiologic and cardiac catheterization technologist who worked at hospitals in at least eight states, most recently Exeter Hospital in New Hampshire, stole fentanyl syringes intended for patients undergoing procedures, injected himself, and replaced the drug with saline-filled syringes reused from earlier procedures. Knowing since at least June 2010 that he was infected with hepatitis C, he continued the practice, contaminating the replacement syringes with his infected blood. The scheme, uncovered after a hepatitis C cluster was detected at Exeter Hospital in May 2012, triggered a multistate public-health investigation and led the CDC to recommend testing for more than 12,000 patients; dozens were confirmed infected and at least one death was linked to the outbreak. Kwiatkowski pleaded guilty to federal drug-tampering and obtaining-controlled-substances charges and was sentenced to 39 years in prison.

Delaware nurse suspended two years after unrecorded cabinet withdrawals and muscle-relaxant theft at a state prison

A Delaware nurse first received a Board of Nursing letter of reprimand after sixteen drug withdrawals from a hospital's automated dispensing cabinet went unrecorded over three shifts and a Vicodin pill was pocketed rather than administered or documented. Later, while working at a state correctional institution, the nurse was recorded on video removing cards of Soma from a medication drawer after the prison pharmacy noticed an unusual spike in orders for the drug. The State filed a complaint in September 2012, the Board suspended the license for two years, and the Superior Court affirmed the suspension in November 2013.

Hospital pharmacist convicted of stealing oxycodone and Ambien from Mid Coast Hospital for personal use

Brunswick, ME

A pharmacist working at Mid Coast Hospital in Brunswick was convicted of two counts of Stealing Drugs after pleading guilty on October 17, 2013. The pharmacist diverted Oxycodone and Ambien from the hospital for personal use in 2011 and 2012. The sentence included imprisonment with most suspended, probation, and fines, and the pharmacist’s license was revoked by the Maine Board of Pharmacy in April 2012.

Hospital Settles Adderall Diversion Allegations Involving Medical Residents — New York, 2013

Brooklyn, New York

The United States filed and settled a civil action against New York Methodist Hospital in Brooklyn after alleging that, between May 2008 and July 2010, medical residents employed by the hospital wrote 194 Adderall prescriptions on hospital prescription forms without a legitimate medical purpose, filled them at local pharmacies, and consumed or sold the pills. A related criminal prosecution of one former resident led to a 2012 conviction. Under a consent judgment, the hospital paid a $70,000 civil penalty and agreed to implement a prescription-tracking database and compliance program, without admitting wrongdoing.

Psychiatrist found to have unlawfully possessed controlled substances taken back from patients and kept no required records

Albuquerque, NM

A federal Decision and Order found that a New Mexico psychiatrist unlawfully possessed controlled substances he took back from patients after they had already been dispensed, and that he failed to keep required inventories or receipt/dispensing records for those drugs and for controlled-substance samples in his office. The agency rejected the government's separate claim that he redistributed the drugs to other patients as unproven. Based on the recordkeeping and unlawful-possession findings, and because the state medical board had restricted his authority to prescribe narcotics, DEA suspended his registration for six months and limited his renewed registration to non-narcotic controlled substances.

California retail pharmacy technician accused of conspiring with physician to divert opioids; Board decision issued

The California Board of Pharmacy accused a pharmacy technician at a Glendale retail pharmacy of conspiring with or assisting a physician in the unlawful distribution of controlled substances, including oxycodone, hydrocodone and hydromorphone, between 2004 and 2005. The accusation also alleged the pharmacy dispensed 157 prescriptions from the physician after his medical license was revoked in March 2005. The technician denied key statements attributed to him by federal agents, and the administrative law judge noted the interview was not recorded or independently corroborated. The Board adopted the proposed decision on July 17, 2013, effective August 16, 2013.

Sweetbriar Assisted Living nurse sentenced for hydrocodone theft and falsifying records

Charleston, WV

A former nurse at Sweetbriar Assisted Living in Dunbar, West Virginia, was sentenced in federal court in Charleston to five years of probation for obtaining hydrocodone by fraud. The nurse had pleaded guilty and admitted to stealing hydrocodone intended for patients for personal use and falsifying records to cover up the theft. The case was investigated by the Drug Enforcement Administration and the United States Department of Health and Human Services.

New Hampshire pharmacy technician's registration suspended after admitted hydrocodone theft and resale

The New Hampshire Board of Pharmacy issued an emergency suspension order against a pharmacy technician from Hudson following her June 2013 arrest on drug-related charges. According to the board's order, she was terminated from a Londonderry pharmacy after acknowledging she had taken between 100 and 150 hydrocodone tablets on about 10 occasions beginning in late April and had been selling them to friends. Police charged her with possession of a controlled narcotic, possession with intent to distribute, theft from a building and possession of drugs in a motor vehicle. The suspension was temporary pending a board hearing on whether to continue it or impose permanent sanctions.

Licensed practical nurse found to have ingested prescription medications and possessed Adavan at Delaware Hospital for the Chronically Ill

A hearing officer recommendation found that a licensed practical nurse, while working at the Delaware Hospital for the Chronically Ill in 2008, ingested several prescription medications without telling her supervisor. The recommendation also described a March 2010 incident in which the nurse was found with Adavan in her pocket that should have been administered to a patient but was claimed missing, and found a pattern of theft and consumption of controlled substances. The Board suspended the license for five years, ordered monthly random drug screens, and required 12 continuing education hours.

Hospital Nurse Sentenced for Diverting Dilaudid, Causing Patient Infections — Minnesota, 2013

St. Cloud, Minnesota

Blake Daniel Zenner, a registered nurse at a hospital in St. Cloud, Minnesota, accessed hospital lockboxes and used syringes to withdraw hydromorphone (Dilaudid) from patients' IV bags between November 2010 and March 2011, at times reinjecting the bags with saline to mask the missing drug before they were returned for patient use. Approximately 25 hospital patients developed bacterial infections traced to the tampered bags. Zenner pleaded guilty to obtaining a controlled substance by fraud and was sentenced to 24 months in federal prison and ordered to pay $340,000 in restitution.

VA Hospital Pharmacy Technician Sentenced for Stealing Oxycodone and Other Narcotics — Oregon, 2013

Roseburg, Oregon

Denise Richardson, a pharmacy technician with roughly 18 years of experience at the Roseburg VA Medical Center in Oregon, found a way to manipulate the hospital pharmacy's narcotics tracking and dispensing system. From January 2010 to June 2011 she stole more than 6,000 pills of oxycodone, clonazepam, zolpidem, and OxyContin for her own use and to give to friends and family. A VA Office of Inspector General and DEA investigation uncovered the theft, and she was sentenced to 24 months in federal prison and ordered to pay restitution equal to the VA's purchase cost of the stolen drugs.

New Hampshire pharmacy technician surrendered registration after alleged theft of oxycodone tablets

A pharmacy technician at an Exeter retail pharmacy voluntarily surrendered her New Hampshire pharmacy technician registration rather than proceed to a scheduled January 2013 board hearing. Under the surrender agreement she did not admit the allegations, but accepted that the surrender would be treated as a disciplinary action on her record. The Board of Pharmacy had temporarily suspended her registration after receiving information that her employer's loss-prevention investigation had developed evidence of diversion over a six-month period. She had been arrested in late December 2012 on felony narcotics possession and misdemeanor theft charges, which remained pending.

Dentist had patients and staff fill painkiller prescriptions for his own use

While practicing dentistry in Pennsylvania, a dentist had patients and staff fill prescriptions for painkillers intended for his own use, feeding a drug addiction. He pled guilty to 86 counts in 2013, and Pennsylvania's dental board suspended his license for 10 years as a result. Arizona's dental board reportedly took no action against him despite being aware of the conviction.