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

Trail of tears: Drug diverting health care workers too often fired but not reported, allowing them to infect patients at their next job

Surprisingly, drug diverters in health care settings are not easy to spot by outward mannerisms, as most can appear perfectly collected and professional even under the influence of opioids, says Kim New, RN, JD, an independent drug diversion consultant in Knoxville, TN.

“When I work with institutions my first question is how many diversions have you uncovered in the last year and what method did you use,” says New, who previously ran a drug diversion prevention program at the University of Tennessee Medical Center (UTMC). “I feel very uncomfortable when I hear that hospitals are only picking up diversion through reports of behavioral issues. The reason for that is that behavioral manifestations are typically a late sign. Usually these folks are very high achievers. They are able to do a number of things and they are very well respected. They are top performers and continue to be that way even when they are diverting and using large amounts of opioids. So we need to be able to have a mechanism to pick up diversion before there are behavioral manifestations.”

Over the past decade, outbreak investigations have documented more than 100 infections and nearly 30,000 potentially exposed patients stemming from drug diversion in U.S. health care facilities, a Centers for Disease Control and Prevention study reveals. Yet the reported outbreaks of infections related to drug diversion by health care workers represent only a small snapshot of what is actually occurring, as many infections are not being tracked back to drug diversion activity that is apparently rampant in the health care system.

“Initially when I started the program [at UTMC] I was catching 3 or 4 [drug diverters] per month and then it leveled out to one to two per month and pretty much stayed there,” she says. “I have no reason to believe that what I experienced in that medical center is any different than what [is happening] at a similar institution. In fact, I work extensively with hospitals and health institutions across the country on this topic and I have heard from more than one academic medical center of approximately the same size that they were catching the same [number of diverters] when a they had an aggressive program.“

Compounding the problem, hospitals fearing liability or even the perception of some culpability in drug diversion may be reluctant to report and prosecute diverters, firing them or allowing them to resign -- which leaves them free to find work in another facility.

“Unfortunately the cases that fall through the cracks are the ones that aren’t prosecuted -- aren’t pursued and reported,” New says. “Most institutions that I am aware of will only provide dates of employment when asked for a reference. “

For more on this story see the February 2015 issue of Hospital Infection Control & Prevention