"I think diversion of controlled substance medications intended for patients occurs at absolutely every institution that handles controlled substances —every nursing home, physician practice, and hospital, and it's something that will happen at every institution regardless of what prevention efforts you put into place. It's gone too far," says New, now a drug diversion consultant and blogger for the CDC's new website.
The best thing a healthcare facility can do, to the extent they are capable, she says, is to "identify it quickly and respond appropriately."
But hospitals have many reasons and incentives to look the other way. In talking with experts, I counted at least six:
- The time between the patient's exposure to the drug diverter's theft and appearance of symptoms and diagnosis may be years.
- Linking the patient's infection back to the drug diverting healthcare worker requires genetic analysis that may require sophisticated and costly testing.
- If symptoms of infection do appear relatively soon after the patient is discharged, they may be written off as stemming from the patient's original medical condition that drew them to the hospital for care. Some patients die.
- Reporting to law enforcement and public health or state licensing agencies means assignment of hospital personnel and resources to conduct investigations of staff workers, which may lead to morale problems, especially for smaller hospitals.
- Negative publicity could cripple a hospital.
- Reporting can expose a hospital to lawsuits from patients even if they weren't infected but merely exposed. Recent litigation has resulted in financial findings against hospitals accused of improper infection control and drug administration practices.