Merrimack County Nursing Home reports drug diversion

A contracted employee at the Merrimack County Nursing Home has been fired and may face prosecution after she was caught swapping out liquid pain medication for tap water, according to a facility official.

Administrator Lori Shibinette said the Boscawen nursing home became aware of the possible drug diversion in September, triggering an investigation that continued until late December. Shibinette said no residents were given the altered painkillers over those four months. And she said the medication is given orally, eliminating any concern about contamination or infection through needles.

Shibinette declined to say what kind of medication was taken, but according to Peter Spaulding, chairman of the county’s board of commissioners, the nurse was stealing morphine. Spaulding said the woman was taking some of the medication and then diluting the remaining portion with water.

But initially, nursing home employees didn’t know where the medicine was being tampered with, according to Spaulding. Shibinette said several of her staff nurses noticed a “deviation” and notified her. She then contacted the county sheriff’s office and the New Hampshire attorney general’s office, which began an investigation.

“You didn’t know at which point (it was diluted),” Spaulding said. “I’m assuming it probably left the manufacturer in good condition. So you didn’t know what step in that process this occurred. And we later found out that it was somebody who was not an employee but a contracted (nurse).”

Shibinette referred questions about the investigation – including whether the nurse appeared to be taking the medication for personal use or with the intent of selling it – to the attorney general’s office. An official there also said she couldn’t talk about the matter. Shibinette did say the investigation continued until late December and that residents were monitored during that time to make sure none received tainted medication.

The nurse, who Shibinette said was a contracted employee working from one to four shifts a week, was fired in early January. She said the woman worked at the 290-bed facility for “at least a year.”

Because administrators did not become aware of the alleged diversion until September, Shibinette said they conducted a review going back to the beginning of 2012 of medical records for between 20 and 30 residents who took the potentially affected medication. Staff reviewed dosing information and also pain scores, in which residents are asked to rate their discomfort on a level of zero to 10, she said.

“If someone was supposed to be getting something and they weren’t, they would have been requesting it more because their pain needs wouldn’t have been met,” she said. “So we reviewed all of the records for the people involved. . . . No one had showed any signs of being harmed or having unmet pain needs.”

Assistant Attorney General Karin Eckel confirmed yesterday that her office is conducting an investigation, but she declined to provide details. She said the state has taken steps to ensure the nurse is not working in a field where she has access to controlled drugs. But Eckel wouldn’t say if the woman has worked at other health care facilities and, if she has, whether breaches could have taken place there as well.

Shibinette said the affected medication, which is given to residents throughout the nursing home, is a liquid administered in small cups. She said prior to distribution narcotics are typically stored behind two locks on a medication cart.

Shibinette declined to describe the deviation initially noticed by the staff nurses but said they regularly take note of things like where a drug is stored, what its consistency is or how much of it is stocked.

The nursing home alerted residents and their families to the situation in a Jan. 10 letter.

Medication diversion came to public attention in New Hampshire last summer when more than 30 patients who were given painkillers at Exeter Hospital were infected with hepatitis C after a laboratory technician, 33-year-old David Kwiatkowski, allegedly stole syringes of the drug from the hospital’s catheterization laboratory and emergency room and left behind used syringes full of a saline-like fluid as a decoy.

“In this case, you’re talking about something given by mouth, so you don’t have that same risk of what happened at Exeter Hospital as you do in this case,” Shibinette said. “I think every case of drug diversion makes any health care professional stand up and look around and become very aware of who is working for you.”



(Tricia L. Nadolny can be reached at 369-3306 or tnadolny@cmonitor.com or on Twitter at @tricia_nadolny.)