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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Drug Diversion Deja Vu: Yet Again, Testing Urged for Thousands of Patients

By Gary Evans, Senior Staff Writer

In an all too familiar scenario, a healthcare worker charged with diverting drugs had a history of moving from hospital to hospital, prompting several other facilities in other states to advise thousands of patients to get tested for bloodborne pathogens.

According to a federal indictment, Rocky Allen, 28, a former surgical tech/technologist at Swedish Medical Center in Englewood, CO, has been indicted by a federal grand jury on charges of tampering with a consumer product and obtaining a controlled substance by deceit. On January 22, 2016, Allen allegedly took a syringe containing Fentanyl Citrate and replaced it with a similar syringe containing another substance, the indictment charges.

As a result, Swedish Medical Center has advised some 3,000 patients who had surgery between August 17, 2015 and January 22, 2016 to be tested for HIV, hepatitis B and hepatitis C. As many as six other hospitals in three other states where Allen previously worked have also advised surgical patients to seek testing. Allen has pled not guilty and it was not known at this posting if he is positive for a bloodborne pathogen.

However, the case is similar to one discovered in a New Hampshire hospital in 2012, when an HCV-infected traveling radiology technician was linked to a cluster of HCV patient infections. The subsequent investigation uncovered a large HCV outbreak spanning several years, involving more than a dozen hospitals, and impacting thousands of patients in 8 states. The technician was stealing syringes filled with narcotics, self-injecting, refilling them with saline, and placing them back into the procedure area, officials reported. He was sentenced to 39 years in prison.

More than 100 patient infections and nearly 30,000 potentially exposed patients via drug diversion have been reported in U.S. healthcare facilities over the last decade, according to the Centers for Disease Control and Prevention.1 Most of the infections in these cases involve HCV.

Disturbingly, the reported outbreaks of infections related to drug diversion by healthcare workers represent only a small snapshot of what is actually occurring. Many healthcare associated infections are not being tracked back to drug diversion activity that experts say is rampant in the health care system. Compounding the problem, hospitals fearing liability or even the perception of some culpability in drug diversion incidents may be reluctant to report and prosecute diverters. Typically diverters have been fired or allowed to resign — which leaves them free to find work in another facility.


  1. Schaefer, M.K., Perz, J.F. Outbreaks of infections associated with drug diversion by US health care personnel. Mayo Clin Proc 2014;89: 878–887