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Leadership Sector: Drug Abuse Scandals

As an EMS manager, you never want to open the morning paper and read a headline claiming one of your employees is responsible for stealing drugs from your service. But cases of prehospital drug abuse are making the news across the U.S.

A small fire protection district just outside St. Louis recently made headlines when a deputy fire chief was charged with seven counts of stealing morphine from the local hospital where his department’s narcotics were replaced. In Tennessee, a paramedic admitted during a department and police investigation that she had stolen morphine for about a month. She resigned and was then hired by a private ambulance service, where the same thing happened again while she was in a state-sanctioned rehab program.

A paramedic who worked for Decatur County (In.) Memorial Hospital was sentenced to 15 days in jail for stealing morphine and replacing the syringes with harmless but ineffective liquids. In Troy Township, Ohio, the wife of an assistant chief was accused of stealing morphine, atropine and Valium from ambulances parked inside the fire station. She was released on bond, subject to curfew and drug testing.

Negative behavior by emergency providers erodes the public’s confidence in your service. Further, these situations can damage trust among crews. So what can you do to avoid it?

First, limit access to the central repository of drugs to one person in order to create accountability. Second, do a quarterly audit of all controlled substances handled by your department. This includes not only a physical count of what’s on vehicles but also what’s stored in cabinets and safes. If one person is responsible for maintaining the central repository of drugs, they shouldn’t be included in the audit. Along with a physical count, audits include examination of any records and containers to check for tampering. Properly document all audits for your records.

Remember, your audit doesn’t relieve crews of doing a drug check and examining containers at the beginning of each shift.

If a problem is brought to your attention, either through an audit or some other means, you should immediately conduct a more comprehensive examination of all controlled substances. If your department has multiple stations and multiple ambulances, you may find problems at several sites. A widespread problem can be due to a lax departmental attitude that results in poor practicesƒsuch as poor record keeping or the lack of a formal restocking procedureƒand ample opportunities for abuse. Or it could be because the person responsible for thefts or tampering has access to multiple vehicles.

In some cases, you may be suspicious that a vial containing a controlled substance has been tampered with, resulting in a theft. Before contacting law enforcement, it’s best to have the substance tested at a laboratory to confirm or disprove any theft. The state agency that grants you the authority to carry controlled substances can recommend laboratories to perform the testing. Then if theft is confirmed, you must bring law enforcement into the matter for a criminal investigation. In many states, theft of a controlled substance is a felony.

You should also conduct an internal review of how your agency handles controlled substances. It should encompass the entire process of when drugs are ordered to how drugs are replaced after use. All steps in between should be considered, including handling, distribution, ordering, transfer, application and waste. You can do this analysis yourself, or you can delegate it to a subordinate or committee and ask for recommendations toward a goal of strengthening the system and preventing future problems.

Some agencies have devised innovative containers that prevent tampering or theft. One service in Florida created a device that looks like a test tube and contains a morphine syringe. The tube is sealed, and any tampering at the opening is immediately recognizable. The morphine syringe is clearly visible in the tube so you can see the product, the expiration date and any discoloration.

Finally, remember the personal side of drug tamperingƒyour employees. A crewmember who recognizes they have a drug abuse problem should be able to confidentially seek help before feeling the need to steal, and you should have an employee assistance program in place for those who want help. The objective of the program should be proactive assistance, not saving someone’s job after being caught.

If an employee is caught, the disciplinary processes dictated by your agency or state should take effect. Some departments have a zero-tolerance policy, and the end result would be termination, plus any criminal charges.

The theft and misuse of controlled substances by personnel is nothing any EMS manager looks forward to. However, with good planning and internal controls, your headaches can be minimized and you can stay off the front page of the local paper.

Gary Ludwig, MS, EMT-P, is a deputy fire chief with the Memphis (Tenn.) Fire Department. He has 29 years’ experience, retiring as the chief paramedic from the St. Louis Fire Department. He’s vice chair of the EMS Section for the International Association of Fire Chiefs and can be reached online at„www.garyludwig.com.